Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lisa Heelan-Fancher

Second Advisor

Teri Aronowitz

Third Advisor

Priscilla Gazarian


Nurse practitioners (NP) are integral members of the healthcare delivery team. The NP role has evolved in practice since the inception of the role in 1965 when the aim was to expand access to pediatric patients in rural areas. Today, NPs can be found in all healthcare settings. Physician shortages and changes in hospital models of care continue to burden the healthcare system. As medical and surgical residents work hours and educational programs continue to have stricter mandates reducing their time on the inpatient wards, hospitals are changing the workforce to have 24-hour NP teams. NPs have been found to provide safe, high-quality patient care and are a solution to ease the burden on our healthcare system.

NP scope of practice can be restricted and vary based on their state’s legislation despite standardization of educational requirements. Limits placed on NP scope of practice impact patient access, contribute to increased healthcare costs, and increase administrative burdens. A barrier to NP scope of practice legislation changing has been mostly led by physician advocacy groups. Continual evidence supporting that NPs provide similar care to physicians and the Massachusetts Health Policy Commission demonstrating the impact that NPs have on lowering costs and servicing individuals from underserved areas, has led to legislation for full practice authority that became law in 2021 (Barnett et al., 2021; Fraze et al., 2020; Gellar & Swan, 2021; Massachusetts Health Policy Commission, 2018).

Understanding the factors that contribute to NP’s job satisfaction is relevant to healthcare leaders. A multi-study systematic review was completed to understand factors that contribute to NP job satisfaction. Sixteen articles were identified for review and three themes were found that contribute to higher levels of satisfaction: level of challenge and autonomy, patient care, and feeling valued. Themes that contributed to lower levels of satisfaction were reporting structure, organizational commitment, relationships, and benefits/money. NP reporting structure was a consistent theme in evaluating NP job satisfaction yet there is a lack of literature on this topic. A grounded theory study was completed to understand inpatient NP’s perception of their reporting structure. The theoretical model ‘fostering an environment' emerged from the data supported by three categories: time, support, and identity.


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