Closing the Gap: A Comparison of Engagement Interventions to Achieve Equitable Breast Cancer Screening in Rural Illinois.

Mammography screening rates are typically lower in those with less economic advantage (EA). This study, conducted at an integrated health care system covering a mixed rurality population, assessed the ability of interventions (text messages linking to a Web microsite, digital health care workers, and a community health fair) to affect mammography screening rates and disparity in those rates among different EA populations. Payor type served as a proxy for greater (commercially insured) versus lower (Medicaid insured) EA. 4,342 subjects were included across the preintervention ("Pre") and postintervention ("Post") periods. Interventions were prospectively applied to all Medicaid subjects and randomly selected commercial subjects. Applying interventions only to lower EA subjects reversed the screening rate disparity (2.6% Pre vs. -3.7% Post, odds ratio [OR] 2.4 P < 0.01). When intervention arms ("Least," "More," "Most") were equally applied, screening rates in both EA groups significantly increased in the More arm (Medicaid OR = 2.04 P = 0.04, Commercial OR = 3.08 P < 0.01) and Most arm (Medicaid OR 2.57 P < 0.01, Commercial OR 2.33 P < 0.01), but not in the Least (text-only) arm (Medicaid OR 1.83 P = 0.11, Commercial OR 1.72 P = 0.09), although this text-only arm was inadequately powered to detect a difference. In summary, targeting interventions to those with lower EA reversed screening rate disparities, text messaging combined with other interventions improved screening rates in both groups, and future research is needed to determine whether interventions can simultaneously improve screening rates for all without worsening the disparity.

Access to Care: End-to-End Digital Response for COVID-19 Care Delivery.

The coronavirus disease 2019 pandemic disrupted health care, requiring organizational leaders to act quickly to manage the health-related concerns of individuals and communities. The ability to offer a variety of digitally enabled telehealth services with 24/7 access to nurse practitioners and physician assistants allowed us to care for patients in their homes. It reduced the spread of the virus, protected our employees from further disease spread, and provided early interventions to those in need. The roles of nurse practitioner leaders, the enacted strategies, and patient outcomes demonstrate the impact of an innovative digital care delivery model on care across the continuum.

Investigating practice-level and individual factors of advanced practice registered nurses and physician assistants and their relationship to resilience.

BACKGROUND: Gaps in research persist related to practitioners' resilience, although much has been written about the need for strategies to strengthen personal resilience. PURPOSE: The study's purpose was to examine practice-level (quality of physician relationship, physician presence, and autonomy) and individual factors and how they affect resilience. METHODOLOGY: An online survey invited advanced practice registered nurses (APRNs) and physician assistants (PAs) from four states to participate in a cross-sectional study. Hierarchical ordinary least squares regression was used to test the impact of main effect variables in the context of identified control variables. SAMPLE: A sample of 1,138 APRNs and PAs completed the survey questions. RESULTS: Findings from the covariate model (model 1) and the main effect model (model 2) show that both models were significant at the p < .01 level, with the adjusted R2 differing from 0.02 to 0.13, respectively. Regression results show a significant positive association between quality of the physician relationship and APRN/PA resilience (b = 0.09, p < .01). A negative association between the lack of autonomy and higher levels of resilience (b = -0.14, p < .01) was also demonstrated. CONCLUSIONS: Advanced practice registered nurse/PA resilience is affected by both practice-level and personal factors, suggesting that workplace interventions could increase resilience. IMPLICATIONS FOR PRACTICE: Work environments allowing APRNs and PAs to function autonomously and with professional support from physician colleagues are favorable contributors to their resilience. Future studies need to investigate the meaning of physician presence/availability and organizational interventions that extend beyond individual resilience.

Perceptions of Role Transition into Practice among Advanced Practice Providers and Physicians.

This study sought to examine the experiences of advanced practice providers (APPs) as an approach to inform the development of formalized programs for transition into practice and to compare APP (N = 122) and physician (N = 84) perceptions of the novice practitioners' acclimation into a provider role within the first year of practice. Using a cross-sectional survey design, two separate web-based questionnaires were distributed to APPs and physicians. The APPs' perspectives echoed findings of earlier studies with regard to perceived confidence, feelings of anxiety/fear, and inadequacy. In 16 of 23 paired items, physicians and APPs had similar perspectives about confidence/competence after orientation. Significant differences in their perceptions included amount of physician support, time management, length of time to become a fully functional APP, and independence. Better understanding of the perceptions of APPs and physicians can augment APP preparation for a shifting workforce composition and team-based, interprofessional practice designed to meet the population's health care needs.

Development of an advanced practice preceptor evaluation tool.

BACKGROUND: Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor. PURPOSE: The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program. METHODOLOGICAL ORIENTATION: A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity. Over a period of 19 months, five different focus groups were conducted. Study participants completed an independent analysis of the tool prior to engaging in a focus group discussion. Further testing of new items was performed using the last two focus group cohorts and achieved data saturation. SAMPLE: The sample included 23 fellows who had completed an acute, ambulatory, or primary care yearlong fellowship. More than half of the fellows ranged in age from <30 to 40 years. CONCLUSIONS: All original 19 items were retained, with the majority (79%) requiring slight modifications. Using feedback from fellows, 10 items were added to the final version, including two open-ended questions. The new items added a focus on preceptors' ability to foster domains of professional growth in the fellows' provider role. IMPLICATIONS FOR PRACTICE: This newly developed tool with face validity provides a new mechanism for preceptor evaluation by APRN and PA fellows. Additional research is needed with larger groups of fellows as a means to establish the tool's psychometric properties.

Strategies of Advanced Practice Providers to Reduce Stress at Work.

Background: High levels of stress and burnout, documented among healthcare professionals, result in high levels of job turnover. However, little is known about personal strategies employed by advanced practice providers (APPs) to mitigate stress. Methods: 3,939 APPs were invited to complete an online, anonymous, cross-sectional survey to examine work stress and burnout among APPs using quantitative and qualitative analyses. The Maslach Burnout Inventory (MBI) served as the measure for burnout. Work-stress reduction strategies were identified by an open-ended question. Findings: 854 APPs (70% of 1,218 respondents) (nurse practitioners, physician assistants, nurse midwives, anesthetists, and clinical nurse specialists) from four different United States health systems completed the free text portion of the survey. Qualitative analyses revealed that almost all of the APPs (94%) reported at least one stress reduction strategy. Four main themes were derived from the free-text responses: "Self-focused" (67.5%), "relational-focused"(16.1%), "job-focused" (11.5%) and "nothing" (4.9%). Quantitative results from the MBI revealed high levels of burnout among APPs with insignificant differences between those who provided a response to the qualitative question and those who did not: emotional exhaustion (p = .188); depersonalization (p = .265); personal accomplishment (p = .213). Conclusion/Application to Practice: Qualitative results highlighted strategies, many evidence-based, that APPs use to mitigate stress. Further research is needed to determine the frequency and consistency of APPs' enactment of personal strategies. These initial findings provide insights for occupational health practitioners and researchers planning primary prevention and secondary interventions for improving workplace health, enhancing personal wellness, and reducing job-related stressors.

Advanced Practice Provider Perspectives on Organizational Strategies for Work Stress Reduction.

Unresolved work stress contributes to burnout, compassion fatigue, disengagement, and other work-contextualized factors. The impact of occupational stressors extends to the organization in a negative fashion as well. In 2017, advanced practice providers (APPs) from four health systems, including nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, and physician assistants, participated in a quantitative online cross-sectional survey; 754 participants responded to a free-text question related to work stress and work-family balance. Suggested organizational strategies were ordered into 29 codes, 10 subthemes, and four main themes: "reduce job stressors," "improve leadership and operations," "promote APP well-being," and "maintain the status quo." Findings are consistent with other research related to occupational stress with many of the reported strategies considered as evidence-based. Targeted interventions for reducing job stress will need to include improved autonomy for APPs, role delineation, support for work-family balance, and better communication as part of management practices.

Exploring burnout and job stressors among advanced practice providers.

BACKGROUND: Minimal research exists on how engagement, burnout, work-family balance, and job stressors impact advanced practice nurses and physician assistants, collectively referred to advanced practice providers (APPs). PURPOSE: To investigate the interrelationships among burnout, job stressors, work-family balance, and engagement with APPs. METHODS: An online questionnaire was distributed to APPs working in four healthcare systems. A total of 1,216 APPs completed the survey. A hypothesized model was tested using structural equation modeling. FINDINGS: There was a high correlation of job stressors with development of burnout. A significant negative effect between job stress and work engagement was supported; however, indirect effects of stress through job burnout had a stronger impact on work engagement. Higher levels of work-family balance contributed to a lower level of stress experienced by providers. DISCUSSION: Organizational leaders desiring to improve employee engagement and reduce burnout need to focus on the significance of work-family balance to job stressors.