Examining the Extent of Nurse Practitioner Practice at a Large Academic Medical Center: Recommendations for Full Professional Practice

Nursing has been charged to lead and transform health care into the next century. Despite this mandate, nurse practitioners are unable to practice to their full capacity and thus meet the nation’s health care needs.  At a large, urban, academic medical center (AMC), the nurse practitioners (NPs) were surveyed to ascertain their level of involvement across the five domains of advanced practice as outlined in the Strong Model of Advanced Practice Role Delineation Tool. The Strong model of advanced practice was developed by advanced practice nurses and faculty at Strong Memorial Hospital of the University of Rochester Medical Center in Rochester, New York. The model depicts 5 domains of advanced practice including direct comprehensive care, support of systems, education, research, publication and professional leadership.  The competencies of collaboration, scholarship, and empowerment are interwoven in the model and inform advanced practice nursing standards.

An anonymous survey was sent electronically to 295 NPs at this institution to ascertain the level of engagement with the five domains of advanced practice as outlined by the Strong Model. The response rate was 36% and included NPs in administrative and clinical roles across a variety of settings.  More than 50% of the participants had been in overall practice for greater than 5 years and were between the ages of 30-39 years.  The findings suggest that NPs consistently ranked themselves highest in the direct comprehensive care (very great/ great extent: 84%), support of systems (very great/ great extent: 58%) and education (very great/ great: 42%) domains while consistently ranking themselves lower in the research (little/ not at all: 71%), publication and professional leadership (little/ not at all: 64%) domains. The implications for practice are significant because the findings suggest that NPs in this AMC are potentially being underutilized.

The findings will provide a framework for further exploration of NP practice and alignment with the tenants of the Strong Model and the National Organization of Nurse Practitioner Faculties (NONPF) NP Competencies.  The author posits that actualization of the domains of advanced practice as delineated in the Strong Model are critical for optimizing NP practice in the study institution.