Factors affecting integration of the nurse practitioner workforce into health systems: a Delphi consensus study.

backgroundResearch has documented the positive impact of the nurse practitioner workforce on patient and system outcomes in multiple countries. Achieving these outcomes relies on successfully integrating the workforce into the health system. Research has reported negative effects of integration barriers on the ability for nurse practitioners to improve outcomes. Barriers include scope of practice restrictions, organizational climates inconducive to nurse practitioner care, and lacking mentorship. To design efficacious policies, organizational and national policy decision-makers require knowledge of the factors affecting the integration of this human resource into care settings. No research has synthesized these factors into an easily understandable and applicable inventory for policy decision-makers. This study aimed to reach expert consensus on an inventory of factors affecting the integration of nurse practitioners into the health system.

methodsThis study used a Delphi method to survey experts in integrating nurse practitioners into the United States health system. Participants were asked to rate their level of agreement with each factor and its description. Participants provided open-ended feedback. Summary statistics were used to analyze ratings and inductive content analysis was used to analyze open-ended feedback. Three rounds of analysis by separate team members occurred to determine changes to the inventory. Data collection ceased once expert consensus was reached on the inventory.

resultsThere were 29 participants. The final inventory included 17 factors spanning national, organizational, and care team levels. National-level factors included clear scope of practice and reasonable financial support for nurse practitioner services. Organizational-level factors included onboarding and retention strategies, organizational culture, and organizational leadership messaging. Care-team level factors included relationships with care team members and patient understanding of the nurse practitioner role.

conclusionsThe results highlight the importance of organizational-level management strategies, such as representation and recognition, fair and reasonable nurse practitioner compensation and professional development. The factors aligned closely with implementation science frameworks, indicating that the integration of the nurse practitioner workforce could be conceptualized as an implementation issue. The inventory may be useful to aid in designing policies to better integrate nurse practitioners into health systems.