Date of Award


Degree Name

Doctor of Nursing Science


managed care, nurse-patient relationship, Nurse Practitioners, nursing, patients


Determination of patient outcomes associated with new and return business is a primary objective of the managed care marketplace. Identification of variables which contribute to both positive and negative patient experience in managed care systems is crucial to their effectiveness. The purpose of this study was to test the functional relationships between the variables of nurse practitioner attributes and behaviors, patient perceptions of the managed care system, and outcomes of patient satisfaction and intention to return to and recommend the managed care system. Functional relationships were measured with the Patient Satisfaction Semantic Differential (Greeneich and Long, 1992), and the Service Survey (Swan, Sawyer, Van Matre and McGee, 1985). Subjects (N = 86) were primarily female, Caucasian, and had some college education. Nurse practitioner effects on positive and negative patient service experiences emerged. In the positive service experience, nurse practitioner practice and inherent personality characteristics accounted for 35% of the variance found in attributes of satisfaction. In addition, attributes of satisfaction explained 22% of the variance in the patient's positive perception of the managed care system. In the negative service experience, the inherent personality characteristics of the nurse practitioner explained 25% of the variance. While nurse practitioner practice and inherent personality characteristics accounted for 35% of the variance in attributes of satisfaction, attributes of satisfaction only moderately predicted a negative service experience with 4% of the variance. An ANOVA post hoc analysis indicated that a difference in patient perceptions occurred relative to the number of visits during a one month period. These results demonstrated the effect of frequency of exposure to healthcare personnel attributes and behaviors on patient perceptions of their managed care experience, and their intention to return and to recommend the system.

Document Type

Dissertation: Open Access



Included in

Nursing Commons