Perceptions of nurse practitioners among Montana critical access hospital leadership

Abstract

Challenges associated with provider recruitment, as well as rural populations' access to healthcare, are well-documented in the literature. While primary care physician numbers continue to fall behind demand, nurse practitioners (NPs) are forecasted to drastically increase in numbers in upcoming years. Montana is a full-practice state for advanced practice registered nurses (APRNs), and critical access hospitals (CAHs) commonly employ APRNs, including NPs. Little is known regarding perceptions of NPs among CAH boards of directors, chief executive officers, or other senior-management officials. It is important to understand how leadership teams perceive NPs, as these are the individuals who will collectively make decisions affecting the number and type of providers employed within their respective facilities. This study employed focus-group methodology to interview four CAH leadership teams spanning the entire state of Montana. Focus-group analysis suggests CAH leadership teams have primarily positive perceptions of NPs. There is a lack of consistency regarding comprehension of the NP's scope, role, and autonomy. Lastly, the challenges of provider recruitment were affirmed. However, it was noted that a number of NPs currently employed at CAHs previously worked as registered nurses within the facility, suggesting a potential provider recruitment advantage with regard to hiring NPs. Future implications include expanding research to include larger health systems within Montana, in addition to studying CAHs in states with restricted NP practice. Finally, more work should be done to raise CAH leadership awareness of the NP's role, scope, and autonomy.