How Organisational Dynamics Impact Decision Latitude, Social Support, Self-Identity Through Work and Job Insecurity for Nurse Practitioners

Abstract

AIM: To identify whether nurse practitioners (NPs) in New Zealand (NZ) have the organisational opportunities to make decisions related to performing their role.

DESIGN: A cross-sectional study of self-reported decision-making, social support, psychosocial demands and identification with role in a representative population of NPs employed in a range of practice settings in NZ.

METHODS: This study utilised the internationally validated Job Content Questionnaire. Reliability and construct validity were assessed using co-efficient α and confirmatory factor analysis. Linear regression analyses were conducted to understand the strength and direction of the relationships between the constructs.

RESULTS: All scales demonstrated acceptable levels of internal reliability. Factor analysis supported a five-factor model, with decision latitude, psychological job demands, co-worker support, supervisor support and job insecurity as the main factors fitting the theoretical model. Regression models suggested that NPs (n = 169) have more control over their decision-making when supported by their colleagues rather than supervisors. NPs perceive improved relationships with healthcare consumers if they feel an increase in support from their colleagues; this relationship is mediated by the freedom to make decisions. NPs in rural settings had more job security when they felt valued and appreciated at work.

CONCLUSION: The presence of collegial support significantly influences the freedom and autonomy of NPs in making decisions. Workforce policy, the organisation of practice and vocational training may be effective ways of helping NPs expand access to healthcare services.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Collegial and supervisory support are critical for NPs to work to their full scope. A funded, first-year-in-practice vocational training program designed to support role transition, foster collegial support and build a community of practice for newly qualified NPs.

IMPACT: For the first time, nurse practitioner decision-making and autonomy determinants have been described in NZ. These findings should be considered within the context of international evidence and in global nursing workforce policies that seek to create opportunities for NPs to work to the limit of their scope.

REPORTING METHOD: The authors have adhered to relevant EQUATOR guidelines-STROBE checklist.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.