Embattled and embittered or empowered and evolving: nurse practitioner attitudes toward managed care.

PURPOSE: To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. DATA SOURCES: NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. CONCLUSIONS: The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.

Nurse practitioner self-confidence and attitudes regarding managed care.

PURPOSE: To examine the relationship between nurse practitioner (NP) perceived self-confidence in performing managed care tasks and NP attitudes toward managed care. DATA SOURCES: A random sample of NPs--members of the Massachusetts Coalition of Nurse Practitioners--completed a demographic survey, responded to questions measuring self-confidence in performing managed care tasks and attitudes toward managed care, and wrote about their managed care experiences. CONCLUSIONS: NPs were only moderately confident in performing managed care tasks and had mostly negative attitudes toward managed care. They reported intense frustration related to prescriptive coverage and referrals to specialty services, potential trust issues between providers and patients, and ethical and legal dilemmas in tailoring plans of care to fit the patient's insurance. The NPs' written comments indicate a need for more in-depth exploration of NP attitudes toward managed care. IMPLICATIONS FOR PRACTICE AND EDUCATION: Continuing education in selected managed care competencies, better education of NP students, and promotion of organizational cultures that support interdisciplinary teamwork as well as population- and evidence-based practice may help NPs to embrace the promise of managed care and to offer solutions to its problems.

Challenge and opportunity: nurse practitioner programs partnering with managed care.

PURPOSE: To examine the experiences of nurse practitioner (NP) students who participated in a collaborative educational program between the University of Massachusetts, Amherst, and Health New England (HNE) Health Plan, Springfield, MA. Nurse practitioner faculty and managed care executives shared resources to educate NP students and to address their perceptions about managed care. DATA SOURCES: Verbatim transcriptions and journal writings of students specifically designated as "Partnerships for Quality Education (PQE) trainees" and reports of their fellow classmates, all of whom received varying extent of access to managed care theory, administrative, and clinical experiences within the HNE plan. CONCLUSIONS: The experiences of the PQE trainees revealed a greatly expanded understanding of managed care that challenged students' previous beliefs. They reported greater satisfaction with program participation than their classmates, had an unprecedented opportunity to articulate the NP role to a managed care organization (MCO), and learned that a collaborative, rather than an adversarial, relationship with an MCO produces better outcomes for patients and providers. Many students in the class, including some of the PQE trainees, were concerned, however, about what they perceived as managed care "taking time away from clinical issues," which they considered more important. IMPLICATIONS FOR TEACHING AND PRACTICE: There is a need for balance between both managed care and clinical content in NP programs, yet students must have an intimate grasp of both if they are to survive in today's health care environment.