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Grota T, Betihavas V, Burston A, Jacob E. Roles of nurse-surgeons in global surgical care: A scoping review. J Adv Nurs 2024; 80:3006-3036. [PMID: 37897097 DOI: 10.1111/jan.15906] [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: 05/18/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
AIM To identify the roles of nurse-surgeons in the provision of surgical care. DESIGN Scoping review. METHODS This scoping review adhered to the JBI guideline for scoping reviews and EQUATOR Network's PRISMA-ScR checklist. Searches were performed from May 2022 to July 2022 using a combination of MeSH headings, keywords and filters via database and hand searching based on the eligibility criteria. Keywords included nurse-surgeon, nurse endoscopist, nurse hysteroscopist and nurse cystoscopist. Data sources were CINAHL, Cochrane, Google Scholar, PubMed and Scopus. Descriptive analysis was used to report the findings. RESULTS Ninety-six included records indicated nurse-surgeon practice in 26 countries. Forty-one nurse-surgeon titles were found, the majority of which were types of nurse practitioner. A total of 5,684,198 surgeries were performed by nurse-surgeons varying from laparotomies to biopsies. Nine records reported that nurse-surgeons perform surgeries safely and on par with physicians with zero to minimal complications. Nineteen records reported improved surgical care efficiency by nurse-surgeons in terms of patient access to surgery, waiting times, surgery times, patient show rates, patient education, physician workload and junior physicians' training. Seven records reported high patient satisfaction. Nurse-surgeons were cost-effective according to five records. Thirteen records recommended the standardization of nurse-surgeon practice. CONCLUSION Nurse-surgeons performed millions of surgeries worldwide assisting in easing the global surgical burden. This review identified the roles and benefits nurse-surgeons play in global surgical care. Research gaps on nurse-surgeon roles were discovered including the ambiguity in nurse-surgeon titles and the need to regulate nurse-surgeon practice. IMPACT This research addressed the clinical safety, quality, contribution to timely surgical access and cost efficiency of nurse-surgeon performed surgeries, as well as the need to standardize nurse-surgeon practice and use a more consistent nurse-surgeon title to ensure role identification and monitoring.
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Affiliation(s)
- Tenber Grota
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
| | - Vasiliki Betihavas
- School of Nursing & Midwifery, University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Adam Burston
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia
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Zuma D, Zink M, Tran N, Chen L. Bridging the gap: Implementing a pilot radiology-focused curriculum in an acute care Nurse Practitioner program. J Am Assoc Nurse Pract 2024:01741002-990000000-00206. [PMID: 38381085 DOI: 10.1097/jxx.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
ABSTRACT Knowledge in diagnostic radiology and performance of point-of-care ultrasound are integral to acute care nurse practitioners (ACNPs) in the inpatient settings, especially true in specialty areas such as interventional radiology and critical care. However, existing ACNP training programs, including at our institution, often lack robust relevant course content. To address this educational gap, we designed and implemented a pilot acute care radiology course, incorporating a flipped classroom approach and hands-on simulation activities led by expert faculty. Our course evaluation revealed high levels of student satisfaction, self-reported confidence, and perceived course effectiveness. The course aligns with key competencies outlined by the American Association of Colleges of Nursing, demonstrating its potential to advance ACNP education in radiology content.
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Affiliation(s)
- Danielle Zuma
- Columbia University School of Nursing, New York, New York
| | - Mara Zink
- Columbia University School of Nursing, New York, New York
| | - Nhani Tran
- Columbia University School of Nursing, New York, New York
| | - Leon Chen
- Columbia University School of Nursing, New York, New York
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Schwegel C, Rothman N, Muller K, Loria S, Raunig K, Rumsey J, Fifi J, Oxley T, Mocco J. Meeting the evolving demands of neurointervention: Implementation and utilization of nurse practitioners. Interv Neuroradiol 2018; 25:234-238. [PMID: 30269668 DOI: 10.1177/1591019918802411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Growth in the neurointerventional field, as a result of the emergence of thrombectomy as the gold standard treatment for large vessel occlusions, has created complex challenges. In an effort to meet evolving demands and fill workflow gaps, nurse practitioners have taken on highly specialized roles. Neurointerventional care has rapidly evolved similarly to interventional cardiac care, in that nurse practitioners are successfully being incorporated as procedural assistants in catheterization laboratories. Similar utilization of nurse practitioners in interventional neuroradiology holds the capacity to decrease physician workload, mitigate stresses contributing to burn-out, and reallocate more physician time to procedures. Nurse practitioner practice faces procedural, clinical, legal and interpersonal barriers. Despite calls for expanded practice by the Institutes of Medicine, a paucity of nurse practitioner training opportunities exists. Fragmented privileging processes contribute to environments where nurse practitioners must navigate hurdles without established interventional neuroradiology-specific precedent. Increased nurse practitioner mentorship, fluoroscopy law standardization, physician support surrounding nurse practitioner autonomy, and role consistency is imperative for optimal nurse practitioner utilization. Nurse practitioners are uniquely equipped to bridge evolving gaps through the provision of safe, efficacious care, and generating revenue at lower costs. Discussion surrounding nurse practitioner use to bridge workflow gaps is an exciting opportunity for future practice development.
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Affiliation(s)
- Claire Schwegel
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Nicole Rothman
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Kimberly Muller
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Stephanie Loria
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Katherine Raunig
- 2 Columbia University Medical Center, School of Nursing, New York, NY, USA
| | - Jamie Rumsey
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Johanna Fifi
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - Thomas Oxley
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
| | - J Mocco
- 1 The Mount Sinai Health System, Cerebrovascular Center, New York, NY, USA
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Nandwana SB, Walls DG, Ibraheem O, Murphy F, Tridandapani S, Cox K. Beyond complications: Comparison of procedural differences and diagnostic success between nurse practitioners and radiologists performing image-guided renal biopsies. J Am Assoc Nurse Pract 2016; 28:554-558. [PMID: 27183896 DOI: 10.1002/2327-6924.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/21/2016] [Indexed: 11/05/2022]
Abstract
PURPOSE Radiology-trained nurse practitioners (NPs) may perform image-guided medical renal biopsies with computed tomography (CT). This study evaluates the procedural differences and diagnostic success between biopsies performed by NPs compared to radiologists. DATA SOURCES A retrospective study was performed on patients who underwent nontargeted, CT-guided renal biopsy between 2009 and 2014. Provider type (NP or radiologist), number of core specimens obtained, sedation medication dose, CT dose index (CTDI), and diagnostic success were recorded. Categorical and continuous variables were analyzed using χ2 and Student's two-tailed t-test, respectively, comparing NPs with radiologists. CONCLUSIONS A total of 386 patients were included; radiologists performed 215 biopsies and NPs performed 171 biopsies. There was no significant difference in diagnostic success, amount of tissue harvested (number of cores), radiation dose, or sedation dosage between NPs and radiologists performing CT-guided renal biopsies. Only 4% were nondiagnostic (n = 7, radiologists; n = 9, NPs; p = .325). Overall mean number of cores obtained was 3.7, mean CTDI was 176.5 mGy, mean fentanyl dose was 86.3 μg, and mean midazolam was dose 1.54 mg without a statistically significant difference between provider types. IMPLICATIONS FOR PRACTICE NPs perform image-guided medical renal biopsies in a similar fashion to radiologists with respect to diagnostic success, amount of tissue harvested, total radiation dose exposure, and administration of sedation.
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Affiliation(s)
- Sadhna B Nandwana
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
| | - Deborah G Walls
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Oluwayemisi Ibraheem
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Frederick Murphy
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Srini Tridandapani
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Kelly Cox
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
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Image-Guided Nontargeted Renal Biopsies Performed by Radiology-Trained Nurse Practitioners: A Safe Practice Model. J Am Coll Radiol 2015; 13:819-21. [PMID: 26541458 DOI: 10.1016/j.jacr.2015.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/23/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022]
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Hawkins CM, Bowen MA, Gilliland CA, Walls DG, Duszak R. The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Operational and Educational Implications. J Am Coll Radiol 2015; 12:898-904. [DOI: 10.1016/j.jacr.2015.03.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/23/2015] [Indexed: 01/05/2023]
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Hawkins CM, Bowen MA, Gilliland CA, Walls DG, Duszak R. The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Regulatory, Billing, and Compliance Perspectives. J Am Coll Radiol 2015; 12:776-81. [DOI: 10.1016/j.jacr.2015.03.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/23/2015] [Indexed: 01/02/2023]
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Practice Parameter for Interventional Clinical Practice and Management. J Vasc Interv Radiol 2015; 26:1197-204. [PMID: 26142141 DOI: 10.1016/j.jvir.2015.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022] Open
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Duszak R, Walls DG, Wang JM, Hemingway J, Hughes DR, Small WC, Bowen MA. Expanding Roles of Nurse Practitioners and Physician Assistants As Providers of Nonvascular Invasive Radiology Procedures. J Am Coll Radiol 2015; 12:284-9. [DOI: 10.1016/j.jacr.2014.08.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022]
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Chittle MD, Vanderboom T, Borsody-Lotti J, Ganguli S, Hanley P, Martino J, Mueller P, Penzias A, Saltalamacchia C, Sheridan RM, Hirsch JA. An overview of clinical associate roles in the neurointerventional specialty. J Neurointerv Surg 2015; 8:323-7. [DOI: 10.1136/neurintsurg-2014-011576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 11/03/2022]
Abstract
Neurointerventionalists have long partnered with certain types of clinical associates to provide longitudinal care. This overview summarizes differences in education, background, roles, and scopes of practice of the various clinical associates (physician assistants, nurse practitioners, clinical nurse specialists, radiology practitioner assistants, radiologist assistants, and nursing care coordinators). Key differences and similarities are highlighted to alleviate confusion about the roles clinical associates can assume on a neurointerventional service. This overview is intended to guide practices as they consider broadening their clinical support teams.
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Duszak R, Bilal N, Picus D, Hughes DR, Xu BJ. Central venous access: evolving roles of radiology and other specialties nationally over two decades. J Am Coll Radiol 2013; 10:603-12. [PMID: 23770064 DOI: 10.1016/j.jacr.2013.02.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/05/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE The aim of this study was to evaluate national trends in central venous access (CVA) procedures over 2 decades with regard to changing specialty group roles and places of service. METHODS Aggregated claims data for temporary central venous catheter and long-term CVA device (CVAD) procedures were extracted from Medicare Physician/Supplier Procedure Summary Master Files from 1992 through 2011. Central venous catheter and CVAD procedure volumes by specialty group and place of service were studied. RESULTS Between 1992 and 2011, temporary and long-term CVA placement procedures increased from 638,703 to 808,071 (+27%) and from 76,444 to 316,042 (+313%), respectively. For temporary central venous catheters, radiology (from 0.4% in 1992 to 32.6% in 2011) now exceeds anesthesiology (from 37% to 22%) and surgery (from 30.4% to 11.7%) as the dominant provider group. Surgery continues to dominate in placement and explantation of long-term CVADs (from 80.7% to 50.4% and from 81.6% to 47.7%, respectively), but radiology's share has grown enormously (from 0.7% to 37.6% and from 0.2% to 28.6%). Although volumes remain small (<10% of all procedures), midlevel practitioners have experienced >100-fold growth for most services. The inpatient hospital remains the dominant site for temporary CVA procedures (90.0% in 1992 and 81.2% in 2011), but the placement of long-term CVADs has shifted from the inpatient (from 68.9% to 45.2%) to hospital outpatient (from 26.9% to 44.3%) setting. In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters all peripherally inserted central catheters. CONCLUSIONS Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably. Radiology is now the dominant overall provider.
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Affiliation(s)
- Richard Duszak
- Harvey L. Neiman Health Policy Institute, Reston, Virginia 20191, USA.
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