a b s t r a c t
Article history:
Received 6 September 2013
Revised 7 January 2014
Accepted 11 January 2014
Keywords:
Ethics confidence
Ethics preparedness
Nurse practitioners
Physician assistants
Practice autonomy
Quality of care
Purpose: Nurse 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.
Methods: This 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.
Results: Ethics preparedness and confidence were significantly associated with perceived quality of care
(p b 0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid,
patient demands, physician collegiality, and practice autonomy (p b 0.01). Forty-four percent of the variance
in quality of care was explained by these factors.
Conclusions: Investing in ethics education and addressing restrictive practice environments may improve
collaborative practice, teamwork, and quality of care.
© 2014 Elsevier Inc. All rights reserved