UCSF

The presence of nurse practitioners in ambulatory specialty care is growing, but few studies have systematically examined the role and contribution of nurse practitioners in these settings. This dissertation aims to explore the role and contribution of nurse practitioners in ambulatory specialty care.

Chapter 1 is a qualitative exploration of the role and contribution of nurse practitioners in ambulatory medical and surgical specialties, beyond providing billable visits. This study identified five themes regarding nurse practitioner contribution: care coordination and promoting patient care continuity, promoting departmental continuity, institutional historical and insider knowledge, addressing time-sensitive issues, and participating in leadership and quality improvement activities.

Chapter 2 quantifies non-billable activities performed by advanced practice providers (nurse practitioners, clinical nurse specialists and physician assistants) in ambulatory care settings, in regard to their number and duration. It also includes a brief qualitative exploration of these activities. Findings of this study showed that advanced practice providers spend significant amounts of time on these activities, the majority of which relate to orders, chart review, and documentation.

Chapter 3 identifies some key differences between nurse practitioners in primary care settings and in non-primary care settings in the state of California, in order to better understand how the role of nurse practitioners in these settings differ. This study showed that nurse practitioner practicing in non-primary care settings have lower odds of reporting time as a barrier to practice, lower odds of reporting practice to full scope, and higher odds of reporting a hierarchical or supervisory relationship with the physician, compared with nurse practitioners in primary care settings.

Further understanding of the role and contribution of nurse practitioners and other healthcare providers in specialty care settings will facilitate optimal use of their skills and training to maximize the provision of high-quality healthcare to patients and populations.