Nurse practitioner self-confidence and attitudes regarding managed care.

Purpose: To examine the relationship between nurse practitioner (NP) perceived self-confidence in performing managed care tasks and NP attitudes toward managed care.

Data Sources: A random sample of NPs--members of the Massachusetts Coalition of Nurse Practitioners--completed a demographic survey, responded to questions measuring self-confidence in performing managed care tasks and attitudes toward managed care, and wrote about their managed care experiences.

Conclusions: NPs were only moderately confident in performing managed care tasks and had mostly negative attitudes toward managed care. They reported intense frustration related to prescriptive coverage and referrals to specialty services, potential trust issues between providers and patients, and ethical and legal dilemmas in tailoring plans of care to fit the patient's insurance. The NPs' written comments indicate a need for more in-depth exploration of NP attitudes toward managed care. IMPLICATIONS FOR PRACTICE AND EDUCATION: Continuing education in selected managed care competencies, better education of NP students, and promotion of organizational cultures that support interdisciplinary teamwork as well as population- and evidence-based practice may help NPs to embrace the promise of managed care and to offer solutions to its problems.