Master's Theses



Degree Name

Master of Science in Nursing (MSN)


The identification of barriers to the optimal use of the nurse practitioner (NP) within the Rural Health Clinics (RHC) in Kansas is essential in solidifying the role of the NP as a primary health care provider. As health care reform mandates the paradigm shift from treatment to prevention, more research regarding the optimal use of the NP is essential for several reasons. The nation is demanding accessibility of quality, cost-effective primary care for all. In spite of the research that has substantiated the quality and cost effectiveness of the care that NPs provide, barriers still exist that hinder their optimal utilization. This investigation was a quantitative descriptive study using a combination of Lewin's Force Field Analysis and Margaret Newman's Health Model to identify the existence of barriers and any variance in the views of the cohorts studied. The specific research questions were 1) What barriers to the use of nurse practitioners in Rural Health Clinics in Kansas exist? and 2) Are barriers to nurse practitioners in Rural Health Clinics in Kansas perceived the same way by administrators, physicians, and nurse practitioners who work in these Rural Health Clinics in Kansas? The subjects studied were nurse practitioners, physicians, and administrators who work in but are not confined to Rural Health Clinics in Kansas. There were 216 surveys distributed to a random sample and 92 cohorts responded from 61 different sites which is a 42.5% return. There were 27 nurse practitioners, 38 physicians, and 27 administrators who participated. The majority of the cohorts were in the age range of 40-50 years. The nurse practitioner cohort was female. The administrator and physician cohorts were 56% to 79% male. The majority of the Rural Health Clinics studied were Independent Based (75%) and physician owned (61%). Limitations of the study were: (a) population was limited to those cohorts who worked within the Rural Health Clinic system in Kansas, (b) the consumer was not surveyed, (c) the analysis was limited to three possible barriers, (d) all nurse practitioners surveyed were women which was a product of randomization, (e) only certified Rural Health Clinics were surveyed, and (f) the demographic area was limited to the state of Kansas. The findings of this study were that barriers to the use of the nurse practitioner do exist within the Rural Health Clinics setting and that the three cohorts studied have varying views regarding those barriers. Recommendations of the study are: (a) further education of the consumer, (b) further research of the knowledge base of the consumer, (c) further analysis of data obtained via the survey tool, (d) further studies of the female nurse practitioner versus the male nurse practitioner in the male dominated world of primary health care, and (e) further studies to clarify factors which affect the physicians views of supervising the nurse practitioner. In summary, this study identified that barriers do exist within the Rural Health Clinics in Kansas and that the cohorts studied have varying views. The Rural Health Clinics were established to enhance the use of the nurse practitioner. If there are barriers which exist within this system, it is indicative that barriers outside the system also exist. It is the desire of the investigator that more research will be initiated to improve the use of the nurse practitioner. It is also the opinion of this researcher that the nurse practitioner can play a major role in addressing the many issues of providing quality cost-effective primary health care for our nation.


Mary R. Hassett

Date of Award

Fall 1995

Document Type

Thesis - campus only access


© 1995 Ramona L. Derousseau


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