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Factors affecting integration of the nurse practitioner workforce into health systems: a Delphi consensus study
Joshua Porat-Dahlerbruch1, Rebecca Clark2,3,4, Branden Dutchess5
1Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, 336 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA. jop186@pitt.edu.
BMC Health Services Research
|June 2, 2025
Summary
Integrating nurse practitioners (NPs) into healthcare systems is crucial for improving patient outcomes. This study identified key national, organizational, and care-team factors essential for successful NP integration and policy development.
Area of Science:
- Health Services Research
- Nursing Workforce Studies
- Implementation Science
Background:
- Nurse practitioners significantly benefit patient and system outcomes globally.
- Barriers like scope of practice restrictions hinder nurse practitioner (NP) integration and impact outcomes.
- Policy decision-makers need a clear understanding of integration factors for effective NP workforce strategies.
Purpose of the Study:
- To achieve expert consensus on an inventory of factors influencing nurse practitioner integration into the US health system.
- To provide a comprehensive resource for policymakers designing effective integration strategies.
- To synthesize existing knowledge on NP integration into an actionable framework.
Main Methods:
- A three-round Delphi method survey was employed with 29 US-based experts.
- Participants rated agreement on factors and provided qualitative feedback.
- Data analysis included summary statistics for ratings and inductive content analysis for feedback.
Main Results:
- A consensus inventory of 17 integration factors was developed across national, organizational, and care-team levels.
- Key national factors: clear scope of practice, financial support.
- Key organizational factors: onboarding, culture, leadership; care-team factors: relationships, patient understanding.
Conclusions:
- Organizational strategies (recognition, compensation, development) are vital for NP integration.
- NP workforce integration aligns with implementation science principles.
- The developed inventory can guide policy to optimize NP integration in healthcare systems.
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