“I feel abandoned by nursing and not accepted by medicine”: Factors undermining a healthy work environment for hospital-based nurse practitioners in the United States

BACKGROUND: Nurse practitioners (NPs) are a rapidly growing segment of the US health care workforce and are increasingly integral to patient care in hospital settings. Despite their expanding roles, little is known about the work environment factors that affect their well-being in hospital settings. PURPOSE: To examine the factors that influence hospital-based NPs' work environments and identify strategies to enhance their well-being and support retention. METHODOLOGY: This qualitative descriptive study used directed content analysis to examine responses from 493 NPs across 264 hospitals in 10 US states with varying scope-of-practice laws to three open-text survey questions regarding their workplace experiences and work environment, drawn from the 2024 Penn Nurses4All Study. To identify factors influencing healthy work environments, themes were developed using both inductive and deductive analytic approaches, guided by the American Association of Critical-Care Nurses' Healthy Work Environment (HWE) framework. RESULTS: Six emergent themes related to factors that influence NPs' work environments included the following: (1) structural barriers to effective communication; (2) workplace incivility and lack of inclusion; (3) limited clinical autonomy and organizational influence; (4) misalignment between NP roles and staffing demands; (5) invisibility and devaluation of NP contributions; and (6) leadership gaps in supporting NP practice and well-being. CONCLUSIONS: Hospital-based NPs face unique barriers to a HWE that affect their well-being and hinder optimal practice. IMPLICATIONS: Implementing NP-informed strategies can foster supportive work environments that enhance NP well-being, retention, and the quality of patient care.