Abstract
The U.S. healthcare system has a cost-quality paradox with the highest costs and lowest healthcare quality of industrialized nations. APRNs have been posited as a solution to this value dilemma, but existing barriers to practice must be alleviated to make this a reality. Considerable progress has been made toward mitigating federal and state barriers, whereas organizational-level barriers may be intensifying. The Theory of Psychological Ownership defines how work environment psychologically impacts the worker. Work environments that foster high psychological ownership demonstrate improved work performance and outputs. Healthcare organizations such as hospitals restrict APRN activities leading to decreased effectiveness, which in turn may decrease ownership for work. The Theory of Psychological Ownership provides a potential explanatory mechanism for how removing common barriers to APRN practice improves APRN perception of their practice environment, and may improve motivation and performance. This study aims to investigate the relationship of common organizational-level barriers to APRN practice and their perceptions of their practice environment, and the role psychological ownership may play in this relationship. Using a nested cross-sectional descriptive design, this study consists of a convenience sample survey of hospital CNOs in one state about institution-level APRN scope of practice and APRN’s (CRNA, CNM, CNP) perceptions of organizational climate and psychological ownership in the corresponding institution. Structural equational modeling and correlation is employed to investigate the relationship between the APRN practice environment components of actual scope of practice and perceived organizational climate, and whether feelings of psychological ownership play a role in the relationship. Previous nursing research has linked improvement of these components of practice environment to positive nurse and ultimately, patient outcomes. Improved patient outcomes will be the economic driver of future hospital reimbursement. Providing empiric evidence that removing organizational barriers to practice can increase APRN feelings of ownership for, and thereby improve APRN performance and perceptions of their environment, and can provide the motives necessary to help alleviate these indoctrinated obstacles to APRN utilization.