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Document Type

Thesis - University Access Only

Award Date


Degree Name

Master of Science (MS)


Graduate Nursing

First Advisor

Margaret Hegge


nurse practitioners, role expectation


Certified nurse practitioners (CNP) represent one quality, cost-effective option for primary care in nursing facilities. Determining expectations of administrators, directors of nursing, and medical directors in nursing facilities concerning CNP practice is important, since these key decision makers would likely be instrumental in deciding if CNP could become part of the nursing facility or medical staff. An extensive review of the literature revealed little about CNP practice in rural or small nursing facilities.
This non-experimental, descriptive, comparative study addressed the needs and expectations of nursing facility administrators, directors of nursing, and medical directors concerning CNP practice in nursing facilities. The purposes of this study were to: (a) identify and compare the needs and expectations of nursing facility administrators, directors of nursing, and medical directors for CNP functions in nursing facilities; (b) compare the benefits of and barriers to CNP practice identified by these groups; and (c) compare the same three groups' expectations of the impact of CNP practice on staff satisfaction and resident outcomes.
The factors addressed in this study were CNP functions, benefits and barriers to CNP practice, and impact of CNP practice on staff satisfaction and resident outcomes in nursing facilities. A survey designed by the researcher, based on literature findings, was used to gather data for this study. Sixty-four administrators, 81 directors of nursing, and 26 medical directors of nursing facilities (N=171) participated in the study.
There was general agreement as to the most important nursing, overlapping medical, and communication/management CNP functions desired by nursing facility administrators, directors of nursing, and medical directors. No significant differences were found in the number of functions chosen by each group. The benefits of CNP practice most frequently identified were fewer telephone calls and unscheduled visits to the physician, early recognition of resident status changes, and more continuity of care. The top barriers to CNP practice in nursing facilities included Medicare/Medicaid reimbursement, medical staff reluctance, regulatory constraints, and insufficient information about the role. Nursing facility administrators and directors of nursing reported significantly higher expectations for improved staff satisfaction and resident outcomes than did medical directors (F=3.80, p =.024; F =6.98, p =.001). All groups expected more appropriate medication use, although directors of nursing had higher expectations (p =.001).
These findings may benefit key decision makers in nursing facilities, schools of nursing, and particularly CNPs. The results may give nursing facility governing boards insight into the potential functions and roles for CNPs in the primary care and treatment of nursing facility residents, and could help nurse practitioner students and practicing CNPs prepare for roles in nursing facilities.

Library of Congress Subject Headings

Nurse practitioners
Role expectation



Number of Pages



South Dakota State University


Copyright © 1999 Claudia Kapp. All rights reserved