Development and Validation of a Short Form of the Nurse Practitioner Primary Care Organizational Climate...

Organizational climate affects patient, clinician, and health care organization outcomes. The 29-item Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ) has been a valuable research tool for measuring four domains of NP organizational climate in primary care settings: Professional Visibility, Independent Practice and Support, NP-Administration Relations, and NP-Physician Relations. It can benefit from shortening to reduce survey burden and improve response rates.

To design a shortened NP-PCOCQ-2 and assess the psychometric reliability and validity.

To shorten the NP-PCOCQ, in Phase 1, we used data from 1,212 NPs collected in a cross-sectional survey of primary care NPs in 2018-2019. We used quantitative data and expert content review to select the items to retain in the NP-PCOCQ-2, based on data from half the sample. With the other half of the sample data, we evaluated the NP-PCOCQ-2's reliability, factor analytic structure, and correlation with the original scores and two key NP job outcomes, job satisfaction and intention to leave. In phase 2, we used data from a new sample of 915 NPs to further evaluate the reliability, factor analytic structure, and correlation to job satisfaction and intention to leave, and compared the categorical classification of the organizational climate of NP practices of the NP-PCOCQ-2 to the original NP-PCOCQ.

In phase 1, the NP-PCOCQ-2 subscales were all reliable, demonstrated a four-factor Confirmatory Factor Analysis (CFA) fit, and were highly correlated with scores on the 29-item NP-PCOCQ. All subscales were significantly positively correlated with job satisfaction and negatively correlated with intention to leave. In Phase 2, we found the same patterns: the NP-PCOCQ-2 subscales were all reliable, demonstrated a four-factor CFA fit, and were highly correlated with scores on the 29-item NP-PCOCQ. All subscales were significantly positively correlated with job satisfaction and negatively correlated with intention to leave. In addition, each NP-PCOCQ-2 subscale classified greater than 75% of NP's practices the same as the NP-PCOCQ.

The 17-item NP-PCOCQ-2 demonstrated reliability, maintenance of the constructs measured by the original scale, and convergent validity. Researchers can use the NP-PCOCQ-2 to measure the four domains of NP's organizational climate in primary care.