Date of Award

2018

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Julie A. Fairman

Second Advisor

Kathryn H. Bowles

Abstract

Purpose

Twenty states, including Florida, require nurse practitioners to maintain a collaborative practice agreement (CPA) with a physician as a component of state occupational licensure. Occupational licensure can raise prices and limit access to services. Details regarding the terms and cost of participation in a CPA for providers are poorly understood. This study addressed three specific aims: 1) Examine the effects of collaborative practice agreements and similar models of health professional regulation on the cost and delivery of health services. 2) Describe variation in the collaborative services provided by physicians to nurse practitioners under collaborative practice agreements and explore associations between nurse practitioner employer, practice setting, and health professional shortage area (HPSA) with no physician terms in the CPA in Florida. 3) Describe variation in the cost of collaborative practice agreements provided by physicians to nurse practitioners and explore associations between nurse practitioner employer, practice setting, and HPSA with payment by the nurse practitioner for the CPA in Florida.

Methods

A multi-methods study with distribution of an electronic survey to nurse practitioners in Florida with two-steps of recruitment at the Florida Nurse Practitioner Network Annual Conference and via email utilizing publically available licensure. Data analysis included descriptive statistics, chi-squares, and qualitative descriptive methodology.

Results

Structures of regulation similar to CPAs in various health disciplines increase the cost of health services and decrease the number of health professionals delivering care. CPAs include vague language, and 24% of nurse practitioners in Florida report no terms of physician collaboration in the agreement. Ten percent of nurse practitioners report paying a physician for participation in a CPA. Nurse practitioner self-employment and non-hospital practice setting were associated with no terms for physician collaboration and payment to the physician for participation in the CPA. Collaborative practice agreements with no terms for physician collaboration were associated with payment to a physician for the CPA. Associations with HPSA demonstrate non- significant findings.

Conclusions

This dissertation increased our understanding of the structure, terms and cost of CPAs in Florida. Variability in the terms and cost of CPAs do not promote equitable conditions for nurse practitioner and physician collaboration.

Embargoed

Available to all on Saturday, October 23, 2021

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