THE DEVELOPMENT AND VALIDITY EVIDENCE OF A NURSE PRACTITIONER SELF-EFFICACY SURVEY

Abstract

Nurse practitioners (NPs) are advanced practice nurses with graduate-level training who are addressing the provider shortage by increasing access to quality care. Nurses are at increased risk of burnout which can lead them to leave the profession. Self-efficacy is one’s belief in the capability to exercise control over their own functioning and over events that affect their lives. Studies from a variety of disciplines have found that increased levels of self-efficacy are associated with decreased levels of burnout, and increased satisfaction and retention. Self-efficacy is likely an important concept to understand how NPs can be supported. With a deeper knowledge of the role of self-efficacy in NP work, programs can increase their effectiveness in supporting professional success, which in turn can better serve the needs of the profession. To support Hawai`i’s NP workforce, it is essential to care for the caregivers and provide NPs with the appropriate support. The purpose of this study is to develop and provide validity evidence for an NP self-efficacy survey so that programs have a measuring tool to identify self-efficacy levels in NP core competencies in order to recognize areas in need of enhanced curriculum and support for NP students and the NP workforce. I designed this NP Self-efficacy Survey development project using Kane’s interpretive use argument (IUA) framework and produced validity evidence that backs scoring, generalization, extrapolation, and use inferences. The survey content was guided by the Nursing Organization for Nurse Practitioner Faculties (NONPF, 2017) core competencies. I conducted eight cognitive interviews to examine response-process evidence with new graduate NPs (< 2 years of experience) and experienced NPs (> 2 years of experience). A survey development expert also reviewed the survey and provided recommendations. Next, I distributed the survey to NPs and registered nurses (RNs) using non-probability-based sampling methods. There was a total of 230 NP and 127 RN surveys that I used for the analysis. I attempted to conduct a confirmatory factor analysis (CFA) on a nine-factor model corresponding with the theory but a solution to the model could not be estimated. I then adopted an exploratory perspective and accepted a theoretically plausible alternative to the original scoring structure and developed an eight-factor model, which the CFA model fit, as inferred from the goodness-of-fit indices (CFI = .97, TLI = .96, RMSEA = .05). To further examine model fit, I performed a chi-square difference test comparing the eight-factor model to a one-factor model, which resulted in the eight-factor model holding significantly better fit (chi-square = 267, df = 28, p < .001). Next, I conducted reliability studies to evaluate the revised model’s internal consistency, which resulted in acceptable reliability in seven of the eight scales (α ranged from .67 to .87), with technology and information having lower reliability. Multiple t-tests provided evidence that the instrument can distinguish between NPs and RNs (Hedges’ g ranged from 0.07 to 0.92 across the eight scales), and more- and less-experienced NPs (Hedges’ g ranged from 0.08 to 0.42 across the eight scales), which served as validity evidence for the survey’s extrapolation inference. Using the IUA framework, this survey development study provided provisional validity evidence to support the interpretation and use of the NP Self-efficacy Survey.