Acute care nurse practitioner: an advanced practice role for RN first assistants

Practice audit of the role of the Non-medical surgical assistant in Australia, an online survey

The term Non-Medical Surgical Assistant (NMSA) encompasses all roles where healthcare clinicians without a medical degree provide clinical services during the perioperative cycle. The role of NMSA is gaining momentum within Australia. It is timely to ascertain who is preforming the role and quantify the practice setting and scope of practice to enable a nationally recognised platform for role evolution. For two months in 2015 a NMSA Practice Audit was available online. Sampling was initially of a convenience modality. A total of 83 clinicians responded. The majority of NMSAs were experienced RNs [>11yrs]; held post-graduate qualifications [80%], practiced predominantly in metropolitan areas [65%] and had been performing the role for 8 years or less. The specialty with the highest uptake of the NMSAs is orthopaedic surgery. This paper provides an overview of NMSAs practicing in Australia and provides cost effective evidence of the need for this service in Australian healthcare.

Role Development of Nurse Practitioners and Physician Assistants in Liver Transplantation

Background:

Nurse practitioners (NPs) and physician assistants (PAs) are increasingly utilized in health care. However, their roles in liver transplantation (LT) have not been investigated.

Materials and Methods:

In this study, we reviewed the employment and development of NPs and PAs and their impact on our deceased-donor LT (DDLT) program.

Results:

We found a safe and efficient way to utilize NPs and PAs in a DDLT program. Since the beginning of our program, Model of End-Stage Liver Disease (MELD) scores have increased significantly, suggesting patients are sicker at the time of transplant, and wait times of patients have become longer. With the incorporation of NPs and PAs, we found that length of stay (LOS) was not affected. The overall median warm ischemic time did not increase. Outcomes of LT for both patient and graft survival actually improved and remain at or above the expected values. These results collectively support the usefulness and validity of NPs and PAs in a DDLT program.

Conclusion:

We have determined that surgical and medical NPs and PAs are essential for optimal patient outcomes. They facilitate a better learning experience for residents and fellows on their transplant rotations. Further investigations to assess the roles of these providers and their impact on the education of residents and fellows in transplantation are warranted. Further transplant hepatology education programs and/or fellowships are recommended to assist in the education and professional development of transplant NPs and PAs.