BRIEF REPORT
Essential nurse practitioner business knowledge: An interprofessional perspective David LaFevers1 , Peggy Ward-Smith1 , & Wendy Wright2 1 2
School of Nursing and Health Sciences, University of Missouri-Kansas City, Kansas City, Missouri Wendy Wright and Associates, Bedford, New Hampshire
Keywords Quality; systems; risk reduction; finance; education; management; practitioners. Correspondence David LaFevers, School of Nursing & Health Sciences, University of Missouri-Kansas City, Kansas City, MO 64108. Tel: 816-235-5181; Fax: 816-235-1701; E-mail: [email protected] Received: 27 September 2013; accepted: 29 January 2014 doi: 10.1002/2327-6924.12204
Abstract Purpose: To describe business practice knowledge from the perspectives of nurse practitioners (NPs) who are practicing clinicians, academic instructors, and clinic managers. Data source: Using the eight domains of business practice attitudes identified by the Medical Group Management Associations Body of Knowledge (MGMA), which are supported by the American Association of Colleges of Nursing (AACN), a study-specific survey was developed. Data, which describe the knowledge and attitudes with respect to business practices, were obtained from 370 participants. Conclusion: Regardless of their job classification, these participants described (1) quality management, (2) risk management, and (3) patient care systems as critical business practice knowledge. Consensus was also achieved when ranking the content for business practice knowledge: (1) patient care systems, (2) business operation, and (3) financial management. Implications for practice: These data identify gaps in business practice knowledge and content that should be included in educational programs. Business practice knowledge is essential for a successful clinical practice and should be a professional practice skill for the NP.
The inclusion of business practice knowledge should be included in the skill set of nurse practitioners (NPs). Other healthcare professions have noted the lack of formal organized teaching of business concepts and recognized that more formalized approaches are necessary to correct these deficiencies (Allen, Reinke, Pohl, Martyn, & McIntosh, 2003; As-Sanie et al., 2005; Kennerly, 2006; King, Sharp, & Lipsky, 2001). Despite this awareness, there is a paucity of data, and no research evidence, related to the business knowledge content that NPs should have, or the suggestion of how or where this knowledge is attained. In light of a lack of substantial evidence regarding the business skills of NPs, more information is needed. The purpose of this study was to assess the current perception, related to business practice knowledge, of NPs that are practicing clinicians, faculty that teach NP students, and clinic managers. Obtaining data from three separate populations would provide a comprehensive assessment of the challenge. It is essential that in order to provide appropriate and cost-effective care NPs have business knowledge, the Journal of the American Association of Nurse Practitioners 27 (2015) 181–184 C 2015 American Association of Nurse Practitioners
ability to apply business principles, and advanced clinical skills (Buppert, 2005). If the NP does not understand essential business concepts and their application, they and the profession risks marginalization and decreased professional validity. Development of improved general business knowledge and practices is necessary for the success of the individual APN and the profession as a whole (Abel & Longworth, 2002; Buppert, 2005; Kennerly, 2006). The American Association of Colleges of Nursing (AACN) (2006) has described and defined the importance of business and financial acumen practice skills sets as essential educational requirements. This document was used to develop a study-specific survey, which was subsequently utilized to develop specific survey questions to obtain data.
Background As-Sanie et al. (2005) and Kennerly (2006) asserted that graduate healthcare education does not provide comprehensive understanding of business practices or how 181
Essential NP business knowledge
this lack of knowledge affects job security. The outcomes of insufficient business practice knowledge have been realized in the ability to sustain a clinical practice, become financially stable, and ultimately the ability to provide patient care (Heidelbaugh, Riley, & Habetler, 2008; Thorwarth, 2005; Vincent, 2002). Any healthcare provider that is perceived as being less financially productive may find him or herself at risk of being replaced (Abel & Longworth, 2002). Anecdotally, conflict occurs between clinic managers, who are charged with the business operations of health care, and NPs, who provide the health care. The lack of baseline business knowledge creates a myriad of expectations, which frequently strain the relationship between managers and clinicians. According to Chalice (2007), when the strategic plan is stated in a common language, all may understand. Clearly stating the roles and responsibilities of each member of the organization with respect to the strategic plan provides a common ground for communication. Literature supports increased education, communication, and collaboration to improve overall outcomes when involving different disciplines (Brown, White, & Leibbrandt, 2006; Lennox & Anderson, 2012). It is the opinion of the authors of this article that this information should be provided in the educational process of becoming an NP. Results of a systematic review (Zwarenstein, Goldman, & Reeves, 2009) describe how the lack of interprofessional collaboration and communication can potentially result in less than desired outcomes. Practicing NP clinicians, faculty that teach NPs, and clinic managers must come together to improve educational opportunities for graduate students and practicing NPs. Increasing the interactions and exchange of ideas between these three groups will allow for improved educational opportunities for students and practicing clinicians (Davidson, McCollom, & Heineke, 2005). Improved educational opportunities, focused on communication and the business skills required for a successful collaborative practice, can only be accomplished when a combined understanding of the knowledge and needs of groups are provided (Belza, 2007; D’Amour, Ferrada-Videla, San Martin Rodriquez, & Beaulieu, 2005).
Methods Using the eight domains of business practice attitudes, as identified by the Medical Group Management Associations Body of Knowledge (MGMA) (American College of Medical Practice Executives [ACMPE], 2011; Gulko, 2006) and business practice items noted by the AACN (2006), a study-specific survey was developed. According to the MGMA (ACMPE, 2011), business practices 182
D. LaFevers et al.
attitudes may be classified into eight domains that vary in importance based on one’s perception. The domains are (a) operations, (b) financial management, (c) human resource management, (d) information management, (e) organizational governance, (f) patient care systems, (g) quality management, and (h) risk management. Each of these domains was used to develop an item on the study-specific survey. The use of previously identified business practice domains provided survey validity. Participant responses were used to objectively describe and rank the importance of each domain, in their perception. The study survey consists of 33 items. This provides the ability to demographically describe the study population (n = 17), dichotomously describe each item as important or not (n = 8), and rank each item (n = 8). Example items are “Risk management knowledge is critical for the NP in a collaborative practice” and “Each NP should have knowledge of organizational governance structures.” These items reflect the eight domains, as defined by the MGMA (ACMPE, 2011). There were no reverse-scored items, nor neutral response, but the ability to nonrespond was available. Once developed, content validity for the study survey was secured by having it reviewed by three individuals who are practicing NPs and faculty members or clinic managers. There were no recommendations suggested. The development of the instrument allowed for it to be included in the Institutional Review Board (IRB) application, thus both the survey and the study were reviewed and approved by the Social Science IRB at the University that employs the researchers. As a low-risk study, using a healthy volunteer population, participation in the study was determined to be implied upon submission of the responses, thus exempt from needing an informed consent. Data collection occurred using several modalities, specific to each study population. Practicing NPs’ participation was obtained during regional and national conferences; academic instructors for NP programs, identified by their Dean; and clinic managers, identified by a colleague familiar with NP clinics, received an e-mail study invitation. Survey data were received from 414 participants. There were no adverse study-related adverse effects reported. Once responses were reviewed and incomplete data sets were deleted, analyses were performed on 370 responses. While it is unknown what the potential study population could be, Worthington and Whittaker (2006) recommend a range of 5–10 participants per item. Cochran (1977) states this is considered a sufficient study population when the study sample is homogeneous. Once data collections were completed, all responses were transferred into SPSS 13.0 for analysis.
Essential NP business knowledge
D. LaFevers et al.
Results Analysis of the self-described demographic data revealed that a study population was primarily female (94.2%) and employed as a clinician (90.6%). Response data were analyzed using percent data and by participant grouping (clinician, faculty, manager). This provided the ability to describe the varied perceptions of business knowledge, based on position, rather than the total number of responses. A summary of the domains perceived as important, and a ranking of the domains, by study population, is displayed in Table 1. Responses from study participants who self-described themselves as practicing NPs indicate that the top five domains, in importance, as defined by MGMA (ACMPE, 2011; Gulko, 2006) were (1) quality management, (2) risk management, (3) patient care systems, (4) financial management, and (5) business operations. The top five domains, by rank, of these individuals were: (1) business operation knowledge, which tied with patient care systems knowledge, (3) financial management knowledge, which tied with quality management, (5) risk management knowledge, (6) information management, and (7) human resource management, which tied with organizational governance knowledge. Academic educators identified quality management as the most important domain, followed by (2) risk management, (3) patient care systems, (4) financial management, and (5) human resources. Ranking responses by perception of importance indicated that (1) patient care knowledge systems is most important, followed by (2) business operations knowledge, (3) financial management knowledge, (4) information management, which tied with organizational governance knowledge, (6) human resource management, (7) quality management, and (8) risk management knowledge. Responses from clinic managers differed from the other study populations. While these individuals ranked qual-
Table 1 Identification and ranking of importance of each domain
Item Quality management Risk management Patient care systems Financial management Business operations Information management Human resource management Organizational governance knowledge
Importance clinician/ educator/managers
Ranking clinician/ educator/managers
111 222 33 44 53 4 55
378 587 111 335 122 643 764 846
ity management as the most important domain, followed by risk management, business operations was third; information management and human resources were noted to be of lesser (4 and 5) importance. Clinic managers ranked patient care systems as the most important domain, followed by (2) business operations knowledge, (3) information management, (4) human resource management, (5) financial management knowledge, (6) organizational governance knowledge, (7) risk management knowledge, and (8) quality management.
Discussion Variability exists within these responses, which may reflect the importance of business practice knowledge needs, from the perception of individuals, and reflective of role function and job responsibility. In terms of importance, these participants, regardless of job function, agree that quality management and risk management are important. Agreement between clinicians and educators, when identifying domains of importance, are most similar. Managers, perhaps as a function of their job responsibilities, perceive operations, information, and human resources management as critical knowledge, which is not supported by the other study groups. When ranking the items, all study participants agree that patient care systems are most important, with business operations a close second. From there, the responses diversify, and appear to reflect the focus of the specific job responsibility. Neither the MGMA (ACMPE, 2011, Gulko, 2006) nor the AACN (2006) rank the domains or content stated as important for business practices. The data obtained in this study provides a ranking, in order of importance, of the business practices necessary for NPs to know. The results of this study are limited by the data collection methods, which included individuals who were attending a regional and national NP conference. As such, the sample population is skewed toward NPs that seek educational opportunities and/or are capable (financially and with time off work) of attending a conference. Snowball sampling techniques were used to locate academic instructors and clinic managers. Purposeful sampling methods rarely provide generalizability to any study; the participants of this study were known to the researchers, or within a small circle of colleagues. These limitations, combined with a small sample size, result in the need to repeat this study with a larger and more geographically diverse population. Until that is done, these results should be viewed with caution, and no intervention developed. 183
Essential NP business knowledge
Conclusion The results of this study highlight the varying perception, related to job classification, with respect to essential business practices, and the business practice knowledge needed by NPs. A discourse is present, between clinic managers, clinicians, and academic instructors. The perception of clinicians and academic instructors, with respect to the importance of each domain (ACMPE, 2011; Gulko, 2006), are similar. Only the clinicians perceive human resources as of little importance; only the clinic managers perceive information management as critically important. Patient care systems was highly ranked (#1) by each study population. From this juncture, perceptions vary; the perceptions of academic instructors and clinic managers are similar and do not coordinate with the perceptions of clinicians in any domain.
Implications and next steps The results identify different priorities, with respect to business knowledge, based on job classification. This provides an evidence-based approach toward content that should be included in NP educational programs. Program curriculum changes should not occur as a result of this study, because of the small sample population and limitations in data collection. Certainly replication of this study is warranted to validate these results and determine if there are geographical, educational, or demographical differences that affect business knowledge. These results do provide an initial effort toward attaining research evidence, capable of guiding educational programs that improve the business knowledge skill set of NPs. Improving this skill set will enhance professionalism, improve patient care, and decrease clinic closures as a consequence of poor business management.
References Abel, E., & Longworth, J. D. C. (2002). Resources for practice: Developing an economic IQ in primary care. Journal of the American Academy of Nurse Practitioners, 14(1), 3–10.
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Allen, K. R., Reinke, C. B., Pohl, J. M., Martyn, K. K., & McIntosh, E. P. (2003). Nurse practitioner coding practices in primary care: A retrospective chart review. Journal of the American Academy of Nurse Practitioners, 15(5), 231–236. American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced practice nursing. Retrieved from http://www.aacn.nche.edu/publications/position/DNPEssentials.pdf American College of Medical Practice Executives (ACMPE). (2011). Medical practice management (2nd ed.). Englewood, CO, Medical Practice Management Association. As-Sanie, S., Zolnoun, D., Wechter, M. E., Lamvu, G., Tu, F., & Steege, J. (2005). Teaching residents coding and documentation: Effectiveness of a problem-orientated approach. American Journal of Obstetrics and Gynecology, 193, 1970–1793. Belza, B. (2007). Interprofessional collaboration: Using the 7 habits of highly effective people questions to think about as you work as a team. Journal of Gerontological Nursing, 33(10), 3. Brown, D., White, J., & Leibbrandt, L. (2006). Collaborative partnerships for nursing faculties and health service providers: What can nursing learn from business literature? Journal of Nursing Management, 14(3), 170–179. Buppert, C. (2005). Capturing reimbursement for advanced practice nurse services in acute and critical care: Legal and business considerations. AACN Clinical Issues, 16(1), 23–25. Chalice, R. (2007). Improving healthcare using Toyota lean production methods. Milwaukee, WI, Quality Press. Cochran, W. G. (1977). Sampling techniques (3rd ed.). New York: John Wiley & Sons. D’Amour, D., Ferrada-Videla, San Martin Rodriquez, & Beaulieu, M. D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, 19(1), 116–131. Gulko, E. (2006). Medical practice management body of knowledge review: Business and clinical operations. Englewood, CO, MGMA. Heidelbaugh, J. J., Riley, M., & Habetler, J. M. (2008). 10 billing & coding tips to boost your reimbursement. Journal of Family Practice, 27(11), 724–730. Kennerly, S. (2006). Positioning advanced practice nurses for financial success in clinical practice. Nurse Educator, 31(5), 218–222. King, M. S., Sharp, L., & Lipsky, M. S. (2001). Accuracy of CPT evaluation and management coding by family physicians. Journal of the American Board of Family Practice, 14(3), 184–192. Lennox, A., & Anderson, E. S. (2012). Delivering quality improvements in patient care: The application of the Leicester Model of interprofessional education. Quality in Primary Care, 20(3), 219–226. Thorwarth, W. T. (2005). Get paid for what you do: Dictation patterns and impact on billing accuracy. Journal of the American College of Radiology, 2(8), 665–669. Vincent, D. (2002). Using cost-analysis techniques to measure the value of nurse practitioner care. International Nursing Review, 49(4), 243–249. Worthington, R. L., & Whittaker, T. A. (2006). Scale development research: A content analysis and recommendations for best practices. Retrieved from http://www.who.int/whosis/whostst/EN WHS08 Full.pdf Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interpersonal collaboration: Effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Systematic Review. doi: 10.1002/14651858.CD000072.pub2
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Essential nurse practitioner business knowledge: An interprofessional perspective David LaFevers1 , Peggy Ward-Smith1 , & Wendy Wright2 1 2
School of Nursing and Health Sciences, University of Missouri-Kansas City, Kansas City, Missouri Wendy Wright and Associates, Bedford, New Hampshire
Keywords Quality; systems; risk reduction; finance; education; management; practitioners. Correspondence David LaFevers, School of Nursing & Health Sciences, University of Missouri-Kansas City, Kansas City, MO 64108. Tel: 816-235-5181; Fax: 816-235-1701; E-mail: [email protected] Received: 27 September 2013; accepted: 29 January 2014 doi: 10.1002/2327-6924.12204
Abstract Purpose: To describe business practice knowledge from the perspectives of nurse practitioners (NPs) who are practicing clinicians, academic instructors, and clinic managers. Data source: Using the eight domains of business practice attitudes identified by the Medical Group Management Associations Body of Knowledge (MGMA), which are supported by the American Association of Colleges of Nursing (AACN), a study-specific survey was developed. Data, which describe the knowledge and attitudes with respect to business practices, were obtained from 370 participants. Conclusion: Regardless of their job classification, these participants described (1) quality management, (2) risk management, and (3) patient care systems as critical business practice knowledge. Consensus was also achieved when ranking the content for business practice knowledge: (1) patient care systems, (2) business operation, and (3) financial management. Implications for practice: These data identify gaps in business practice knowledge and content that should be included in educational programs. Business practice knowledge is essential for a successful clinical practice and should be a professional practice skill for the NP.
The inclusion of business practice knowledge should be included in the skill set of nurse practitioners (NPs). Other healthcare professions have noted the lack of formal organized teaching of business concepts and recognized that more formalized approaches are necessary to correct these deficiencies (Allen, Reinke, Pohl, Martyn, & McIntosh, 2003; As-Sanie et al., 2005; Kennerly, 2006; King, Sharp, & Lipsky, 2001). Despite this awareness, there is a paucity of data, and no research evidence, related to the business knowledge content that NPs should have, or the suggestion of how or where this knowledge is attained. In light of a lack of substantial evidence regarding the business skills of NPs, more information is needed. The purpose of this study was to assess the current perception, related to business practice knowledge, of NPs that are practicing clinicians, faculty that teach NP students, and clinic managers. Obtaining data from three separate populations would provide a comprehensive assessment of the challenge. It is essential that in order to provide appropriate and cost-effective care NPs have business knowledge, the Journal of the American Association of Nurse Practitioners 27 (2015) 181–184 C 2015 American Association of Nurse Practitioners
ability to apply business principles, and advanced clinical skills (Buppert, 2005). If the NP does not understand essential business concepts and their application, they and the profession risks marginalization and decreased professional validity. Development of improved general business knowledge and practices is necessary for the success of the individual APN and the profession as a whole (Abel & Longworth, 2002; Buppert, 2005; Kennerly, 2006). The American Association of Colleges of Nursing (AACN) (2006) has described and defined the importance of business and financial acumen practice skills sets as essential educational requirements. This document was used to develop a study-specific survey, which was subsequently utilized to develop specific survey questions to obtain data.
Background As-Sanie et al. (2005) and Kennerly (2006) asserted that graduate healthcare education does not provide comprehensive understanding of business practices or how 181
Essential NP business knowledge
this lack of knowledge affects job security. The outcomes of insufficient business practice knowledge have been realized in the ability to sustain a clinical practice, become financially stable, and ultimately the ability to provide patient care (Heidelbaugh, Riley, & Habetler, 2008; Thorwarth, 2005; Vincent, 2002). Any healthcare provider that is perceived as being less financially productive may find him or herself at risk of being replaced (Abel & Longworth, 2002). Anecdotally, conflict occurs between clinic managers, who are charged with the business operations of health care, and NPs, who provide the health care. The lack of baseline business knowledge creates a myriad of expectations, which frequently strain the relationship between managers and clinicians. According to Chalice (2007), when the strategic plan is stated in a common language, all may understand. Clearly stating the roles and responsibilities of each member of the organization with respect to the strategic plan provides a common ground for communication. Literature supports increased education, communication, and collaboration to improve overall outcomes when involving different disciplines (Brown, White, & Leibbrandt, 2006; Lennox & Anderson, 2012). It is the opinion of the authors of this article that this information should be provided in the educational process of becoming an NP. Results of a systematic review (Zwarenstein, Goldman, & Reeves, 2009) describe how the lack of interprofessional collaboration and communication can potentially result in less than desired outcomes. Practicing NP clinicians, faculty that teach NPs, and clinic managers must come together to improve educational opportunities for graduate students and practicing NPs. Increasing the interactions and exchange of ideas between these three groups will allow for improved educational opportunities for students and practicing clinicians (Davidson, McCollom, & Heineke, 2005). Improved educational opportunities, focused on communication and the business skills required for a successful collaborative practice, can only be accomplished when a combined understanding of the knowledge and needs of groups are provided (Belza, 2007; D’Amour, Ferrada-Videla, San Martin Rodriquez, & Beaulieu, 2005).
Methods Using the eight domains of business practice attitudes, as identified by the Medical Group Management Associations Body of Knowledge (MGMA) (American College of Medical Practice Executives [ACMPE], 2011; Gulko, 2006) and business practice items noted by the AACN (2006), a study-specific survey was developed. According to the MGMA (ACMPE, 2011), business practices 182
D. LaFevers et al.
attitudes may be classified into eight domains that vary in importance based on one’s perception. The domains are (a) operations, (b) financial management, (c) human resource management, (d) information management, (e) organizational governance, (f) patient care systems, (g) quality management, and (h) risk management. Each of these domains was used to develop an item on the study-specific survey. The use of previously identified business practice domains provided survey validity. Participant responses were used to objectively describe and rank the importance of each domain, in their perception. The study survey consists of 33 items. This provides the ability to demographically describe the study population (n = 17), dichotomously describe each item as important or not (n = 8), and rank each item (n = 8). Example items are “Risk management knowledge is critical for the NP in a collaborative practice” and “Each NP should have knowledge of organizational governance structures.” These items reflect the eight domains, as defined by the MGMA (ACMPE, 2011). There were no reverse-scored items, nor neutral response, but the ability to nonrespond was available. Once developed, content validity for the study survey was secured by having it reviewed by three individuals who are practicing NPs and faculty members or clinic managers. There were no recommendations suggested. The development of the instrument allowed for it to be included in the Institutional Review Board (IRB) application, thus both the survey and the study were reviewed and approved by the Social Science IRB at the University that employs the researchers. As a low-risk study, using a healthy volunteer population, participation in the study was determined to be implied upon submission of the responses, thus exempt from needing an informed consent. Data collection occurred using several modalities, specific to each study population. Practicing NPs’ participation was obtained during regional and national conferences; academic instructors for NP programs, identified by their Dean; and clinic managers, identified by a colleague familiar with NP clinics, received an e-mail study invitation. Survey data were received from 414 participants. There were no adverse study-related adverse effects reported. Once responses were reviewed and incomplete data sets were deleted, analyses were performed on 370 responses. While it is unknown what the potential study population could be, Worthington and Whittaker (2006) recommend a range of 5–10 participants per item. Cochran (1977) states this is considered a sufficient study population when the study sample is homogeneous. Once data collections were completed, all responses were transferred into SPSS 13.0 for analysis.
Essential NP business knowledge
D. LaFevers et al.
Results Analysis of the self-described demographic data revealed that a study population was primarily female (94.2%) and employed as a clinician (90.6%). Response data were analyzed using percent data and by participant grouping (clinician, faculty, manager). This provided the ability to describe the varied perceptions of business knowledge, based on position, rather than the total number of responses. A summary of the domains perceived as important, and a ranking of the domains, by study population, is displayed in Table 1. Responses from study participants who self-described themselves as practicing NPs indicate that the top five domains, in importance, as defined by MGMA (ACMPE, 2011; Gulko, 2006) were (1) quality management, (2) risk management, (3) patient care systems, (4) financial management, and (5) business operations. The top five domains, by rank, of these individuals were: (1) business operation knowledge, which tied with patient care systems knowledge, (3) financial management knowledge, which tied with quality management, (5) risk management knowledge, (6) information management, and (7) human resource management, which tied with organizational governance knowledge. Academic educators identified quality management as the most important domain, followed by (2) risk management, (3) patient care systems, (4) financial management, and (5) human resources. Ranking responses by perception of importance indicated that (1) patient care knowledge systems is most important, followed by (2) business operations knowledge, (3) financial management knowledge, (4) information management, which tied with organizational governance knowledge, (6) human resource management, (7) quality management, and (8) risk management knowledge. Responses from clinic managers differed from the other study populations. While these individuals ranked qual-
Table 1 Identification and ranking of importance of each domain
Item Quality management Risk management Patient care systems Financial management Business operations Information management Human resource management Organizational governance knowledge
Importance clinician/ educator/managers
Ranking clinician/ educator/managers
111 222 33 44 53 4 55
378 587 111 335 122 643 764 846
ity management as the most important domain, followed by risk management, business operations was third; information management and human resources were noted to be of lesser (4 and 5) importance. Clinic managers ranked patient care systems as the most important domain, followed by (2) business operations knowledge, (3) information management, (4) human resource management, (5) financial management knowledge, (6) organizational governance knowledge, (7) risk management knowledge, and (8) quality management.
Discussion Variability exists within these responses, which may reflect the importance of business practice knowledge needs, from the perception of individuals, and reflective of role function and job responsibility. In terms of importance, these participants, regardless of job function, agree that quality management and risk management are important. Agreement between clinicians and educators, when identifying domains of importance, are most similar. Managers, perhaps as a function of their job responsibilities, perceive operations, information, and human resources management as critical knowledge, which is not supported by the other study groups. When ranking the items, all study participants agree that patient care systems are most important, with business operations a close second. From there, the responses diversify, and appear to reflect the focus of the specific job responsibility. Neither the MGMA (ACMPE, 2011, Gulko, 2006) nor the AACN (2006) rank the domains or content stated as important for business practices. The data obtained in this study provides a ranking, in order of importance, of the business practices necessary for NPs to know. The results of this study are limited by the data collection methods, which included individuals who were attending a regional and national NP conference. As such, the sample population is skewed toward NPs that seek educational opportunities and/or are capable (financially and with time off work) of attending a conference. Snowball sampling techniques were used to locate academic instructors and clinic managers. Purposeful sampling methods rarely provide generalizability to any study; the participants of this study were known to the researchers, or within a small circle of colleagues. These limitations, combined with a small sample size, result in the need to repeat this study with a larger and more geographically diverse population. Until that is done, these results should be viewed with caution, and no intervention developed. 183
Essential NP business knowledge
Conclusion The results of this study highlight the varying perception, related to job classification, with respect to essential business practices, and the business practice knowledge needed by NPs. A discourse is present, between clinic managers, clinicians, and academic instructors. The perception of clinicians and academic instructors, with respect to the importance of each domain (ACMPE, 2011; Gulko, 2006), are similar. Only the clinicians perceive human resources as of little importance; only the clinic managers perceive information management as critically important. Patient care systems was highly ranked (#1) by each study population. From this juncture, perceptions vary; the perceptions of academic instructors and clinic managers are similar and do not coordinate with the perceptions of clinicians in any domain.
Implications and next steps The results identify different priorities, with respect to business knowledge, based on job classification. This provides an evidence-based approach toward content that should be included in NP educational programs. Program curriculum changes should not occur as a result of this study, because of the small sample population and limitations in data collection. Certainly replication of this study is warranted to validate these results and determine if there are geographical, educational, or demographical differences that affect business knowledge. These results do provide an initial effort toward attaining research evidence, capable of guiding educational programs that improve the business knowledge skill set of NPs. Improving this skill set will enhance professionalism, improve patient care, and decrease clinic closures as a consequence of poor business management.
References Abel, E., & Longworth, J. D. C. (2002). Resources for practice: Developing an economic IQ in primary care. Journal of the American Academy of Nurse Practitioners, 14(1), 3–10.
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