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Published in final edited form as: Nurs Outlook. 2023 Aug 22;71(5):102029. doi: 10.1016/j.outlook.2023.102029

Advancement of Research on Nurse Practitioners: Setting a Research Agenda

Lusine Poghosyan a, Suzanne Courtwright a, Kathleen R Flandrick a, Madeline M Pollifrone a, Amelia Schlak b, Monica O’Reilly-Jacob c, J Margo Brooks Carthon d, Kristin Hittle Gigli e, Joshua Porat-Dahlerbruch f, Gregory Alexander a, Heather Brom g, Claudia B Maier h, Edward Timmons i, Stephen Ferrara a, Grant R Martsolf f
PMCID: PMC10810357  NIHMSID: NIHMS1928589  PMID: 37619489

Abstract

Background

Primary care delivered by nurse practitioners (NPs) helps to meet the United States’ growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them.

Purpose

We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce.

Methods:

Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions.

Findings

The research agenda includes top-ranked research questions within five categories: 1) policy regulations and implications for care, quality, and access; 2) systems affecting NP practice; 3) health equity and the NP workforce; 4) NP education and workforce dynamics, and 5) international perspectives.

Discussion

The agenda can advance evidence on the NP workforce to guide policy and practice.

Keywords: nursing research, nurse practitioners, nursing workforce, primary care

Introduction

Between 2016 and 2034, the population of Americans aged 65 and older will grow from 49 million to 77 million—a 36% increase – and many will have complex health needs that require effective primary care to manage them (Fulmer et al., 2021; United States Census Bureau, 2017). Yet, the primary care system faces major challenges, including a shortage of primary care providers, fragmentation of care, and lack of resources that may prevent the delivery of high-quality care (Buerhaus, 2018; Timmins et al., 2022). These concerns are especially prevalent in rural and other underserved communities, which makes it particularly difficult for the primary care system to meet the growing demand for services in these areas (Basu et al., 2019). Policymakers, healthcare organizations, and clinicians have called for reforms to ensure access to timely, high-quality primary care and improve outcomes (National Academies of Sciences et al., 2021; World Health Organization and the United Nations Children’s Fund (UNICEF), 2020).

Many stakeholders, including the National Academy of Medicine, recommend leveraging the growing nurse practitioner (NP) workforce and view NPs as key to meeting the primary care demand (National Academies of Sciences et al., 2021). Nearly 90% of NPs are trained to deliver primary care (American Association of Nurse Practitioners (AANP), 2021), and the primary care NP workforce is projected to increase by 107% from 2018 to 2030 (Health Resources & Services Administration, 2022). Studies consistently demonstrate that NPs deliver high-quality, safe primary care (Barnett et al., 2021; Newhouse et al., 2011). Yet, many barriers exist that limit NPs’ ability to provide comprehensive, timely primary care. For example, at the federal level, Medicare reimburses NPs at 85% of the physician fee, encouraging organizations to bill under the physician rather than the NP – a practice known as “incident-to-billing” (Patel et al., 2022). Such billing gives NPs an “invisible provider” status (Rapsilber, 2019) and makes it challenging to link NP care to patient outcomes, a necessary step for transparent public reporting on NP care.

State-level barriers related to NP scope of practice (SOP) laws also exist (Buerhaus, 2018). Only 27 states and the District of Columbia allow NPs to practice to the fullest extent of their education and training, enabling NPs to care for their patients fully (American Association of Nurse Practitioners, 2022). The rest of the states either reduce SOP by requiring physician collaboration or restrict SOP by requiring physician supervision despite the growing evidence that full NP SOP is associated with improved access to care with no negative impacts on cost or quality of care (Martsolf & Kandrack, 2017; Patel et al., 2019).

Healthcare organizations also play a critical role in shaping NPs’ role in patient care and their ability to practice to the fullest extent of their education and training (Poghosyan, Liu, et al., 2017; Poghosyan, Nannini, Smaldone, et al., 2013). While healthcare organizations increasingly rely on the NP workforce (Barnes et al., 2018), NPs often practice in poor practice environments characterized by challenging work relationships or a lack of support for the NP practice (Poghosyan et al., 2020b; Poghosyan, Norful, et al., 2017). For example, even though NP roles within primary care practices are often similar to physicians, organizational resources and support, such as exam rooms or ancillary support, are often not available to NPs (Poghosyan et al., 2020b; Poghosyan, Norful, et al., 2017). In other settings, such as long-term care, NPs often work with scarce resources and poor practice infrastructure (Alexander et al., 2022).

To enhance the ability of the NP workforce to meet the demand for primary care and achieve the best patient and health system outcomes, more research is needed to understand and eliminate these barriers. Lack of evidence on the NP workforce hinders policymakers’, administrators’, and clinicians’ ability to act. Identifying the barriers and strategies to overcome them is not only highly relevant in the US but also globally. Many countries across the globe are developing NP roles, yet the knowledge gap on how effectively support NPs impedes their optimal utilization (Almukhaini et al., 2022; Black et al., 2020; Maier, et al., 2017; Poghosyan & Maier, 2022). Thus, in June 2022, we convened the Advancement of Research on Nurse Practitioners (ARNP) conference, funded by the Agency for Healthcare Research and Quality (AHRQ), to advance the evidence base on the primary care NP workforce and design a research agenda from now through the 2030s. ARNP brought together an expert group of national and international researchers, administrators, and clinicians to develop a comprehensive research agenda for studying the primary care NP workforce and barriers affecting their practice. The objective of this paper is to report on the proceedings of the ARNP conference and the development of the resulting research agenda. This research agenda will facilitate the production of timely evidence on eliminating barriers to optimizing the NP workforce, which is essential to meeting the growing demand for primary care services.

Conference Planning Committee, Experts, and Attendees

Prior to the conference, a planning committee of 11 experts was convened, who were selected based on their recognized subject matter expertise in primary care, healthcare administration and management, public health, advanced practice nursing, health policy, nursing outcomes research, NP workforce, and health services research (Appendix A). Two experts in advanced practice nursing and nursing health services research co-chaired the committee. The committee held virtual meetings to design the conference. After reviewing and discussing the existing literature on major determinants of optimal NP primary care, the committee selected four topics that represented the most relevant factors. The topics were revised with feedback from all committee members before being finalized. An agenda was developed, including a plenary session and small group discussions for each topic. The committee selected experts to deliver the plenary sessions and developed the participant list. The planning committee invited potential speakers and participants from the U.S. and internationally, including the United Kingdom, Canada, Germany, and Israel.

Conference Proceedings

In June 2022, 35 national and international attendees met in New York City for the inaugural ARNP conference and engaged in robust discussions over 1.5 days. Participants had diverse subject matter knowledge and represented leaders in nursing education, public health, professional nursing organizations, NP care provision, and nursing health services research (Appendix A). Experts delivered presentations in four plenary sessions: 1) NP workforce in primary care globally: regulations, practice settings; 2) care of the underserved and NP workforce; 3) methodologies to study NP workforce and practice; and 4) new environments and roles: NP training and continuum of health care. Following plenary sessions, small group discussions were formed to identify facilitators and barriers related to the session focus, develop research questions, and strategize methods to investigate these research questions.

The research agenda was primarily developed with a view on the U.S. healthcare system, policy, educational, and regulatory context. However, embedding the research agenda in an international context was seen as critical. Therefore, international experts offered their perspectives and insights into the global significance of our research questions. The international experts were chosen for their experiences with international NP and advanced practice nurse (APN) research. Additionally, most international researchers also had research experience in the U.S. and were able to contribute to developing U.S.-specific research questions while broadening discussions from a global perspective.

Participant Consensus and Expert Evaluation

After each plenary session, small group discussions allowed the participants to discuss session content and design potential research questions. A peer-appointed leader from each group presented a summary of the group’s discussion, including 3–4 research questions they developed. At the end of each day, data were synthesized, and research questions were refined. Following the final plenary session, all research questions were grouped by theme and compiled into an online survey to elicit participant feedback, provide clarification, and initiate a prioritization process. All participants then voted on the questions they believed were most important to future research to advance the evidence on the NP workforce providing primary care. The top-ranked research questions were then compiled into a draft research agenda. At the end of the conference, the participants completed evaluation forms.

Several planning committee members, including the co-chairs, met after the conference to review the evaluations, finalize the research agenda, and discuss dissemination. Two external researchers with health services and nursing research expertise joined the team. One expert independently reviewed the feedback from the conference participants, who were asked to rate the quality of plenary sessions, small group discussions, topics discussed, networking opportunities, and conference logistics, as well as offer open-ended feedback. The expert summarized the feedback and presented it back to the conference organizers. Another expert reviewed the research questions developed during conference proceedings. After these steps, the research agenda was finalized.

The Research Agenda

The research questions that emerged from the ARNP conference are presented in Table 1. They are organized into four categories for the U.S. context and one category taking an international perspective. Each category has two to six questions. The first category, Policy regulations and implications for care, quality, and access, consists of two questions addressing the issues around full NP practice authority and barriers to identifying NP contributions to clinical practice and outcomes. The second category, Systems affecting NP practice, has four questions that explore the NP role as it relates to practice settings, patients’ experience of care, patient outcomes, and emerging technologies. Health equity and the NP workforce is comprised of six questions concerning the integration of the social determinants of health into NP care, as well as NP contributions to health outcomes in low-resource communities, NP workforce diversity, and structural biases in NP practice. In the fourth category, NP education and workforce dynamics, four questions examine the role of different NP training programs and the implications of NP certification alignment with clinical practice. Finally, the fifth category highlighted the International perspective and covered the need to improve the sharing of research and lessons for policy and practice between the U.S. and other countries while giving sufficient attention to different health systems and policy contexts across countries.

Table 1.

Research Agenda

Topic Research Questions
Policy regulations and implications for care, quality, and access What are the effective strategies to generate and translate the evidence on the impact of full NP practice authority on cost, quality, and access?
How do we use current billing and clinical documentation to describe and analyze the contributions of NPs to clinical practice, team-based care, and outcomes?
Systems affecting NP practice What are the facilitators and barriers to NP integration and NP practice in different practice settings?
What are the NP interventions that impact patients’ experience of care?
What are the unique attributes of NP care, and how do they contribute to patient outcomes?
How do telehealth and emerging digital technologies affect care delivery by NPs?
Health equity and the NP workforce To what extent do NPs integrate social determinants of health in their care?
What is the impact of the integration of social determinants of health in NP care on patient outcomes?
What are the unique attributes of NP care, and how do they contribute to patient outcomes in low-resource communities?
To what extent does the diversity of the NP workforce affect population and system outcomes?
What are effective strategies to diversify the NP workforce?
Identify structural biases at the institutional level affecting NPs and patient outcomes and develop strategies to address them.
NP education and workforce dynamics What are the characteristics of NP education programs that result in NP graduates practicing in underserved areas?
What is the role of residency/fellowship programs in preparing NPs?
What is the impact of DNP preparation on patient outcomes across various settings?
How do various NP certifications align with their patient population foci and practice setting?
International perspective What is the link between the variations in NP educational qualifications, practice patterns, and patient outcomes within and across countries?
What is the relationship between NP qualifications and practice and universal health coverage globally?
How can sharing research between the U.S. and other countries globally be supported and transferred for practice and policy change to enhance the NP workforce in different country contexts?
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Policy regulations and implications for access, quality, and cost

Continued restrictions on NP full practice authority affect their ability to deliver care despite clear evidence that NP care is safe, high-quality, and cost-effective (Mundinger et al., 2000; Patel et al., 2019; Traczynski & Udalova, 2018; Yang et al., 2021). Three systematic reviews investigating the impact of NP state SOP laws show strong uniform evidence that states with less restrictive SOP laws have higher healthcare utilization—especially in rural and underserved areas—increased preventive screening, fewer emergency department visits for ambulatory care-sensitive conditions, and decreased costs (Laurant et al., 2018; Patel et al., 2019; Yang et al., 2021). Regardless, barriers to NP full practice authority persist.

Even in states with full SOP regulations, NPs may face barriers at the federal level. For example, federal law still mandates that only physicians may direct care in rural health centers (RHCs) and federally qualified health centers (FQHCs) (“Patient Protection and Affordable Care Act,” 2023). Although NPs may have full practice authority at the state level, they must practice under the direction of a physician for clinics to be federally certified as an RHC or FQHC.

Federal restrictions also affect how existing data collection systems capture NP care. For example, identifying and attributing NP contributions to patient outcomes is difficult due to incident-to-billing practices in Medicare, co-signed clinical documentation, or non-reimbursable NP care (O’Reilly-Jacob, 2020). These challenges will likely become more complex as patients are increasingly assigned to a team of clinicians rather than an individual provider, and value-based reimbursement methods are increasingly implemented. Emerging methodologies to correct incident-to-billing will help circumvent these data challenges (Patel et al., 2022). For example, through nursing informatics, electronic health records data can link NP models of care to outcomes.

Generating novel evidence on NP outcomes will enable tailored messaging for particular constituencies. For example, state legislators are compelled by state-specific evidence over national data trends. Similarly, organizations and payers may be motivated by the financial benefits of reduced administrative burden linked with eliminating mandatory physician collaboration or supervision and better utilization of NP and physician time. Addressing practice restrictions on NPs at all levels of the healthcare system and translating new evidence from NP outcomes research into successful policy will require interdisciplinary collaborations of researchers, political scientists, communication experts, healthcare administrators, and legislative advocates. The ARNP research agenda calls for investigations of the impact of NP care and existing policies on patient and system outcomes. The agenda also emphasizes the need to translate emerging evidence into effective policy reform to improve primary care access, quality, and cost across settings.

Systems affecting NP practice

The growing NP workforce is key to meeting the demand for primary care services. Increasingly, NPs deliver primary care in a wide range of settings in addition to traditional primary care practices, including school-based health centers, home-based care, long-term care, NP-owned practices, retail clinics, and telehealth (Alexander et al., 2021; Birch et al., 2021; Daley et al., 2019; Donald et al., 2013; Finley et al., 2021; Looman et al., 2018; Osakwe et al., 2020). NPs also deliver primary care within specialty and subspecialty practices, often in healthcare provider shortage areas and other underserved communities (Auerbach et al., 2021; Buerhaus, 2018). While delivering care across the continuum creates many opportunities for NPs to take a central role in patient care, it can also create many challenges. For example, evidence is clear that NPs often practice in challenging environments, characterized by a lack of support and resources and poor relationships with administrators, which affects NP and patient outcomes (Kueakomoldej, Turi, et al., 2022; Poghosyan et al., 2018; Schlak et al., 2022). Furthermore, poor NP practice environments lead to higher NP job dissatisfaction, burnout, and intent to leave (Kueakomoldej, Liu, et al., 2022; Schlak et al., 2022). The NP practice environment also affects the quality of care and outcomes of patients with chronic conditions (Poghosyan et al., 2020a; Poghosyan et al., 2022; Poghosyan et al., 2018). If NPs deliver care in primary care practices with favorable practice environments, chronically ill patients are more likely to receive high-quality care and avoid using emergency rooms and hospitals (Poghosyan et al., 2022; Poghosyan et al., 2018). To date, most research on NP-delivered care has focused on adult populations in traditional primary care settings. Little evidence exists on NP care in other environments (e.g., home-based care, long-term care, school-based care, etc.).

The main measure of the NP practice environment, the NP-Primary Care Organizational Climate Questionnaire (NP-PCOCQ), was developed within the traditional primary care setting (Poghosyan et al., 2019). Several researchers use the NP-PCOCQ to measure NP practice environment in other care settings, including internationally (Adams et al., 2022; Scanlon et al., 2018), while others adopt it to measure the organizational climate among other advanced practice registered nurses, certified nurse-midwives, and oncology physician assistants (Han et al., 2018; Tetzlaff et al., 2021; Thumm & Meek, 2020). Such modifications of the NP-PCOCQ and its application in other settings will produce evidence about the impact of the practice environment on NPs and patients. A clearer understanding of unique components of NP practice environments across healthcare settings could help stakeholders target interventions.

As healthcare systems globally integrate NPs across the care continuum (National Association of Pediatric Nurse Practitioners, 2020; Porat-Dahlerbruch et al., 2022), more evidence is needed to support optimal integration across settings. While some system-level facilitators and barriers to NP integration have been identified in the literature (e.g., financing and reimbursement models, practice environment quality, and mentorship availability), more research is needed (Barnes et al., 2017; Porat-Dahlerbruch et al., 2022). Future work should explore the full spectrum of facilitators and barriers to NP integration and their subsequent impact on outcomes.

Health equity and the NP workforce

Health and socioeconomic inequity is a persistent challenge affecting healthcare systems (National Academies of Sciences et al., 2021). Due to their advanced education, training, and ability to work with autonomy, NPs are particularly well-suited to address health disparities and social determinants of health (Davis & Chapa, 2015; National Institute of Nursing Research, 2022). NPs are often the only providers caring for low-income or underinsured people, Medicaid beneficiaries, or from historically disadvantaged backgrounds in rural and urban populations (Buerhaus, 2018). Yet, many factors affect the ability of the NP workforce to contribute to patient care and eliminate health disparities (Poghosyan et al., 2016; Poghosyan & Carthon, 2017). Barriers at federal, state, organizational, and workforce levels limit the ability of the NP workforce to contribute maximally to national priorities. Notably, a lack of workforce diversity might limit NPs’ ability to address factors preventing health equity (Auerbach et al., 2021), as health disparities are linked to limited care provision by a diverse healthcare workforce (Plemmons et al., 2023). Healthcare providers from underrepresented backgrounds often improve communication and trust among racial and ethnic minority populations through language and patient-provider racial and ethnic concordance (Meghani et al., 2009). They are also more likely to work in medically underserved communities, increasing provider services and patient-centered care (Carthon et al., 2020; National Advisory Council on Nurse Education and Practice (NACNEP), 2019). Despite the documented relationship between a diverse workforce and health outcomes, the NP workforce remains racially and ethnically homogenous, with Black (6.2%), Hispanic (9.2%), and Asian (4.3%) NPs, making up a disproportionately low fraction compared to White (75.3%) NPs (Health Resources and Services Administration Bureau of Health Workforce, 2018). Rigorous NP-focused studies are needed to determine the impact of NP workforce diversity on outcomes and to produce evidence to remove barriers to practice for NPs from underrepresented groups.

NP education and workforce dynamics

The NP workforce has seen tremendous growth in size, and NPs are entering the workforce younger in age and with less clinical experience than historically (Auerbach et al., 2020). Effectively transitioning new NPs into practice is important for improved outcomes; recent evidence suggests that structured transition to practice programs is associated with decreased intent to leave and increased job satisfaction among novice NPs in primary care settings (Hart et al., 2022; Park et al., 2021). While this is promising, more robust research is needed to examine the impact of varying types of NP educational preparation on NP and patient outcomes. Ensuring high-quality NP education and training assures a well-qualified primary care NP workforce.

Over the past 20 years, many nursing organizations endorsed the Doctor of Nursing Practice (DNP) degree as the entry level for NP education, indicating that doctoral education was the preferred preparation for NPs to deliver care in the changing healthcare landscape (American Association of Colleges of Nursing, 2004; Idzik et al., 2021). While the DNP may empower the newer generation of NPs, recognizing the additional time and financial resources required is critical. Experts caution that this may be a barrier for underrepresented populations choosing an NP career—a potentially limiting factor to diversifying the NP workforce (McCauley et al., 2020). Further, little evidence demonstrates the clinical value of doctoral education as the appropriate entry-level (Martsolf et al., 2021). Scientists need to examine the impact of DNP education on patient and system outcomes and determine the attributes of NP programs that generate diverse NP cohorts with promising tenure in underserved communities. While some believe post-graduate NP training programs improve practice preparedness, especially in specialty settings (Barnacle et al., 2021; Kesten & Beebe, 2021), their role in underserved areas is unclear.

Importantly, the alignment of NP education with clinical practice is a concern (Gonzalez & Gigli, 2021; Martsolf et al., 2020). State policies regulating the requirements for licensure, accreditation, certification, and education are informed by the 2008 report, Consensus Model for APRN Regulation, that addressed the wide variation in educational preparation for APNs nationwide (National Council of State Boards of Nursing APRN Advisory Committee and APRN Consensus Work Group, 2008). The results are position statements and policies with inconsistent implementation nationally (National Council of State Boards of Nursing, 2022). Currently, little research evaluates workforce, patient, and organizational outcomes associated with graduate nursing educational programs, diverse entry-to-practice educational expectations, and transition-to-practice programs, including residency and fellowship programs or NP alignment. As the NP role changes, the science behind NP education should similarly evolve; the questions included in this agenda seek to advance the evidence needed to educate a more robust, more diverse NP workforce.

International perspective

An increasing number of countries implemented or are in the process of introducing NPs or other APN roles, making this agenda relevant to the global nursing community (Maier et al., 2017; Scanlon et al., 2020; World Health Organization and the United Nations Children’s Fund (UNICEF), 2020). The global sharing of evidence, and lessons for policy and practice, was seen as critical to supporting NP role development. Yet, more rigorous research is needed from different healthcare systems, educational, and policy contexts to understand transferability across countries. Comparative research on APN educational qualifications, curricula, practice patterns, and how they affect outcomes is needed. While an international body of evidence on various APN roles (e.g., NPs, clinical nurse specialists) is increasing (International Council of Nurses, 2020; Maier et al., 2017; Maier et al., 2016), a gap remains in comparing curricula, skills, practice patterns, and patient and system outcomes. This gap raises a critical question on APNs’ contribution to the World Health Organization’s 2030 Sustainable Development Goal of universal health coverage, for which the APN workforce has been suggested as a key driver (World Health Organization, 2023; Bryant-Lukosius et al., 2017). Moreover, the availability and quality of international data on NPs/APNs need improvement, including systematic data collection, given the increasing size of this workforce globally (Maier & Aiken, 2016). Internationally, more research is required to link APN workforce data with data on quality, prevention outcomes, resource use, costs, and patient satisfaction in countries with different healthcare systems.

Discussion and Implications

For the first time, international experts convened to design a research agenda to advance evidence on the NP workforce and practice. While our research agenda is not intended to be all-inclusive, it does contain a selected list of relevant research questions to guide future research priorities and encourage evidence production. The agenda seeks to address policy, regulatory, organizational, and other barriers to NP practice at all levels and across settings. Below we discuss several key findings.

Despite the recent progress in achieving full practice authority in many states, several still restrict NP practice. Thus, it remains important for researchers to continue generating state-specific evidence and disseminating it to policymakers. Full practice authority at the state level is critically important for supporting the expansion of the NP workforce. Progressively, the NP workforce is expanding across the continuum of healthcare settings, including home-based care, nursing homes, NP-owned practices, and telehealth. Evidence is needed to guide efforts in creating a favorable NP policy, effectively integrating them across the healthcare continuum, and assuring supportive organizational structures for successful NP practice.

To meet the changing primary care demands, increasing the diversity of the NP workforce and studying how NPs address social determinants of health to achieve health equity are national priorities. Despite the emphasis on recruiting and training NPs from underrepresented backgrounds, effective recruitment and retention strategies remain unknown (American Association of Colleges of Nursing, 2022). Structural racism limits the diversity of NP providers and nurse scientists, which hinders the capacity to adequately advance NP practice and research (Aycock et al., 2022). Generating high-quality evidence on factors supporting or hindering the diversity of the NP workforce is imperative.

Our research agenda highlights the need to strengthen existing data collection strategies and databases to track NP care and highlight direct contributions to patient outcomes. Many datasets only identify a portion of the care provided by NPs, limiting the advancement of NP research. Furthermore, many datasets need more adequate representation of ethnically and socioeconomically diverse patients, preventing evidence generation crucial to the health equity work (Ibrahim et al., 2021; Scobie et al., 2021). Administrative data systems in many primary care settings do not allow NP care to be identified and periodically validated or evaluated, which is necessary for reviewing performance and ensuring accountable care. The lack of these data features impedes the evaluation of clinical outcomes, minimizing the ability to improve healthcare and population health at the individual, organizational, state, and federal levels.

Finally, the development of the APN workforce globally should be supported by international research and routine data collection. As the global NP/APN workforce grows, evidence linking their practice to achieving universal health coverage as a sustainable development goal and patient and population outcomes in countries with different healthcare and educational systems is needed (World Health Organization, 2023).

In summary, the growing NP workforce is uniquely positioned to contribute to health equity in the US and globally. Our research agenda highlights only some questions to advance the evidence production. Comprehensive efforts are needed to support research on the NP workforce and practice. One opportunity that NP researchers should leverage is the National Institute of Nursing Research (NINR) Strategic Plan for 2022–2026 (National Institute of Nursing Research, 2022), which creates opportunities for innovative research focused on the NP workforce. NINR supports nursing sciences focused on 1) reducing the systemic and structural inequities that place certain population groups at a disadvantage and impede health equity; 2) developing and implementing interventions that address social determinants of health across the lifespan; and 3) designing systems and models of care to address clinical, organizational, and policy challenges. The research questions in our research agenda align with the NINR’s mission, and we call on investigators to design innovative studies focused on the NP workforce utilizing NINR’s research lenses.

Conclusion

The ARNP conference brought together international, interdisciplinary experts for the first time to develop a research agenda to guide research on the primary NP workforce, policy, and practice. The agenda highlights research questions on barriers and facilitators affecting the NP workforce and NPs’ ability to deliver safe care, including primary care. It calls for the production of evidence with innovative research methods. This agenda has significance for the field as it can guide the production of new evidence to maximize the contribution of the NP workforce in meeting the rising demand for high-quality primary care. As such, it is critical to spread awareness of the agenda amongst the research community and key stakeholders who can support and drive its aims.

Highlights.

  • A conference was convened with national and international experts to design a research agenda to advance evidence on the nurse practitioner workforce and practice.

  • The conference produced a research agenda comprised of 19 key research questions to guide future research priorities and encourage evidence production.

  • The research questions seek to address policy regulations, systems affecting NP practice, health equity, NP education and workforce dynamics, and international perspectives.

Appendix A. Planning Committee and List of Participants for Advancing Research on Nurse Practitioners (ARNP) Conference

Planning Committee

  1. Lusine Poghosyan, PhD, MPH, RN, FAAN; Co-Chair

    Stone Foundation and Elise D. Fish Professor of Nursing

    Professor of Health Policy Management

    Executive Director, Center for Healthcare Delivery Research and Innovation

    Columbia University School of Nursing, USA

  2. Grant R. Martsolf, PhD, FN, FAAN; Co-Chair

    Chair, Nursing Science

    University of Pittsburgh Medical Center

    Professor

    University of Pittsburgh School of Nursing, USA

  3. Amelia Schlak, PhD, RN

    Postdoctoral Fellow

    Center for Healthcare Delivery Research and Innovation

    Columbia University School of Nursing, USA

  4. Claudia B. Maier, Dr. P.H., MScPH

    Research Group Leader of Nursing, Department of Healthcare Management

    Technische Universität Berlin, Germany

    Senior Fellow, European Observatory on Health Systems and Policies

  5. Gerry Lee, PhD, FESC, FHEA

    Division of Applied Technologies for Clinical Care

    King’s College, London, UK

  6. Louise Barriball, PhD, RN, FHEA

    Professor

    Department of Adult Nursing

    Florence Nightingale School of Nursing and Midwifery

    King’s College, London, UK

  7. Miriam J. Laugesen, PhD

    Associate Professor

    Director, Faculty Lead

    Health Policy and Management

    Mailman School of Public Health

    Columbia University, USA

  8. Monica O’Reilly-Jacob, PhD, FNP-BC

    Assistant Professor

    Connell School of Nursing

    Boston College, USA

  9. Ruth Martin-Misener, NP, PhD, FAAN

    Professor and Assistant Dean of Research

    Director, Faculty of Health

    School of Nursing

    Dalhousie University

    Halifax, Nova Scotia, Canada

  10. Ulrike Muench, PhD, RN, FAAN

    Associate Professor

    Social Behavioral Sciences

    School of Nursing

    University of California, San Francisco, USA

  11. Zainab Toteh Osakwe, RN, MSN, WHNP, PhD

    Assistant Professor

    College of Nursing and Public Health

    Adelphi University, USA

List of Participants

  1. Amy McMenamin, MPhil, RN

  2. Christine Tracy, MSW

  3. Edward Timmons, PhD

  4. Eleanor Turi, MPhil, BSN, RN, CCRN

  5. Gregory Alexander, PhD, RN, FAAN, FACMI, FIAHSI

  6. Heather Brom, PhD, RN

  7. Jacqueline Nikpour Townley PhD, RN

  8. Jamie Trexler, EdDc, CRNP, RN, LPC, CARN-AP, PMHNP-BC, CPXP, CPHQ

  9. Joshua Porat-Dahlerbruch, PhD, RN

  10. Joyce Pulcini, PhD, RN, FNP-BC, FAAN, FAANP

  11. J. Margo Brooks Carthon, PhD, RN, FAAN

  12. Justinna Dixon, BS, RN

  13. Katherine Evans, DNP, FNP-C, GNP-BC, ACHPN, FAANP

  14. Supakorn Kueakomoldej, PhD, RN

  15. Stephen. Ferrara, DNP, FNP-BC, FAAN, FAANP

  16. Suzanne E. Courtwright, PhD, NP, NEA-BC

  17. Uzoji Nwanaji-Enwerem, MSN, RN, FNP-BC

Footnotes

Declaration of Competing Interest

There are no conflicts of interest to report.

CRediT authorship contribution statement

Lusine Poghosyan: Funding acquisition, Conceptualization, Methodology, Investigation, Project Administration, Resources, Supervision, Data Curation, Writing – Original draft, Writing – Review & Editing

Suzanne Courtwright: Data Curation, Writing – Original draft, Writing – Review & Editing

Kathleen R. Flandrick: Project Administration, Methodology, Investigation, Writing – Original draft, Writing – Review & Editing

Madeline M. Pollifrone: Project Administration, Data Curation, Writing – Original draft, Writing – Review & Editing

Amelia Schlak: Conceptualization, Methodology, Writing – Original draft, Writing – Review & Editing

Monica O’Reilly Jacob: Conceptualization, Methodology, Investigation, Data Curation, Writing – Original draft

J. Margo Brooks Carthon: Writing – Original draft

Kristin Gigli: Writing – Original draft

Joshua Porat-Dahlerbruch: Writing – Original draft

Gregory Alexander: Writing – Original draft

Heather Brom: Writing – Original draft

Claudia B. Maier: Conceptualization, Methodology, Writing – Original draft

Edward Timmons: Writing – Original draft

Stephen Ferrara: Writing – Original draft

Grant R. Martsolf: Funding acquisition, Conceptualization, Methodology, Investigation, Project Administration, Data Curation, Writing – Original draft

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