1
|
Zhao Y, Quadros W, Nagraj S, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med 2024; 22:286. [PMID: 38978070 PMCID: PMC11232288 DOI: 10.1186/s12916-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
Collapse
Affiliation(s)
- Yingxi Zhao
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | | | - Shobhana Nagraj
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Attakrit Leckcivilize
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
| |
Collapse
|
2
|
Drennan VM, Halter M, Taylor F, Gabe J, Jarman H. Non-medical practitioners in the staffing of emergency departments and urgent treatment centres in England: a mixed qualitative methods study of policy implementation. BMC Health Serv Res 2023; 23:1221. [PMID: 37936220 PMCID: PMC10631061 DOI: 10.1186/s12913-023-10220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Patient demand, internationally, on emergency departments and urgent care treatment centres has grown. Shortages of staff, particularly of emergency medicine doctors, have compounded problems. Some countries are pursuing solutions of including non-medical practitioners e.g., nurse practitioners and physician associates/assistants in their emergency department workforces. This study investigated at the macro and meso level of the health system in England: what the rationale was and the factors influencing the current and future employment, or otherwise, of non-medical practitioners in emergency departments and urgent treatment centres. METHODS Mixed qualitative methods in the interpretative tradition were employed. We undertook, in 2021-2022, a documentary analysis of national, regional and subregional policy (2017-2021), followed by semi-structured interviews of a purposive sample (n = 18) of stakeholders from national, regional and subregional levels. The data were thematically analysed and then synthesised. RESULTS There was general national policy support for increasing the presence of non-medical practitioners as part of the solution to shortages of emergency medicine doctors. However, evidence of policy support dissipated at regional and subregional levels. There were no published numbers for non-medical practitioners in emergency departments, but stakeholders suggested they were relatively small in number, unevenly distributed and faced uncertain growth. While the experience of the COVID-19 pandemic and its aftermath were said to have made senior decision makers more receptive to workforce innovation, many factors contributed to the uncertain growth. These factors included: limited evidence on the relative advantage of including non-medical practitioners; variation in the models of service being pursued to address patient demand on emergency departments and the place of non-medical practitioners within them; the lack of a national workforce plan with clear directives; and the variation in training for non-medical practitioner roles, combined with the lack of regulation of that level of practice. CONCLUSIONS We identified many features of a system ready to introduce non-medical practitioners in emergency departments and urgent treatment centres but there were uncertainties and the potential for conflict with other professional groups. One area of uncertainty was evidence of relative advantage in including non-medical practitioners in staffing. This requires urgent attention to inform decision making for short- and long-term workforce planning. Further investigation is required to consider whether these findings are generalisable to other specialties, and to similar health systems in other countries.
Collapse
Affiliation(s)
- Vari M Drennan
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK.
| | - Mary Halter
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | - Francesca Taylor
- Centre for Applied Health and Social Care Research, Kingston University, Kingston Upon Thames, UK
| | | | - Heather Jarman
- St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Crilly J, Bartlett D, Sladdin I, Pellatt R, Young JT, Ham W, Porter L. Patient profile and outcomes of traumatic injury: The impact of mode of arrival to the emergency department. Collegian 2022. [DOI: 10.1016/j.colegn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
4
|
Parry Y, Willis E, Kendall S, Marriott R, Ankers M. A Nurse Practitioner service designed to address the health needs of children living in housing instability: A non‐randomised, concurrent mixed methods study protocol. J Adv Nurs 2022; 78:1166-1175. [DOI: 10.1111/jan.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/10/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yvonne Parry
- College of Nursing and Health Sciences Flinders University Bedford Park South Australia Australia
| | - Eileen Willis
- College of Nursing and Health Sciences Flinders University Bedford Park South Australia Australia
| | - Sally Kendall
- Centre for Health Services Studies University of Kent Kent UK
| | - Rhonda Marriott
- Pro Vice Chancellor Aboriginal and Torres Strait Islander Leadership, and Director of Ngangk Yira (Sun Rising) Research Centre Murdoch University Perth Western Australia Australia
| | - Matthew Ankers
- College of Nursing and Health Sciences Flinders University Bedford Park South Australia Australia
| |
Collapse
|
5
|
Whitehead L, Twigg DE, Carman R, Glass C, Halton H, Duffield C. Factors influencing the development and implementation of nurse practitioner candidacy programs: A scoping review. Int J Nurs Stud 2021; 125:104133. [PMID: 34837730 DOI: 10.1016/j.ijnurstu.2021.104133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To meet the growing needs of a diverse population, it is critical that healthcare service provision is underpinned by innovative, cost-effective, and sustainable services and solutions. The role of the nurse practitioner creates an opportunity to meet the increasing demands of complex care and enables greater access to high quality care. Understanding how best to support nurse practitioner candidates to develop into the nurse practitioner role will create greater opportunities to transform service delivery and improve healthcare outcomes. AIM To identify key factors that support and positively impact the implementation of nurse practitioner candidacy programs and candidate experiences. METHODS A scoping review of research and grey literature was conducted using Joanna Briggs Institute methodology. For the research literature, eight electronic databases (Embase, Medline, CINAHL, Web of Science, Cochrane Library, Joanna Briggs Institute, PubMed and PsycINFO) were searched followed by a hand search of the reference lists of published systematic reviews and relevant topical papers. A review of national and international grey literature sources was completed. FINDINGS Identification of a service gap, developing and promoting a clear role for the nurse practitioner candidate, integration into a multi-disciplinary team with strong mentorship/preceptorship support, continuing professional development, and evaluation of the program were identified as key factors in the research and grey literature. CONCLUSION A well-designed candidacy program can facilitate transition of the candidate into an autonomous, fully independent nurse practitioner. Recommendations to support the implementation of these roles into the clinical setting have been generated. Tweetable abstract: Key to nurse practitioner candidate programs: Identification of a service gap, clear role, integration, mentorship, training and evaluation.
Collapse
Affiliation(s)
- Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Diane E Twigg
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Rebecca Carman
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Helena Halton
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| |
Collapse
|
6
|
Improving Patient Flow and Decreasing Patient Length of Stay in the Pediatric Emergency Department Through Implementation of a Fast Track. Adv Emerg Nurs J 2021; 43:162-169. [PMID: 33915567 DOI: 10.1097/tme.0000000000000351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Increased utilization of the emergency department (ED) for low acuity concerns saturates EDs, leading to overcrowding. As the ED becomes crowded, the quality of care threatens patient safety and increases length of stay. To improve the efficiency of evaluation and discharge of low acuity patients in the pediatric ED, a performance improvement project was implemented to develop a Fast Track. An interdisciplinary team developed the process of Fast Track, as well as guidelines for low acuity patients who would be evaluated in the designated area by an advanced practice provider and registered nurse team. Within 14 months of operating, length of stay of low acuity patients triaged an emergency severity illness score of 4 or 5 dropped 36% (from 144 to 92 min). Pediatric patients who present to the ED with low acuity concerns can be effectively and efficiently cared for in a timely fashion in a pediatric ED Fast Track.
Collapse
|
7
|
Giannouchos TV, Washburn DJ, Gary JC, Foster MJ. Frequent emergency department use in the paediatric population: A systematic literature review. J Eval Clin Pract 2021; 27:193-203. [PMID: 32141125 DOI: 10.1111/jep.13382] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. METHODS We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. RESULTS Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. CONCLUSIONS Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost-saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA.,Population Informatics Lab, Texas A&M University, College Station, Texas, USA
| | - David J Washburn
- School of Public Health, Department of Health Policy and Management, Texas A&M University, College Station, Texas, USA
| | - Jodie C Gary
- Health Science Center College of Nursing, Texas A&M University, Bryan, Texas, USA
| | - Margaret J Foster
- Medical Sciences Library, Texas A&M University, College Station, Texas, USA
| |
Collapse
|
8
|
O' Keeffe A, O' Grady S, Cronin F, Dolan C, O' Hea A, O' Shea KL, Naughton C. Evaluation of an emergency department falls pathway for older people: A patient chart review. Int Emerg Nurs 2020; 51:100869. [PMID: 32354620 DOI: 10.1016/j.ienj.2020.100869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. AIM This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. METHODS The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. RESULTS The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. CONCLUSION The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team.
Collapse
Affiliation(s)
| | - Sile O' Grady
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Finola Cronin
- North Lee Community Health, Cork City, Co Cork, Ireland.
| | - Clodagh Dolan
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Ann O' Hea
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Katie Louise O' Shea
- School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Corina Naughton
- UCC School of Nursing and Midwifery, Professor in Clinical Nursing in Older Person HealthCare, School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
| |
Collapse
|
9
|
Mowbray FI, DeLaroche AM, Parker SJ, Jones A, Ravichandran Y. Examining the clinical management of asthma exacerbations by nurse practitioners in a pediatric emergency department. Int Emerg Nurs 2020; 50:100844. [PMID: 32205105 DOI: 10.1016/j.ienj.2020.100844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/17/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the clinical management or quality of asthma care provided by nurse practitioners (NP) in a pediatric emergency setting. OBJECTIVE To describe the clinical management of asthma by NPs in our institution's emergency department, and to compare the treatment strategies between NPs, pediatricians, and pediatric emergency physicians. METHODS We conducted a retrospective chart review at a level-one pediatric trauma center. Data were extracted from electronic medical records for all patients between 2 and 18 years of age presenting to the emergency department with an asthma exacerbation. Data were analyzed using binary logistic regression with generalized estimating equations. RESULTS NPs evaluated 18% of all children presenting for asthma care. When compared to pediatric emergency physicians, patients treated by NPs had approximately twice the odds of receiving a β2-agonist (OR = 2.02; 95% CI 1.02 - 3.99) or a systemic corticosteroid (OR = 2.31; 95% CI 1.35 - 3.95) within 60 minutes of clinical evaluation. Adherence rates were similar for the other asthma quality measures between these two clinician groups. CONCLUSIONS NPs were best able to meet time-sensitive asthma quality measures in the emergency department. The addition of NPs to emergency staffing models may improve access to timely care for children with asthma.
Collapse
Affiliation(s)
- Fabrice I Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West., L8S 4L8 Hamilton, Ontario, Canada.
| | - Amy M DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien St., 48201 Detroit, Michigan, United States.
| | - Sarah J Parker
- Department of Family Medicine and Public Health Sciences, Wayne State University, 42 W Warren Avenue, 48202 Detroit, Michigan, United States.
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West., L8S 4L8 Hamilton, Ontario, Canada.
| | - Yagnaram Ravichandran
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien St., 48201 Detroit, Michigan, United States.
| |
Collapse
|
10
|
Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application. Processes (Basel) 2019. [DOI: 10.3390/pr7010048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the present study, problems in emergency services (ESs) were dealt with by analyzing the working system of ESs in Turkey. The purpose of this study was to reduce the waiting times spent in hospitals by employing advanced nurses (ANs) to treat patients who are not urgent, or who may be treated as outpatients in ESs. By applying discrete-event simulation on a 1/24 (daily) and 7/24 (weekly) basis, and by employing ANs, it was determined that the number of patients that were treated increased by 26.71% on a 1/24 basis, and by 15.13% on a 7/24 basis. The waiting time that was spent from the admission to the ES until the treatment time decreased by 38.67% on a 1/24 basis and 53.66% on a 24/7 basis. Similarly, the length of stay was reduced from 82.46 min to 53.97 min in the ES. Among the findings, it was observed that the efficiency rate of the resources was balanced by the employment of ANs, although it was not possible to obtain sufficient efficiency from the resources used in the ESs prior to the present study.
Collapse
|