Efficacy of the Well-Being Index to identify distress and stratify well-being in nurse practitioners and physician assistants

J Am Assoc Nurse Pract. 2019 Jul;31(7):403-412. doi: 10.1097/JXX.0000000000000179.


Background and purpose: To evaluate the ability of the Well-Being Index (WBI) to stratify distress and well-being (high quality of life [QOL]) in nurse practitioners and physician assistants (NPs and PAs) and identify those whose degree of distress place them at an increased risk for medical error or turnover.

Methods: A national sample of NPs and PAs completed a survey that included the WBI and instruments to measure QOL, fatigue, burnout, recent suicidal ideation, medical error, and intent to leave the current job.

Conclusions: Overall, 1,576 of 4,106 (38.4%) NPs and PAs completed the survey. Those NPs and PAs with low mental QOL, extreme fatigue, recent suicidal ideation, or burnout had less favorable WBI scores (all p < .0001). Using a prevalence of low overall QOL among APPs of 14.4% as the pretest probability, the WBI score can reduce the posttest probability of low QOL to 2% or increase it to 64.7%. As the WBI score worsened, the posttest probability of high overall QOL decreased from 73% to 8.2%. Also, WBI score stratified the NPs and PAs likelihood of reporting recent medical errors and intent to leave his or her current job.

Implications for practice: The WBI is a useful screening tool to stratify distress and well-being in APPs across a variety of domains and identify those NPs and PAs whose degree of distress may increase the risk of medical error or turnover.

MeSH terms

  • Adult
  • Burnout, Professional / etiology
  • Burnout, Professional / psychology
  • Chi-Square Distribution
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners / psychology*
  • Nurse Practitioners / statistics & numerical data
  • Odds Ratio
  • Physician Assistants / psychology*
  • Physician Assistants / statistics & numerical data
  • Psychometrics / instrumentation
  • Psychometrics / methods
  • Quality of Life / psychology
  • Stress, Psychological / complications*
  • Stress, Psychological / psychology
  • Surveys and Questionnaires