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Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
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Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
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Abstract
BACKGROUND Neonatal nurse practitioner (NNP) workload is not well studied, and metrics specific to NNP practice are lacking. Factors such as changes in resident duty hours, increasing neonatal intensive care unit admissions, and a shortage of NNPs contribute to NNP workload. Increased workload has been shown to be detrimental to providers and can affect quality of care. PURPOSE This study quantified NNP workload using a subjective workload metric, the NASA Task Load Index, and a newly developed objective workload metric specific to NNP practice. METHODS The NNP group at a level IV academic medical center was studied. The sample included 22 NNPs and 47 workload experiences. RESULTS A comparison of scores from the NASA Task Load Index and objective workload metric showed a moderate correlation (r = 0.503). Mental demand workload scores had the highest contribution to workload. Feelings of frustration also contributed to workload. IMPLICATIONS FOR PRACTICE The NASA Task Load Index can be utilized to measure the workload of NNPs. The objective workload metric has potential to quantify NNP workload pending further validation studies and is a simple, straightforward tool. IMPLICATIONS FOR RESEARCH Additional research is needed regarding NNP workload and methods to quantify workload. Larger studies are needed to validate the objective workload metric.
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Osina S. The Advancement of Nurses is the Advancement of Medicine: A Personal Experience from Israel. Asia Pac J Oncol Nurs 2017; 4:95-97. [PMID: 28503638 PMCID: PMC5412160 DOI: 10.4103/apjon.apjon_3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shaindel Osina
- Department of Pediatric Hematology Oncology, Hadassah Ein Karem Hospital, Jerusalem, Israel
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Jaeger CB, Acree-Hamann C, Zurmehly J, Buck J, Patrick T. Assessment of Neonatal Nurse Practitioner Workload in a Level IV Neonatal Intensive Care Unit: Satisfaction. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Moxon SG, Lawn JE, Dickson KE, Simen-Kapeu A, Gupta G, Deorari A, Singhal N, New K, Kenner C, Bhutani V, Kumar R, Molyneux E, Blencowe H. Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S7. [PMID: 26391335 PMCID: PMC4577807 DOI: 10.1186/1471-2393-15-s2-s7] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preterm birth is the leading cause of child death worldwide. Small and sick newborns require timely, high-quality inpatient care to survive. This includes provision of warmth, feeding support, safe oxygen therapy and effective phototherapy with prevention and treatment of infections. Inpatient care for newborns requires dedicated ward space, staffed by health workers with specialist training and skills. Many of the estimated 2.8 million newborns that die every year do not have access to such specialised care. METHODS The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks" (or factors that hinder the scale up) of maternal-newborn intervention packages. For this paper, we used quantitative and qualitative methods to analyse the bottleneck data, and combined these with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for inpatient care of small and sick newborns. RESULTS Inpatient care of small and sick newborns is an intervention package highlighted by all country workshop participants as having critical health system challenges. Health system building blocks with the highest graded (significant or major) bottlenecks were health workforce (10 out of 12 countries) and health financing (10 out of 12 countries), followed by community ownership and partnership (9 out of 12 countries). Priority actions based on solution themes for these bottlenecks are discussed. CONCLUSIONS Whilst major bottlenecks to the scale-up of quality inpatient newborn care are present, effective solutions exist. For all countries included, there is a critical need for a neonatal nursing cadre. Small and sick newborns require increased, sustained funding with specific insurance schemes to cover inpatient care and avoid catastrophic out-of-pocket payments. Core competencies, by level of care, should be defined for monitoring of newborn inpatient care, as with emergency obstetric care. Rather than fatalism that small and sick newborns will die, community interventions need to create demand for accessible, high-quality, family-centred inpatient care, including kangaroo mother care, so that every newborn can survive and thrive.
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Affiliation(s)
- Sarah G Moxon
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
| | - Kim E Dickson
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, NY, USA
| | - Aline Simen-Kapeu
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, NY, USA
| | - Gagan Gupta
- UNICEF, India 73, Lodi Estate New Delhi, 110 003, India
| | - Ashok Deorari
- Department of Pediatrics, WHO Collaborating Centre for Education & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nalini Singhal
- University of Calgary, 2888, Shaganappi Trail NW, Calgary, Alberta, T3B 6C8, Canada
| | - Karen New
- The University of Queensland, Brisbane, Qld, 4029, Australia
| | - Carole Kenner
- Council of International Neonatal Nurses, Dean of School of Nursing, Health and Exercise Science, The College of New Jersey, Ewing, NJ, 08628-0718, USA
| | - Vinod Bhutani
- Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305-5101, USA
| | - Rakesh Kumar
- India Ministry of Health & Family Welfare, Government of India, Nirman Bhawan, New Delhi, 110108, India
| | | | - Hannah Blencowe
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Saving Newborn Lives, Save the Children, Washington DC, 20036, USA
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Imison C, Sonola L, Honeyman M, Ross S, Edwards N. Insights from the clinical assurance of service reconfiguration in the NHS: the drivers of reconfiguration and the evidence that underpins it – a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundOver the life of the NHS, hospital services have been subject to continued reconfiguration. Yet it is rare for the reconfiguration of clinical services to be evaluated, leaving a deficit in the evidence to guide local reconfiguration of services.ObjectivesThe objectives of this research are to determine the current pressures for reconfiguration within the NHS in England and the solutions proposed. We also investigate the quality of evidence used in making the case for change, any key evidence gaps, and the opportunities to strengthen the clinical case for change and how it is made.MethodsWe have drawn on two key sources of evidence. First, we reviewed the reports produced by the National Clinical Advisory Team (NCAT) documenting its reviews of reconfiguration proposals. An in-depth multilevel qualitative analysis was conducted of 123 NCAT reviews published between 2007 and 2012. Second, we carried out a search and synthesis of the literature to identify the key evidence available to support reconfiguration decisions. The findings from this literature search were integrated with the analysis of the reviews to develop a narrative for each specialty and the process of reconfiguration as a whole.ResultsThe evidence from the NCAT reviews shows significant pressure to reconfigure services within the NHS in England. We found that the majority of reconfiguration proposals are driving an increasing concentration of hospital services, with some accompanying decentralisation and, for some specialist services, the development of supporting clinical networks. The primary drivers of reconfiguration have been workforce (in particular the medical workforce) and finance. Improving outcomes and safety issues have been subsidiary drivers, though many make the link between staffing and clinical safety. Policy has also been a notable driver. Access has been notable by its absence as a driver. Despite significant pressures to reconfigure services, many proposals fail to be implemented owing to public and/or clinical opposition. We found strong evidence that some specialist service reconfiguration including vascular surgery and major trauma can significantly improve clinical outcomes. However, there are notable evidence gaps. The most significant is the absence of evidence that service reconfiguration can deliver significant savings. There is also an absence of evidence about safe staffing models and the interplay between staff numbers, skill mix and outcomes. We found that the advice provided by the NCAT reflects the current evidence, but one of the NCAT’s most valuable contributions has been to encourage greater clinical engagement in service change.ConclusionsThe NHS is continuing to concentrate many district general hospital services to resolve financial and workforce pressures. However, many proposals are not implemented owing to public opposition. We also found no evidence to suggest that this will deliver the savings anticipated. There is a significant gap in the evidence about safe staffing models and the appropriate balance of junior and senior medical as well as other clinical staff. There is an urgent need to carry out research that will help to fill the current evidence gap. There is also a need to retain some national clinical expertise to work alongside Clinical Senates in supporting local service reconfiguration.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Lara Sonola
- Policy Directorate, The King’s Fund, London, UK
| | | | - Shilpa Ross
- Policy Directorate, The King’s Fund, London, UK
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Toren O, Nirel N, Tsur Y, Lipschuetz M, Toker A. Examining professional boundaries between nurses and physicians in neonatal intensive care units. Isr J Health Policy Res 2014; 3:43. [PMID: 25584187 PMCID: PMC4290383 DOI: 10.1186/2045-4015-3-43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medical and technological developments, financial constraints and a shortage of physicians have made it necessary to re-examine professional boundaries between physicians and nurses. Israel's manpower shortage in Neonatal Intensive Care Units (NICUs) has changed the responsibility and authority of nurses. However, these changes have not evolved into a uniform policy defining the division of responsibility between physicians and nurses. This study was designed to examine the work processes and actual division of labor between NICU physicians and nurses; the attitude of physicians and nurses to greater empowerment of the nursing role; and to suggest a model to regulate work processes and develop the role of neonatal nurse specialists in NICUs. METHODS Open interviews with NICU physician-directors and head nurses and a cross-sectional survey of some 50% of the physicians and nurses at 22 hospital NICUs (N = 430). RESULTS Main problems of NICUs: physician shortage, deficient infrastructures, fragmented work processes. Nurses do not perform many practices allowed to them due to the need for organizational approval and their own unawareness. Conversely, they sometimes conduct procedures and make decisions outside of their authority. Most physicians agree that nurse graduates of Post-Basic Education training (PBE) should be authorized to independently perform such activities as resuscitation and medication balancing while reserving invasive procedures for physicians. It is widely agreed that broadening the authority of nurses would improve the quality of NICU care even though it would increase the nursing workload. CONCLUSIONS The study provides important input into decisions about authorizing nurses over complete practice areas rather than isolated activities; the need to remove institutional restrictions on tasks currently permitted to nurses; introducing teamwork from within the NICUs, and expanding nursing decision-making. The study reveals that there is a basis on which to to build the role of the neonatal nurse,since most NICU nurses have the suitable academic and clinical training.
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Affiliation(s)
- Orly Toren
- Hadassah Medical Center, Jerusalem, Israel
| | - Nurit Nirel
- Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | | | | | - Asaf Toker
- Department of Health Systems Management, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
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McDonnell A, Goodwin E, Kennedy F, Hawley K, Gerrish K, Smith C. An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting. J Adv Nurs 2014; 71:789-99. [DOI: 10.1111/jan.12558] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Kay Hawley
- TRI Clinical Research Facility; Princess Alexandra Hospital; Woolloongabba Queensland Australia
| | - Kate Gerrish
- Sheffield University and Sheffield Teaching Hospitals NHS Foundation Trust; UK
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Pirie ES, Sinclair C. Implementation of nurse authorisation of blood components. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2012; 21:1328-1332. [PMID: 23249800 DOI: 10.12968/bjon.2012.21.22.1328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A collaborative project between the Better Blood Transfusion teams in the Scottish National Blood Transfusion Service (SNBTS) and NHS Blood and Transplant (NHSBT) explored the feasibility of nurses prescribing blood components, and clarified that blood components are not considered medicinal products, so the term prescription does not apply. No legal barriers to trained, competent nurses and midwives undertaking this role were identified and nurse authorisation of blood components was seen as having the potential to improve patients' experiences. A number of NHS Scotland boards showed interest in implementing this but there are challenges to ensuring that a robust governance structure is in place to support role development . Progress has been made with support from the Scottish Government Health Department and using a governance framework that was developed to support nurses who wish to undertake this role.
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Morgan C, Barry C, Barnes K. Master's programs in advanced nursing practice: new strategies to enhance course design for subspecialty training in neonatology and pediatrics. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2012; 3:129-37. [PMID: 23762011 PMCID: PMC3650880 DOI: 10.2147/amep.s29270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The advanced nurse practitioner (ANP) role first developed in the USA in the 1960s in primary care. Since then, it has evolved in many different countries and subspecialties, creating a variety of challenges for those designing and implementing master's programs for this valuable professional group. We focus on ANPs in the neonatal and pediatric intensive care setting to illustrate the complexity of issues faced by both faculty and students in such a program. We review the impact of limited resources, faculty recruitment/accreditation, and the relationship with the medical profession in establishing a curriculum. We explore the evidence for the importance of ANP role definition, supervision, and identity among other health professionals to secure a successful role transition. We describe how recent advances in technology can be used to innovate with new styles of teaching and learning to overcome some of the difficulties in running master's programs for small subspecialties. We illustrate, through our own experience, how a thorough assessment of the available literature can be used to innovate and develop strategies to create an individual MSc programs that are designed to meet the needs of highly specialized advanced neonatal and pediatric nursing practice.
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Affiliation(s)
- Colin Morgan
- Liverpool Women’s Hospital, Crown Street, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
| | - Catherine Barry
- Liverpool Women’s Hospital, Crown Street, Liverpool, UK
- Liverpool John Moores University, Liverpool, UK
| | - Katie Barnes
- Liverpool John Moores University, Liverpool, UK
- Liverpool Community Health, Liverpool, UK
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Abstract
Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country's Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP's experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.
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Affiliation(s)
- Julie Hatch
- Level I nursery at Sturdy Memorial Hospital in Attleboro, MA, USA.
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Landsperger JS, Williams KJ, Hellervik SM, Chassan CB, Flemmons LN, Davidson SR, Evans ER, Bacigalupo ME, Wheeler AP. Implementation of a medical intensive care unit acute-care nurse practitioner service. Hosp Pract (1995) 2011; 39:32-9. [PMID: 21576895 DOI: 10.3810/hp.2011.04.392] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Demands for critical care services are increasing, but the supply of qualified physicians is not. Moreover, there are mounting national expectations for continuous on-site, senior providers and for adherence to quality and safety practices. In teaching institutions, manpower shortages are exacerbated by shrinking trainee duty hours, and there is a growing desire to recoup the revenue lost when a non-credentialed provider delivers a service. Increasingly, hospitalists and acute-care nurse practitioners (ACNPs) are meeting these needs. This article describes the development of an ACNP service in a university hospital medical intensive care unit (ICU) designed to improve the range and quality of services and faculty staffing when the ICU expanded from 22 to 34 beds without adding physicians. Eight ACNPs were hired and, over 9 months, received didactic, procedural, simulation center, and supervised patient care training. Progressive workload and graded responsibility were used to transition to a 24-hour, in-house, resident-independent, attending-supervised service, which now admits just under half of all patients (3.4 ± 1.3 patients/day), cares for approximately one-fourth of the unit's critically ill patients (6.0 ± 1.4 patients/day), and responds to medical rapid response team calls daily (1.5 ± 1.7 calls/day). Over the first 5 months of operation, work output in all categories continued to increase, with ACNPs documenting an average of 11.1 ± 2.7 activities per day (all data mean ± standard deviation). Acute-care nurse practitioners also provide 40% of the daily resident core lectures and a monthly staff nurse conference. Insufficient data exist at this time, however, to report accurate billing or collection results. Specific areas discussed within this article include service structure, hiring and training, implementation, scheduling, supervision, problems encountered, productivity, monitoring, and future plans.
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Affiliation(s)
- Janna S Landsperger
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt Medical Center, Nashville, TN 37232-2650, USA
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Abstract
AIMS The comprehensive review sought to examine the impact of Critical Care Nurse Practitioner models, roles, activities and outcomes. METHOD The Medical Literature Analyses and Retrieval (MEDLINE), The Cumulative Index of Nursing and Allied Health Literature (CINAHL); PubMED; PROQUEST; ScienceDirect; and the Cochrane database were accessed for the review. Alternative search engines were also included. The search was conducted with the key words: critical care, intensive care, acute, adult, paediatric, trauma, disease management programs, disease management, case management, neonatal, cardiology, neurological, retrieval, transfer and combined with Nurse Practitioner. From the identified 1048 articles 47 studies were considered relevant. RESULTS Internationally, Critical Care Nurse Practitioners were located in all intensive care areas and services including post intensive care discharge follow-up, intensive care patient retrieval and transfers and follow-up outpatient services. The role focussed on direct patient management, assessment, diagnosis, monitoring and procedural activities. Critical Care Nurse Practitioners improved patient flow and clinical outcomes by reducing patient complication, morbidity and mortality rates. Studies also demonstrated positive financial outcomes with reduced intensive care unit length of stay, hospital length of stay and (re)admission rates. CONCLUSIONS Internationally, Critical Care Nurse Practitioners are demonstrating substantial positive patient, service and nursing outcomes. Critical Care Nurse Practitioner models were cost effective, appropriate and efficient in the delivery of critical care services. RELEVANCE TO CLINICAL PRACTISE: In Australia, there was minimal evidence of Critical Care Nurse Practitioner impact on adult, paediatric or neonatal intensive care units. The international evidence suggests that the contribution of the role needs to be strongly considered in light of future Australian service demands and workforce supply needs. In Australia, the Critical Care Nurse Practitioner role and range of activities falls well short of international evidence. Hence, it was necessary to scope the international literature to explore the potential for and impact of the Critical Care Nurse Practitioner role. The review leaves little doubt that the role offers significant potential for enhancing and contributing towards more equitable health services.
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Affiliation(s)
- Margaret Fry
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, NSW 2007 Australia.
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Tume L. Remodelling the paediatric ICU workforce: there is a case for implementing advance nurse practitioner roles into all paediatric intensive care units. Nurs Crit Care 2010; 15:165-7. [DOI: 10.1111/j.1478-5153.2010.00414.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM To determine the safety and efficacy of neonatal nurses attending at-risk deliveries. METHODS An audit of 2 years of delivery attendance by neonatal nurses at an urban hospital. Attendance also by a paediatrician if expected birth weight <2 kg, gestation < 35 weeks, twin pregnancy, foetal distress or any anomaly anticipated to seriously affect the newborn's health. RESULTS About 3021 deliveries were attended, 2228 (74%) by a neonatal nurse, 776 (25%) by a neonatal nurse and a paediatrician and 17 (1%) by a paediatrician. Twenty-three children required intermittent positive pressure ventilation via endotracheal tube and/or cardiac massage. All but five of these were deliveries where both a neonatal nurse and a paediatrician were present. Three of these five deliveries had foetal tachycardia. There were 33 deliveries managed by the neonatal nurse alone where the 1-min Apgar was three or less. All achieved a 10-min Apgar of seven or greater. Over the study interval, the proportion of deliveries attended only by a neonatal nurse increased and intensity of resuscitation administered decreased. CONCLUSION Appropriately trained neonatal nurses can safely resuscitate newborns. Addition of foetal tachycardia to the indications for paediatrician attendance identifies infants likely to require more resuscitation.
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Affiliation(s)
- Donna Neal
- Special Care Baby Unit, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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Cramer CL, Orlowski JP, DeNicola LK. Pediatric intensivist extenders in the pediatric ICU. Pediatr Clin North Am 2008; 55:687-708, xi-xii. [PMID: 18501761 DOI: 10.1016/j.pcl.2008.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the use of physician extenders in the pediatric ICU setting. The Libby Zion case is highlighted because of its impact on the use of manpower in the hospital setting. The history of physician extenders, including the hospitalist, physician assistant (PA), and nurse practitioner (NP), is discussed. Findings indicate a positive impact within the pediatric intensive care setting with the use of NPs and PAs. The American Academy of Pediatrics has supported the use of physician extenders in the care of hospitalized children.
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Affiliation(s)
- Cheryl L Cramer
- Pediatric Intensive Care Unit, University Community Hospital, 3100 East Fletcher Avenue, Tampa, FL 33613, USA
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Abstract
Perspective on the paper by Patton and Hey (see page 263)
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Affiliation(s)
- O C Onuzo
- University Hospital of Wales, Paediatric Cardiology, Heath Park, Cardiff CF14 4XW, Wales, UK.
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Patton C, Hey E. How effectively can clinical examination pick up congenital heart disease at birth? Arch Dis Child Fetal Neonatal Ed 2006; 91:F263-7. [PMID: 16547080 PMCID: PMC2672726 DOI: 10.1136/adc.2005.082636] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS To assess what proportion of all cardiac abnormality can be suspected at birth when all clinical examination before discharge is undertaken by a small stable team of clinicians. METHODS A prospective audit of all the 14 572 births in a maternity unit only staffed by nurse practitioners between 1996 and 2003. RESULTS 1.2% of all babies born in the unit were found to have a structural defect (as confirmed by echocardiography) within a year of birth. The number not suspected before discharge declined over time, and only 6% were first suspected after discharge in the last four years of this eight year study. Four potentially life threatening conditions initially went unsuspected in 1996-8, but none after that. A policy of referring every term baby with a murmur at 1 day of age that was still present at 7-10 days resulted in 4.2% requiring cardiac referral; 54% of these babies still had a murmur when assessed one to two weeks later, and 33% had a structural defect. Parents said in independent, retrospectively conducted, interviews that they found it confidence building to have any possible heart defect identified early and the cause of any murmur clearly and authoritatively explained. CONCLUSIONS Effective screening requires experience and a clear, structured, referral pathway, but can work much better than most previous reports suggest. Whether staff bring a medical or nursing background to the task may well be of less importance.
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Affiliation(s)
- C Patton
- Maternity Unit, Wansbeck General Hospital, Ashington, Northumberland NE63 9JJ, UK.
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Chan LC, Hey E. Can all neonatal resuscitation be managed by nurse practitioners? Arch Dis Child Fetal Neonatal Ed 2006; 91:F52-5. [PMID: 16131532 PMCID: PMC2672652 DOI: 10.1136/adc.2004.069013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2005] [Indexed: 11/04/2022]
Abstract
AIM To assess the ability of nurse practitioners to manage the care of all babies requiring resuscitation at birth in a unit without on site medical assistance. METHOD A prospective review, and selective external audit, of the case records of all 14 572 babies born in a maternity unit in the north of England during the first eight years after nurse practitioners replaced resident paediatric staff in 1996. RESULTS Every non-malformed baby with an audible heart beat at the start of delivery was successfully resuscitated. Twenty term babies and 41 preterm babies were intubated at birth. Eight term babies only responded after acidosis or hypovolaemia was corrected following umbilical vein catheterisation; in each case the catheter was in place within six minutes of birth. Early grade 2-3 neonatal encephalopathy occurred with much the same frequency (0.12%) as in other recent studies. Independent external cross validated review found no case of substandard care during the first hour of life. CONCLUSION The practitioners successfully managed all the problems coming their way from the time of appointment. There was no evidence that their skill decreased over time even though, on average, they only found themselves undertaking laryngeal intubation once a year. It remains to be shown that this level of competence can be replicated in other settings.
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Affiliation(s)
- L C Chan
- Maternity Unit, Wansbeck Hospital, Ashington, Northumberland, UK.
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