Abstract
Background: Nurse practitioners (NPs) are a rapidly growing segment of the U.S. healthcare workforce1,2 and are increasingly integral to patient care in hospital settings.3,4 Despite their expanding roles,5 little is known about the work environment factors that affect their well-being in hospital settings.6 This study aims to explore the factors that influence hospital-based NPs’ healthy work environments (HWEs) and identify strategies to enhance their well-being and support retention.
Methods: This qualitative descriptive study used directed content analysis7 to examine responses from 493 NPs across 264 hospitals in 10 U.S. states with varying scope-of-practice laws. Participants responded to three open-text survey questions regarding their workplace experiences and environments, drawn from the 2024 Nurses4All Study. To identify factors influencing HWEs among hospital-based NPs, themes were developed using both inductive and deductive analytic approaches, guided by the American Association of Critical-Care Nurses’ HWE framework.8
Results: Six themes related to factors affecting NPs’ HWEs were identified: (1) structural barriers to effective communication, including insufficient transition-to-practice support and mentoring, and technological obstacles to team communication; (2) workplace incivility and lack of inclusion, characterized by bullying, interprofessional disrespect, and equity and inclusion challenges; (3) limited clinical autonomy and organizational influence, reflected in exclusion from hospital decision-making roles and policy constraints on NP autonomy and optimal practice; (4) misalignment between NP roles and staffing demands, marked by unsafe staffing, excessive workloads, and metric-driven documentation burdens; (5) invisibility and devaluation of NP contributions, evident in limited professional recognition and career mobility; and (6) leadership gaps in supporting NP practice and well-being, including prioritization of profits over NPs’ well-being and patient safety and the absence of effective leadership structures for advanced practice.
Conclusions: Hospital-based NPs face unique barriers to HWEs that compromise their well-being and hinder optimal practice. Implementing NP-informed strategies, alongside collaborative efforts across the healthcare team, can foster supportive work environments that enhance NP well-being, retention, and the quality of patient care.
Notes
Presenter notes available in attached slide deck.
References:
1. Smith, S. L., Wilson, K. P., Stone-Gale, V., & Wright, A. (2025). Boot camp: Preparing the next generation of nurse practitioners. Journal for Nurse Practitioners, 21(6), 105387. https://doi.org/10.1016/j.nurpra.2025.105387
2. Auerbach, D. I., Buerhaus, P. I., & Staiger, D. O. (2020). Implications of the rapid growth of the nurse practitioner workforce in the U.S. Health Affairs, 39(2), 273-279. https://doi.org/10.1377/hlthaff.2019.00686
3. Reed, D., & Ross, D. (2024). The pivotal role of nurse practitioners as hospitalists: Opportunities and challenges. Nurse Leader, 23(1), 44-47. https://doi.org/10.1016/j.mnl.2024.09.021
4. Patel, E., Munn, L. T., Broyhill, B., & Fraher, E. P. (2024). Drivers of hospital nurse practitioner turnover: A national sample survey analysis. Nursing Outlook, 72(4), 102180. https://doi.org/10.1016/j.outlook.2024.102180
5. Kapu, A. (2021). Origin and outcomes of acute care nurse practitioner practice. Journal of Nursing Administration, 51(1), 4-5. https://doi.org/10.1097/NNA.0000000000000957
6. Yu, H., Connell, K. A., Gorman, D., & Becker, D. (2025). Acute care nurse practitioners and healthy work environments in critical care. Critical Care Nursing Clinics of North America. https://doi.org/10.1016/j.cnc.2025.07.008
7. Assarroudi, A., Heshmati Nabavi, F., Armat, M. R., Ebadi, A., & Vaismoradi, M. (2018). Directed qualitative content analysis: The description and elaboration of its underpinning methods and data analysis process. Journal of Research in Nursing, 23(1), 42-55. https://doi.org/10.1177/1744987117741667
8. American Association of Critical-Care Nurses. (2016). AACN standards for establishing and sustaining healthy work environments. https://www.aacn.org/nursing-excellence/standards/aacn-standards-for-establishing-and-sustaining-healthy-work-environments
Sigma Membership
Xi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Descriptive/Correlational
Research Approach
Qualitative Research
Keywords:
Workforce, Acute Care, Work Environment, Nurse Practitioners--Psychosocial Factors, Nurse Practitioners, Hospitals--United States, Hospitals, Psychological Well-Being, Personnel Retention
Recommended Citation
Yu, Hyunmin; Connell, Kathryn A.; Delgado, Sarah; Brom, Heather; Brooks Carthon, J. Margo; Bettencourt, Amanda; Sicoutris, Corinna; Costa, Deena Kelly; Good, Vicki; and McHugh, Matthew D., "Factors Influencing Healthy Work Environments for Hospital-Based Nurse Practitioners in the U.S." (2026). Creating Healthy Work Environments (CHWE). 44.
https://www.sigmarepository.org/chwe/2026/presentations_2026/44
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Washington, DC, USA
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-04-28
Factors Influencing Healthy Work Environments for Hospital-Based Nurse Practitioners in the U.S.
Washington, DC, USA
Background: Nurse practitioners (NPs) are a rapidly growing segment of the U.S. healthcare workforce1,2 and are increasingly integral to patient care in hospital settings.3,4 Despite their expanding roles,5 little is known about the work environment factors that affect their well-being in hospital settings.6 This study aims to explore the factors that influence hospital-based NPs’ healthy work environments (HWEs) and identify strategies to enhance their well-being and support retention.
Methods: This qualitative descriptive study used directed content analysis7 to examine responses from 493 NPs across 264 hospitals in 10 U.S. states with varying scope-of-practice laws. Participants responded to three open-text survey questions regarding their workplace experiences and environments, drawn from the 2024 Nurses4All Study. To identify factors influencing HWEs among hospital-based NPs, themes were developed using both inductive and deductive analytic approaches, guided by the American Association of Critical-Care Nurses’ HWE framework.8
Results: Six themes related to factors affecting NPs’ HWEs were identified: (1) structural barriers to effective communication, including insufficient transition-to-practice support and mentoring, and technological obstacles to team communication; (2) workplace incivility and lack of inclusion, characterized by bullying, interprofessional disrespect, and equity and inclusion challenges; (3) limited clinical autonomy and organizational influence, reflected in exclusion from hospital decision-making roles and policy constraints on NP autonomy and optimal practice; (4) misalignment between NP roles and staffing demands, marked by unsafe staffing, excessive workloads, and metric-driven documentation burdens; (5) invisibility and devaluation of NP contributions, evident in limited professional recognition and career mobility; and (6) leadership gaps in supporting NP practice and well-being, including prioritization of profits over NPs’ well-being and patient safety and the absence of effective leadership structures for advanced practice.
Conclusions: Hospital-based NPs face unique barriers to HWEs that compromise their well-being and hinder optimal practice. Implementing NP-informed strategies, alongside collaborative efforts across the healthcare team, can foster supportive work environments that enhance NP well-being, retention, and the quality of patient care.
Description
Hospital-based nurse practitioners (NPs) face unique challenges that impact their work environments, well-being, and retention. Drawing on survey responses from nearly 500 NPs, this study highlights barriers such as limited autonomy, incivility, and leadership gaps, while also identifying NP-informed strategies to foster healthy work environments that enhance NP well-being and patient care quality.