PICU Provider Supply and Demand: A National Survey

Career Choices and Experiences in Role Transition: A Multistate Survey of Pediatric-Focused Hospital-Based Nurse Practitioners

INTRODUCTION

We examined factors influencing pediatric hospital-based APPs' career decisions and described the transition to practice experiences.

METHOD

We conducted a cross-sectional, descriptive electronic survey using a novel instrument to examine APP career decisions and transition to practice experiences among APPs in four Southeastern children's hospitals.

RESULTS

There were 158 respondents composed of family nurse practitioners (NPs) (30%), primary care pediatric NPs (24%), and acute care pediatric NPs (18%). APPs chose their career to further their education (46%) and because of interest in pediatrics (18%). Most APPs had experience in pediatrics on APP graduation and were well prepared for the role (47%) and to care for pediatric patients (56%). Nearly two-thirds of APPs had an orientation.

DISCUSSION

Early exposure to pediatrics influenced APP career choices and increased career preparedness. Although most APPs had an orientation, future studies should assess the impact of orientation on patient, professional, and organizational outcomes.

Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles

Nurse practitioner (NP) advocacy efforts often focus on attaining full practice authority. While the effects of full practice authority in primary care are well described, implications for hospital-based NPs are less clear and may differ because of hospitals' team-based care and administrative structure. This study examines associations between state scope-of-practice (SSOP) and clinical roles of hospital-based pediatric intensive care unit (PICU) NPs. We conducted a national survey to assess clinical roles of PICU NPs including daily patient care, procedural, and consultation responsibilities as well as hospital-level administrative oversight practices. We classified SSOP as full or limited (reduced or restricted SSOP) practice. We present descriptive statistics and evaluate differences in clinical roles and hospital-level administrative oversight based on SSOP. The final sample included 55 medical directors and 58 lead (senior or supervisory) NPs from 93 of the 140 (66.4%) PICUs with NPs. There were no significant differences in daily patient care, procedural, or consultation responsibilities based on SSOP (p > .05). However, NPs in full practice authority states were more likely to bill for care than those in limited practice states (66.7% vs. 31.8%, p = .003), while those in limited practice states were more likely to report to advanced practice managers (36.7% vs. 13%, p = .03). For PICU NPs, SSOP was not associated with variation in clinical responsibilities; conversely, there were differences in billing and reporting practices. Future work is needed to understand implications of variation in hospital-level administrative oversight.

Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care

BACKGROUND

Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.

OBJECTIVES

We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.

RESEARCH DESIGN

Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.

MEASURES

The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay.

RESULTS

The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1±5.9 vs. 7.1±6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P=0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P=0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P<0.001). There were no differences in lengths of stay.

CONCLUSIONS

Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.