Patterns of Practice of Nurse Practitioners in an Undeserved Rural Region

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Abstract
An evaluation study explored the impact that graduates from a certificate-level nurse practitioner (NP) program had on rural health care in a large geographic region. Seven years produced 116 NPs, 85 (73 %) of which comprised the study sample. Variables measured included employment rates, practice settings, patient case load, impact on care, role acceptance, and role development. A survey design with a validated questionnaire was employed. Data showed a group involved in hands-on practice mainly to high-risk groups. Eighty-seven percent were subjects employed as NPs mainly in community health agencies. Of those 11 not employed, the main reason cited was personal choice of another nursing role, whereas choice of the NP position itself was based on the location of employment. NP skills/competencies were broken down according to taking of histories and physical, management, counseling, and referral; time allotted to each was proportioned. Findings also point to a strong tendency for continued study among graduates: 27 % of sample subjects were enrolled for a degree; 26 % sought further American Nurses' Association certification. Practice variables such as site, salary, patient case load, collaboration with backup physician, administrative structure, and acceptance of role were investigated and described. Results revealed that the NPs felt that the major contributions of their presence in practice were the increasing of the number of patient/clients with access to care and the providing of services to high-risk and disenfranchised consumer groups.