Practice Environment and Job Outcomes Among Primary Care Nurse Practitioners Caring for Patients With Dementia

As the number of Americans living with dementia increases, healthcare delivery systems face increasing pressure to provide dementia-care services to improve patient and family outcomes. The primary care nurse practitioner (NP) workforce is critical to dementia care; however, many NPs practice in environments that lack organizational attributes needed to maximize their contributions. We examined the associations between the NP practice environment and key indicators of workforce sustainability-burnout, job satisfaction, and intent to leave.

We conducted a national cross-sectional survey of NPs providing care to patients with dementia in 2021-2023. A total of 968 NPs across 847 practices completed the survey. On average, NPs were 47.5 years old, female (84.2%), and White (83.6%).

The NP practice environment was measured using four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). Multivariable regression models assessed the relationship between practice environment and NP workforce outcomes.

Overall, 92.0% of NPs were satisfied with their jobs, 35.8% experienced burnout, and 21.3% reported intent to leave their job in the coming year. Higher NP-PCOCQ subscale scores were associated with better NP outcomes. For example, one standard deviation (SD) increase in Professional Visibility score was associated with 28% lower prevalence of burnout (Prevalence Ratio [PR] = 0.72, p < 0.001); one SD increase in the NP-Administration Relations and NP-Physician Relations scores was associated with 9% and 7% higher prevalence of job satisfaction (PR = 1.09, p < 0.001; PR = 1.07, p < 0.001), and one SD increase in the Independent Practice and Support score was associated with 29% lower prevalence of intent to leave (PR = 0.71; p < 0.001).

Enhancements to the practice environment that promote NP role visibility, independent practice, and collegial relationships could increase job satisfaction, reduce burnout, and expand primary care capacity to care for patients with dementia.