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. 2024 Jul-Aug;38(4):520-543.
doi: 10.1016/j.pedhc.2023.12.003. Epub 2024 Jan 29.

Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review

Suzanne E Courtwright, Eleanor Turi, Emily A Barr, Jade C Burns, Kristin Hittle Gigli, C Robert Bennett, Jennifer Sonney, Lucine Francis, Lusine Poghosyan

Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review

Suzanne E Courtwright et al. J Pediatr Health Care. 2024 Jul-Aug.

Abstract

Introduction: The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice.

Method: We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize.

Results: The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias.

Discussion: Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.

Keywords: Workforce; health equity; health policy; pediatric nurse practitioners; systematic review.

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Conflict of interest statement

CONFLICT OF INTEREST None to report. The authors wish to acknowledge John Usseglio, an informationist at Columbua University, for their assistance with developing the search strategy.

Figures

FIGURE 1.
FIGURE 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
FIGURE 2.
FIGURE 2.
Pediatric nurse practitioner health equity model.
See this image and copyright information in PMC

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