Date of Award

4-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing Science

Research Advisor

Anne Alexandrov, PhD

Committee

Xueyuan Cao, PhD; Joyce C. Graff, PhD; Ansley Stanfill, PhD; Sherry Webb, DNSc.

Keywords

Autonomy; Barriers; Collaboration; Independence; Nurse Practitioner; Stroke

Abstract

Introduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to understand SNPs working in expanded roles to build knowledge of their lived experience.

Methods. A convergent mixed methods design with quantitative and qualitative results merged was used to provide a comprehensive representation of the SNP lived experience. Each participant completed a questionnaire using SurveyMonkey. The questionnaire included personal, education, and work role data, as well as barriers to scope of practice. The questionnaire also included the Dempster Practice Behavior Scale (DPBS) that measures nurse practitioners’ perceived autonomy. Qualitative methods used semi structured focus group interviews after questionnaires were completed. Quantitative data was analyzed using SPSS; qualitative data was analyzed with NVIVO to identify themes. The quantitative and qualitative data were then integrated to support meta-inferences.

Results.A total of 14 SNPs were enrolled: age (Mdn= 44, IQR 38.75, 50.25), 85.7% were female, years of work experience (Mdn = 13, IQR 4.5, 21). All were Masters prepared with five completing higher levels of education. Nine participants worked in reduced or restricted states. Most SNP duties entailed diagnosis, treatment and management of acute illness for assigned patients and administration of thrombolysis. The DPBS findings showed high total autonomy (Mdn = 130, IQR 120.75, 140.50); subscale findings were: Readiness (71.43% high scores and 28.57 moderate scores); Empowerment (71.43% high scores and 28.57 moderate scores); Actualization (100% high scores); and Valuation (85.71% high scores and 14.29 moderate scores). The following themes emerged from the SNP interviews: 1) Independence with subthemes of work related confidence and clinical leadership; 2)Barriers with subthemes of policy-driven and physician-driven scope of practice restrictions; 3) Collaboration with neurology physicians and physician specialties. Merging of data produced meta-inferences confirming SNPs working in expanded roles are highly educated, experienced clinicians with high levels of practice autonomy that is discordant with practice barriers, and their scope of practice. SNPs expanded neurovascular knowledge showcases their value and enhances collaboration with physicians and other practitioners.

Conclusions. The numbers of primary and comprehensive stroke center hospitals continue to increase in the USA, whereas there is an ongoing vascular neurology shortage. The demand for SNPs will continue to increase to meet patient care needs. While highly educated and autonomous, SNPs must become more aware of their scope of practice and legal restrictions to practice expansion to ensure regulatory compliance and increase efforts to remove unnecessary barriers to practice.

Declaration of Authorship

Declaration of Authorship is included in the supplemental files.

ORCID

https://orcid.org/0009-0001-3762-6395

DOI

10.21007/etd.cghs.2025.0686

Additional Files
2025-003-Kiernan-DOA.pdf (323 kB)
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