The complexity of modern tasks promotes the need for the increased efficiency of health workers and their ability to make tough choices and act under pressure. Under these conditions, nurses, who work with patients and who satisfy their needs, become the most vulnerable group. Advanced practitioners have enough autonomy to provide high-quality medical care; however, more responsibilities and opportunities will help them come close to physicians and assist communities in the preservation of their health. Even though today NPs can prescribe medications, there are still barriers related to the scope of authority they might face. The US states fall into three main groups restricted, reduced, and full practice authority (Boylan, Mager, & Kazer, 2012). Operating under the restricted authority nurses have to coordinate their actions and prescriptions with a physician. That is why the current nursing issue is concerned with the idea of comparing whether the care of nurses with varying levels of autonomy yields different results in patient satisfaction and nurses’ retention. It is possible to assume that nurses with more autonomy react differently to their duties, which may also significantly impact patient’s satisfaction with provided care. Thus, this research may help one to see the benefits of giving NPs more autonomy in their practices.
Overview of Selected Project
The suggested evidence-based practice project revolves around nurses ability to provide services like ordering, conducting, supervising, and interpreting diagnostic and laboratory tests, prescription management, and non-pharmacologic therapies, along with the outcomes of NPs care to nurses and patients’ levels of satisfaction. Thus, one may argue that the decision to provide more autonomy in all US states for NPs may be beneficial to hospitals and other medical establishments, especially in areas where care delivery could be complicated by numerous factors (Boylan et al., 2012). Several points should be touched upon during the investigation of this evidence-based practice. First, the existing legal framework provides an NP with an opportunity to prescribe medications and other services. At the same time, it introduces specific limits as in the largest US states such as Texas, Florida, and California NPs act in terms of restricted practice conditions which means that all their prescriptions should be approved by a collaborating physician who becomes responsible for the treatment (Boylan et al., 2012).
Otherwise, in states such as Colorado, Wyoming, and Oregon Family Nurse Practitioners have a full practice authority which means that their autonomy is high and they can prescribe Schedule II-V substances without a physician’s approval (Boylan et al., 2012). Finally, in states such as New York, Vermont, and New Jersey, there is a probationary period which presupposes that NPs have to cooperate with physicians to prescribe medications and acquire their approval to prove their competence (Boylan et al., 2012). Therefore, it is possible to see whether the states, in which NPs have full authority over all actions, have higher levels of patient and nurse satisfaction that in the states with NPs with restricted or reduced autonomy. About the suggested project, the sphere of nursing, and the NPs level of autonomy in different states are discussed.
Moreover, considering the character of the issue, several other spheres should also be touched upon. The great responsibility of any decision in health care introduces several ethical issues. Therefore, liability and legal aspects should also be taken into account. Nevertheless, the great significance and topicality of the questions provide the rationale for its investigation. The fact is that the autonomy of NPs across the USA has always been an ongoing issue (Kleinpell, Hudpeth, Scordo, & Magdic, 2012). Some scholars argue that giving nurses full autonomy might influence the wages of physicians and negatively impact their practices. It gives rise to vigorous debates as ethical, legal, and professional issues are discussed. At the same time, the expected outcomes could help evaluate the possibilities for improvement in the sphere of nursing and care delivery models. That is why the issue of NPs autonomy in different US states and its reconsideration are discussed.
Application to MSN Program Specialty Track
The outlined issue also becomes especially crucial for establishments and practices with a family nurse practitioner. The given MSN program specialty track is focused on the preparation of specialists who work autonomously or in cooperation with other health workers to provide family-focused care (Nyirati, Denham, Raffle, & Ware, 2012). An FNP can offer a wide range of services to monitor the state of a particular family and assure disease prevention during the lifespan. In the course of his or her functioning, the given specialist obtains the most important information about a family case-record and also faces numerous situations that demand specific responses (Nyirati et al., 2012). Analyzing this issue from an FNPs perspective, numerous benefits of being completely independent should be emphasized. As FNPs are one of the main caregivers to many people, their ability to prescribe medications, chose an appropriate treatment without supervision, and provide more complex services in all US states may impact the overall efficiency and accessibility of healthcare significantly. Moreover, the healthcare sectors image can also be improved as the level of the familys satisfaction with a worker may also increase. Furthermore, nurses’ level of retention and job satisfaction may also be positively influenced by the fact that they have more autonomy in their actions. The way that nurses act may be influenced by these opportunities.
Nursing Issue and Evidence
Thus, delving into the selected sphere, it is crucial to provide several most important details that are often associated with it. First, it often comes with legal issues. The fact is that different US states provide various limits for nurses functioning. There are several reasons for the existence of these limits. For instance, some researchers argue that nurses may not possess the necessary skills to operate autonomously. However, according to Spetz, Skillman, and Andrilla (2017), many NPs become the only caregivers available in rural areas. Thus, their skill level should be sufficient in other areas as well because they receive the same level of education. However, as Park, Athey, Pericak, Pulcini, and Greene (2016) note, some specialists continue to argue that NPs should be prohibited to perform certain activities or provide services without the collaboration with a physician. For example, some discuss the issue of power abuse. There is a system introduced to control drug and other medications distribution and ensure that no abuse of power will be admitted.
However, the question about the knowledge base remains. A specialist should know the effect the final diagnosis and applied treatment can have on the state of a persons health. However, NPs go through extensive training to achieve the level of knowledge that can be compared to that of a physician. Despite the complexity of the issue, its comprehensive investigation is still crucial. According to the latest statistics, the modern practice setting provides numerous cases when the problem occurs: in emergent cases, an NP is not able to prescribe treatment or has to obtain a physician’s approval to provide a certain service (Liu, Guarino, & Lopez, 2012). Park et al. (2016) argue that nurses with full autonomy are more confident in their practices, which in turn positively affects the levels of patient satisfaction. The problem of nurses being unable to administer proper care without supervision may have a great negative impact on the image of the healthcare sector. Especially topical the issue becomes in a place where care delivery is complicated because of different reasons.
In such a way, the evaluation of approaches in the majority of the US states may yield different reactions from the main stakeholders. As one can understand, the efficiency of nurses impacts the functioning of a medical unit directly. They improve the state of patients health, assist physicians, and contribute to the improvement of a hospitals functioning greatly (Risling, Risling, & Hottslander, 2017). In such a way, these specialists impact all stakeholders, and alterations in their functioning will impact them. It is possible that the provision of greater autonomy leads to the reconsideration of NPs traditional role and helps to improve spheres that need some alterations. It is expected that when nurses can prescribe pills and provide more diverse services to patients, the outcomes are better due to the timely character of help and their ability to initiate treatment without the physicians approval. Additionally, the state of the health of different communities that suffer from the lack of qualified medical services is improved in these areas as well.
Evidence-Based Practice Model
However, the implementation of the given approach demands a comprehensive investigation of the existing health care setting to guarantee that the suggested intervention will improve the functioning of the system. In such a way, it is crucial to formulate an appropriate evidence-based question. Considering current perspectives and alternatives, one can suggest the following PICO question:
Are the levels of patient and nurses’ satisfaction higher in states, in which FNPs have full autonomy over their actions than in states with nurses, who are restricted in their duties?
FNPs and their patients become the target population, which means that the research will be focused on the examination of their experiences in terms of the working conditions and provided patient care. The creation of the pattern that presupposes one’s attitude towards patients as well as patient’s level of satisfaction and opinion on nursing care provision should be investigated as the results may influence the way other medical professionals see either the existing state of the healthcare sector. It should be compared to the existing pattern which presupposes restricted, reduced, and full practice authority in different states and demonstrates stable outcomes (Liu et al., 2012). In case the suggested research shows that both patients and nurses express better outcomes (which can be linked to the increased autonomy of nurses along with their better functioning) or promotes nurses improved motivation, it could be considered efficient enough to continue the investigation and conduct other research related to the issue. The more efficient functioning could be measured using NPs and patients’ feedbacks, the overall state of the healthcare sector, the scope of physician-nurse relations, and statistics related to outcomes.
Research Literature Support
The suggested nursing issue demands a comprehensive investigation because of its outstanding significance and crucial impact on the healthcare sector. The suggested PICO question shows the need for evaluation of practices with the following discussion of the possible replacement and comparison of the old model with the new one which includes the full practice authority in all US states. The relevant research studies related to the issue should be analyzed and used to create the theoretical framework for further discussion. For instance, the paper by Duncan and Sheppard (2015) delves into the peculiarities of the full practice initiative. This qualitative case study explores the attitudes of NPs towards the new changes in practice.
The results of this study outline several possible issues connected to the legislation of full practice authority. The given information can be applied to the current nursing issue as it provides essential cogitations about potential threats that could appear during the implementation process. Some limitations of this study include its narrow sampling size and the use of a single example. Booker (2015) also touches upon difficulties that are related to the reorganization of the modern healthcare sector. This study analyzed multiple documents connected to the issues of change in medical practices and probation, using the data from mental health trusts and Clinical Commissioning Groups. The focus on the improved outcomes could become a two-edged weapon that makes any alteration impossible. However, the necessity of change becomes obvious as NPs functioning preconditions the outcomes and should be reconsidered (Booker, 2015). This research explores a different sphere of health care, but it relates to the aspect of change as well.
The research paper by Liu, Guarino, and Lopez (2012) is another crucial source that should be used in the investigation as it evaluates the level of satisfaction of family members with care services provided by FNPs. In general, the overall satisfaction was admitted; however, nurses were able to perform a wide array of procedures. In this regard, the information becomes crucial for comparing two approaches in terms of the PICO question. At the same time, there are numerous cases of patients dissatisfaction with the quality of provided services and terms of treatment (Robinson, 2014). A significant number of complaints result from nurses inability to prescribe the treatment without a physicians approval. It slows down the recovery process and undermines the image of the healthcare sector (Robinson, 2014). The number of complaints is significantly smaller in the US states which provide the full practice authority to NPs. This fact should be used in the investigation to evaluate the differences further and establish the importance of autonomy in nursing care (Robinson, 2014).
Another element that can be used in the discussion of the suggested PICO question can be found in the article by Poghosyan et al. (2013) which outlines NPs vision of their roles and responsibilities as primary care providers. This qualitative study uses a descriptive design to show NPs perceptions and thoughts regarding this issue. The investigators conclude that nurses might have the same responsibilities as physicians especially in the sphere of primary care delivery. This similarity shows the possibility of introducing full practice authority for nurses in all US states as their competencies are at the appropriate level.
Nurses positive attitude to the suggested reconsideration of their roles in healthcare is discussed in the article by Donelan, Des Roches, Dittus, and Burehaus (2013). The survey that is conducted by the authors allows them to analyze the statistical data from physicians and health practitioners on the topics of their experiences and attitudes in the setting of primary care. In the course of the study, they conclude that NPs are eager to expand their roles and accept more responsibilities. However, this change should be supported by corresponding payment rates. The high level of nurses motivation to engage in the change process is also revealed by Azedo and Alves (2014) in their descriptive and correlational research of opinions of nurses from various medical facilities. The authors admit NPs desire to increase the overall efficiency by acquiring new authorities. Medical specialists could also be motivated by additional rewards that could be acquired in case new responsibilities are provided to them.
In their discussion of nursing care, Neal-Boylan, Mager, and Kazer (2012) also note an increasingly visible role that nurses play in care delivery and maintenance of a particular health level. However, full authorities become the central issue that preconditions positive outcomes. Park et al. (2016) are sure that “removing barriers at all levels that potentially prevent NPs from practicing to the full extent of their education and training is critical not only to increase primary care capacity but also to make NPS more efficient and effective providers” (para. 1). The data could be applied to the discussion of the PICO question to support the position of scholars that support providing nurses with more autonomy and to justify the necessity of shift of priorities towards the full practice autonomy.
The need for nurses autonomy in areas where care delivery could be complicated is emphasized by Spetz, Skillman, and Andrilla (2017). The study analyzes data from the survey of NPs, which collected answers from more than 22000 randomly selected nurses to assess their working conditions, hours, levels of retention, and overall satisfaction with their jobs. The authors state that the functioning under the restricted authority might significantly deteriorate the outcomes and result in primary care shortages. Under these conditions, the question of NPs autonomy becomes central to the healthcare sector. The given idea is also supported by Ortiz (2017) who discusses different settings and efficiency of care delivery in the form of a comparative study. In the rural environment, or in areas that suffer from the lack of medical units, nurses experience a significant need for increased autonomy to prescribe treatment and assist patients in their recovery (Ortiz, 2017).
Kaasalainen, Papaioannou, Buress, and Van der Horst (2015) also investigate the issue and prove the unique role nurses play in long-term care by conducting a study using a mixed-method with a cross-sectional survey and qualitative interviews. The authors argue that the level of nurses’ competence and experience is high enough for them to perform complex tasks and prescribe the needed treatment. This fact evidences the possibility of the shift towards the full practice authority across the state. Moreover, considering nurses are the main instrument of healing and care delivery and accepting their unique role in the healthcare sector, Lubuniska-Welch, Pearson, Comer, and Metcalfe (2016) outline the necessity of their further development as one of the main motivational factors. Their study uses a survey to determine various self-care practices, main interests, and needs of nurses from multiple patient departments. The authors consider the possibility that the reconsideration of the current role of nurses is essential for their further growth.
Finally, the article by Ladd, Sweeney, Guarino, and Hoyt (2017) analyzes several public use files from Medicaid prescriptions and revolves around security concerns related to the nurses scope of practice and their possibility to prescribe medication. In the course of the investigation, they conclude that it does not threaten the healthcare sector and no abuse of power could be admitted. For this reason, the suggested reconsideration of authority patterns should be considered appropriate.
The investigation of the nursing issue mentioned above demands a structured approach and appropriate methodology to acquire the relevant data needed for discussion. In this regard, the quantitative research should be applied to the case as it will contribute to the improved understanding of NPs experiences and their current attitude to their authorities as well as patients’ levels of satisfaction with provided patient care from nurses with different degrees of autonomy. Moreover, their impressions related to the altered position and full practice authority could also be researched. In such a way, the quantitative method becomes the only possible alternative as it is perfect for measuring data for comparison.
The choice of the research design is also crucial as it preconditions the target population, sampling procedure, data collection methods, and results processing. Because the current research is focused on the investigation of nurses’ and patients’ experience related to their authorities and scope of practice, the stratified sampling method should be applied. It will be used in the form of a survey to assess the attitudes of NPs towards the possible scope of practice, their levels of job satisfaction, and their desire to stay in their current position. Moreover, the surveys should also address patients and their opinions on provided nursing care.
The stratified sampling method is focused on evaluating data from a particular group of people that possess traits necessary for this research. Thus, this technique can help researchers to pick out NPs and patients from different locations to analyze and compare their experiences to each other. Therefore, this approach can yield viable results that will be able to describe the current situation of nurses with or without full autonomy. The use of a quantitative method fits with the PICO question as it reveals the statistical data regarding the issue of comparing different nursing practices. The survey can be conducted on paper or online depending on the availability of nurses and patients and their access to the Internet.
Several main factors precondition the choice of the stratified sampling method for the given case. First, as stated above, it preconditions the increased credibility of data as it is collected straight from the source. NPs who act in terms of the restricted or full practice authority will provide their answers and share impressions related to the perspectives of their functioning. Patients will be able to reflect on their time with nurses and assess their experiences in a structured questionnaire. In such a way, the relevance of data will promote the high practical utility of the research. Second, the stratified sampling method assists in the improved understanding of the way participants think about the suggested phenomenon and precondition its enhanced comprehending.
The main advantage of the suggested research method is the ability to gather information from the main participants of the process, investigate the phenomenon from different perspectives, and receive systematized and visible results. It means that all NPs and patients who participate in the study will contribute to the process of the investigation of this issue and to the possibility of shifting the priorities towards the full practice authority in all US states. Moreover, the credibility of data will not suffer because of the data-collection methods mentioned above.
Unfortunately, there are still some weak points that come from the choice of using the stratified method as the leading research approach. This method utilizes a small number of results that come from particular places. The results are not randomized, which can affect the reliability of the analyzed data. However, the scope of this research should be enough to compare several medical establishments and their practices. The questionnaire will be able to help both nurses and patients to give answers that will not be affected by other people’s opinions.
As it is stated in the PICO question, NPs and patients become the primary target population that is used to collect credible data and investigate the suggested nursing issue. Peculiarities of the project precondition the usage of stratified sampling as the main method to choose participants and collect the data needed to make the conclusion and discuss the selected nursing issue. The sampling procedure will consist of several stages. First, only NPs and patients that have experience in operating or receiving care under the restricted or full practice authority will be chosen. The excepted sample size is about 90 participants divided into two groups, 45 participants each. The first one will be comprised of 30 NPs who function in terms of restricted authority and 15 patients who are or were at some point treated by the establishments where the nurses mentioned above work. Another group will consist of 30 NPs who operate under the full practice authority and 15 patients that are or were treated in the hospitals or practices where these nurses work. The participation in the research is voluntary, anonymous, and respondents answers will not be used without their agreement.
The first advantage of the given sampling method is the opportunity to compare attitudes and experiences related to the investigated issue. The second one is the increased credibility of data collected from experienced nurses and patients due to the questionnaires being anonymous and systematized. The main disadvantage of the suggested sampling is its comparatively small size and the need for two groups to compare findings.
Data Collection Methodology
As it has already been stated, the issue of the full practice authority for nurses demands a comprehensive investigation because of its outstanding significance and vital role in the modern healthcare sector. That is why the quantitative research methodology will provide the relevant data related to NPs experiences and their perspectives on the new pattern as well as the patient’s response to different practices. To elaborate on the most efficient approach and guarantee the increased credibility of information, the chosen methodology should meet specific requirements related to the data collection and analysis process, participants involvement, their answers, outcomes. etc. Therefore, the following part of the project is devoted to the comprehensive description of the main aspects of the quantitative research regarding the suggested PICO question.
Type of Data
Thus, the choice of the research method is not accidental as it is preconditioned by the necessity to assess patients’ levels of satisfaction and NPs understanding of their current experience and perspectives on the role they play in the modern healthcare sector. For this reason, a questionnaire becomes the most appropriate approach to collect the relevant data and use it in further investigation. The efficiency of the given method is proven by numerous research studies that are also focused on the investigation of a particular phenomenon and individuals attitudes to it (Creswell, 2013). Additionally, by using a questionnaire as the primary source of data, a researcher acquires an opportunity to get answers that are not clouded by unnecessary data, and that can be easily measured after the definition of every aspect. In this regard, the use of a survey as the primary type of data is justified by the nature of the research and desired outcomes.
The data collection will occur in several stages. First of all, the NPs that live in states with different levels of autonomy will be contacted. They will then answer the questions in distributed surveys. The patients will be contacted and asked to participate as well. This way, the research will have results from various nurses as well as patients and will be able to analyze the acquired data and display the final results. The questionnaire should include questions about patient care, freedom of diagnosing and treating patients as well as nurses’ and patients’ satisfaction. Nurses’ desire to stay in the profession, as well as attitude towards other medical professionals, can be addressed as well. Some participants that can or want to complete the survey in paper form should be able to do so. Additionally, the use of a survey is needed to guarantee anonymity for all respondents who do not want to communicate directly with a researcher. In such a way, the data collection will occur via paper and Internet-based surveys among NPs and patients who have the needed experience and are ready to share their perspectives on the issue.
The adherence to the outlined research methodology preconditions a distinct character of data points acquired in the process of the investigation. Regarding the fact that the survey is the main approach used to analyze the issue, NPs and patients’ answers should be considered the data points. Therefore, that main data collection points will include the following:
- sampling (choice of respondents appropriate for the research)
- creation of a survey form
- distribution of surveys among NPs and patients via the Internet, paper mail, or meetings
- collection of data
- analysis of results
The existence of this data collection points guarantees the increased accuracy of information acquired in the course of the investigation and ensures that no significant stage will be omitted.
Furthermore, there is no particular time frame for the investigation as the nature of the research issue does not presuppose any significant alterations in the sphere of healthcare that could impact the relevance of data and deteriorate final results. However, to complete the study and provide the conclusion needed for the discussion, a timeline should be established. The choice of the questionnaire as the primary method impacts the period required to conduct a study. Another major factor that should be examined when introducing a time frame is NPs schedules. These specialists have to perform a broad range of complex tasks that demand a high level of concentration and hard effort. For this reason, their timetables should be taken into account to acquire their answers and use them in the research. The aspect of patient availability should also be considered. Internet surveys should not take much time, but paper-based questionnaires may require a longer time to be answered and delivered. Altogether, the term from 3 weeks to 1 month could be considered appropriate for the suggested data collection method as all participants will be able to provide their answers.
Data Quality Enhancement
The suggested research will benefit from the enhanced quality of data collected among participants. For this reason, the use of methods to improve this aspect is essential for the investigation. Two main approaches are implemented in the given study. First, one source of data is used. Regarding the research issue, respondents answers to survey questions are the only source of information that is used to make a particular conclusion. The given method contributes to the enhanced results because of the absence of any corrupted data points or unreliable sources. The quantitative method allows researchers to have a visual representation of the acquired results (Bernard, 2012). All information provided by respondents should be analyzed for correctness and completeness. Patients, as well as nurses, should be advised on how to answer the questions of the survey correctly. The quantitative type of research can ensure the quality of the final results and display one’s findings in a comprehensible form.
There are also several particular demands for the analysis of findings obtained in the course of the study. Regarding the usage of the questionnaire as the primary data collection method, its results should be processed using specific patterns. For instance, NPs answers related to different aspects of the full-practice or restricted authority could be distributed among various groups to improve the comprehension of the issue and visualize the research results. Additionally, an in-depth analysis conducted regarding the given approach will contribute to the enhanced understanding of outcomes (Rubin & Rubin, 2012). Altogether, the content analysis of the acquired data findings will occur through the calculation of results in percentages according to their prevalence. It will ensure that increased comprehension of the issue and precondition meaningful debates over the nursing problem.
Thus, the research findings should answer the questions included in the main thesis and explore the idea of the research study. Considering the character of the research, the answers of patients and NPs are expected to prove the concept that the shift of priorities from the restricted to full-practice authority in all U.S. states will result in the enhanced outcomes and provide NPs with new opportunities to increase their efficiency and result in them being happier with their job. Moreover, the study aims to prove that patients, receiving care from nurses with more autonomy, are more satisfied with the outcomes of their treatment and their interaction with the medical establishment. This research is focused on the evaluation of specific points on people’s experiences. That is why NPs attitudes should prove the idea that at the moment they feel the lack of authority and are limited in their personal and professional development. Furthermore, the assessment of patient satisfaction levels should show that they expect nurses to be able to have full authority over their practices. Finally, the suggested data analysis approach has the primary aim to investigate a certain phenomenon and its impact on the healthcare sector (Jamshed, 2014). Thus, a stratified data sampling method along with further analysis should present a clear picture of the current situation.
The collected data from nurses should show that participants from hospitals and practices, in which nurses have more autonomy over their actions, are more satisfied with their jobs and do not express any desire to change jobs. Moreover, the patients in these areas should have a more positive experience with nurses and provided care. Thus, the results of theses study may serve as the basis for the further implementation of an autonomous system for nurses in areas with reduced or restricted care. While the legal issues connected with this problem cannot be solved quickly, the outcomes of this study can become the grounds for further advocacy towards implementing this system. The patients and the NPs are one of the main stakeholders in this situation. Therefore, the outcomes of this research can significantly affect them. The implementation of additional autonomy for nurses may give them more opportunities to use a full set of learned skills and improve the rates of job retention. Patients’ levels of satisfaction can be expected to rise as well.
The detailed plan of implementation would include further efforts to advocate for giving nurses more autonomy over their operations. One can suggest writing letters to government officials of states where this issue is currently present. Thus, the information from this study can be used as support to convince the officials in the viability of this plan. Furthermore, various organizations that are concerned with nurses and their work can be contacted as well. In the end, the study and its results may become a step towards implementing the system of full autonomy for NPs in all states.
Translation of Results
It is important to remember that this issue is being discussed by other scholars as well. Thus, one can see the changes in the state laws already. However, the implementation of full NPs’ autonomy still has some barriers to overcome. As was previously mentioned, some medical professionals believe that NPs may pose a threat to doctors regarding their scope of practice and income. Therefore, some doctors may feel pressured by these changes and advocate against them. However, this barrier can be overcome by presenting existing research that investigates the relationships between physicians and NPs in areas where the latter have full autonomy over their actions. For instance, Donelan et al. (2013) explores the perspectives of nurses and physicians and concludes that NPs’ autonomy does not have negative effects on physicians’ practice. Moreover, nurses with more autonomy may positively affect patient care as they can work in places with hospital deficiency.
The resources needed to implement this practice include continuous interaction with various authorities, advocacy for the implementation, and financial resources to provide other individuals with the required information as the study’s outcomes need to be disseminated to other members of the specialty.
This EBP proposal explores the issue that is currently being addressed by various organizations. The autonomy of NPs is a matter that should not be neglected by nurses and government officials as well. Thus, it is important to continue spreading ideas that support the change and modernization of the healthcare structure. This research aims to evaluate the difference between two parts of one system to prove that one of these elements works more efficiently than the other. The implementation of the new system to the other states of the US, therefore, can further improve the state of healthcare in the country. However, the effect is doubted by some investigations. For this reason, evidence-based research is needed either to prove or to refute the expected effect and provide the scientific rationale for the application of the approach.
This research allowed us to learn more about the current situation of NPs in the US. Moreover, the process of creating this study allowed us to revise our knowledge on the topics of research types and sampling methods. The in-depth investigation of literature provided us with more information about the roles of NPs and FNPs for peers, patients, and the healthcare system in general.
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