• Connie M Ulrich, Qiuping Pearl Zhou, Alexandra Hanlon, Marion Danis, and Christine Grady.
• University of Pennsylvania School of Nursing, Department of Medical Ethics and Health Policy, and New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA 19104, USA. Electronic address: culrich@nursing.upenn.edu.
• Appl Nurs Res. 2014 Aug 1; 27 (3): 152-6.

PurposeNurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors.MethodsThis paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States.ResultsEthics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors.ConclusionsInvesting in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care.Copyright © 2014 Elsevier Inc. All rights reserved.

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