Exploring Perceptions of Collaboration of Critical Access Advanced Practice Registered Nurses


  • Polly Petersen Montana State University
  • William Schell Montana State University




Purpose: The purpose of the study is to understand the relationship between advanced practice registered nurses (APRNs) and physicians practicing in a rural, northwestern state. Earlier studies found the presence of an oversight relationship. This study sought to deepen our understanding of that relationship in order to determine if this oversight limited APRN scope of practice.

Sample: The study interviewed eleven APRNs with varied specialities in rural practice settings.

Methods: An interview-based qualitative study was conducted with APRNs practicing in Critical Access Hospitals (CAHs). The IRB approved protocol was developed to investigate the influence of the relationship on APRNs' ability to practice to the full scope of care in a state that allows for independent practice. All interviews were transcribed and content analysis was completed using both manual coding and Leximancer software.

Findings: While the level of oversight found varied by the speciality of the APRN, the nature of oversight was generally found to be one of support. Any evidence of restriction of APRN scope of practice was limited to early in the APRN's time in their current location or was experienced at least a decade ago.

Conclusions: Earlier work found evidence of oversight relationships between APRNs and physicians. These findings raised concerns that this relationship restricted the ability of APRNs to provide their full scope of care to rural populations, contributing to the chronic shortage of providers in these areas. This study illustrated that these concerns are largely unfounded in the current environment in CAH settings in this state.

Keywords: APRNs, Physician, oversight, relationships, collaboration

DOI:  http://dx.doi.org/10.14574/ojrnhc.v18i2.451

Author Biographies

Polly Petersen, Montana State University

RN, PhD 
Assistant Professor, College of Nursing, Billings campus

William Schell, Montana State University

Associate Professor, Department of Mechanical and Industrial Engineering, Norm Asbjornson College of Engineering