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Forman K, Bruno CJ, Izatt S, Fuloria M, Adams A, Kim M, Zuber J, Cano N, LaTuga MS. Building Relationships: Advanced Practice Providers and Fellows in Neonatal-Perinatal Medicine. Am J Perinatol 2024; 41:e2514-e2520. [PMID: 37541311 DOI: 10.1055/s-0043-1771503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Advanced practice providers (APPs) are a critical component of health care teams, especially in the neonatal intensive care unit. At times, APPs and neonatal-perinatal medicine (NPM) fellows may experience tension in their professional relationship. They may perceive the other's performance and abilities differently. We hypothesized that satisfaction with the APP-NPM fellow interprofessional relationship would be associated with higher perception of APP competence by NPM fellows. STUDY DESIGN We surveyed 274 medical providers: NPM fellows (24.8%), NPM program directors (24.5%), and APPs (50.7%). APPs were defined as neonatal nurse practitioners, pediatric nurse practitioners, physician assistants, or neonatal hospitalists. We obtained demographic data, information about sources of conflict in the APP-NPM fellow relationship, level of satisfaction with the relationship, and targeted interventions for improvement. NPM fellow perception of APP competence as well as APP self-assessed competence were elicited. Statistical analyses were performed with chi-square tests and Fisher's exact tests. RESULTS Overall, APPs and NPM fellows were generally satisfied with their relationship. All groups reported APP competence as equivalent to a third-year NPM fellow. NPM fellow perception of APP competence increased with year of fellow training. Higher perceived APP competence by NPM fellows correlated with higher relationship satisfaction scores. Difficulties with teamwork, communication and respect were associated with lower satisfaction within the APP-NPM fellow relationship. CONCLUSION The professional working dynamic between these two groups is viewed positively by all. Satisfaction with the APP-NPM fellow relationship correlated with higher perception of APP competence by NPM fellows. Targeted interventions that increase NPM fellow perception of APP competence and ameliorate the difficulties encountered in the APP-NPM fellow relationship may improve this interprofessional relationship. KEY POINTS · Advanced practice providers and NPM fellows may have similar responsibilities leading to challenges.. · NPM fellows with higher perceived competence of APPs had higher satisfaction with their relationship.. · Training APPs to teach, creating interprofessional education, and routine debrief sessions may help..
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Affiliation(s)
- Katie Forman
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Christie J Bruno
- Division of Neonatology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Susan Izatt
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mamta Fuloria
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Aaron Adams
- Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Mimi Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Jennifer Zuber
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nefertiti Cano
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Mariam S LaTuga
- Division of Neonatology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Moss CR. Development and evaluation of a neonatal nurse practitioner mentoring workshop. J Am Assoc Nurse Pract 2024:01741002-990000000-00192. [PMID: 38206112 DOI: 10.1097/jxx.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
ABSTRACT New graduate neonatal nurse practitioners (NNPs) need more than an orientation; they need mentoring to facilitate successful role transition and enhance job satisfaction. A gap exists in the literature about mentoring participant training and launching of successful programs for NNPs. This article provides an overview of the development and evaluation of a nurse practitioner (NP) mentoring workshop before the start of a formalized mentoring program. Workshop participants attended a half-day education event with an emphasis on mentoring program expectations, mentor and mentee roles, and effective communication. After the workshop, participants completed an electronic survey to evaluate satisfaction with the teaching and areas for improvement. From January 2022 through January 2023, newly hired NPs paired with experienced NP mentors participated in this structured workshop. Twenty-eight participants in two cohorts evaluated the workshop to identify meaningful aspects of the presentations and areas for improvement. Participants reported high levels of satisfaction with the interactive components of the 4-hr workshop. An interactive mentoring workshop helps participants establish realistic expectations and mutual goals. Further study is needed to identify time- and cost-efficient strategies in the preparation of effective mentoring participants to enhance the quality of mentoring programs.
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Affiliation(s)
- Colleen Reilly Moss
- Vanderbilt University School of Nursing, Nashville, Tennessee
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
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3
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Dyess NF, Keels E, Myers P, French H, Reber K, LaTuga MS, Johnston LC, Scala M. Optimizing clinical care and training in the neonatal intensive care unit: the relationship between front line providers and physician trainees. J Perinatol 2023; 43:1513-1519. [PMID: 37580512 DOI: 10.1038/s41372-023-01749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/21/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
Changes in neonatal intensive care unit (NICU) coverage models, restrictions in trainee work hours, and alterations to the training requirements of pediatric house staff have led to a rapid increase in utilization of front-line providers (FLPs) in the NICU. FLP describes a provider who cares for neonates and infants in the delivery room, nursery, and NICU, and includes nurse practitioners, physician assistants, and/or hospitalists. The increasing presence and responsibility of FLPs in the NICU have fundamentally changed the way patient care is provided as well as the learning environment for trainees. With these changes has come confusion over role clarity with resulting periodic conflict. While staffing changes have addressed a critical clinical gap, they have also highlighted areas for improvement amongst the teams of NICU providers. This paper describes the current landscape and summarizes improvement opportunities with a dynamic neonatal interprofessional provider team.
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Affiliation(s)
| | - Erin Keels
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Patrick Myers
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Heather French
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Melissa Scala
- Stanford University School of Medicine, Palo Alto, CA, USA.
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Neonatal Care Provider Tasks for Hospitalized Well Newborns. Adv Neonatal Care 2022; 22:523-530. [PMID: 34966057 DOI: 10.1097/anc.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Changes in the pediatrician's practice model have created demand for other medical care providers for hospitalized well newborns. Well newborn care may be the responsibility of those who work in any level I-IV neonatal intensive care units, whether in a primary or secondary role. No recent publications exist about how to approach the organization of tasks. PURPOSE The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of hospitalized well newborns for learners or occasional care providers. METHODS The methods used in this project included literature review to develop evidence-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization of well newborn care provided by skilled providers in the hospital. The goal is to establish a reference to support education about these approaches, which appear to be rooted in tradition. FINDINGS Evidence-based resources include an overview of provider tasks and responsibilities for well newborn care for each hospital day and per shift. IMPLICATION FOR RESEARCH Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes. IMPLICATION FOR PRACTICE These resources may provide structure for learners or occasional providers who have studied the physiology, pathophysiology, and problem management concepts but need to learn how to execute their responsibilities in these busy environments.
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Neonatal Care Provider Tasks in the NICU and Delivery Room. Adv Neonatal Care 2022; 22:215-222. [PMID: 34334678 DOI: 10.1097/anc.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decreased availability of pediatric residents in neonatal intensive care units (NICUs) has created demand for other neonatal medical care providers. No recent publications exist about how to approach the organization of tasks involved in that care. PURPOSE The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of sick and premature infants in the NICU. METHODS The methods included a literature review to develop evidenced-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization during patient rounds and care in the NICU, and for delivery attendance by skilled providers. The goal, to establish a reference to support education about these approaches, is based upon evidence, which appears to be rooted in tradition. FINDINGS Evidence-based resources include documentation templates, problem list in order of systems, and provider tasks for NICU and delivery attendance. IMPLICATION FOR RESEARCH Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes. IMPLICATION FOR PRACTICE These resources may provide structure for learners and providers who have studied the physiology, pathophysiology, and problem management concepts, but need to learn how to execute their responsibilities in these busy environments.
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Growing Neonatal Advanced Practice Providers via Mentorship Can Fill the Need: Program Description and Tool Kit. Adv Neonatal Care 2022; 22:140-153. [PMID: 33783386 DOI: 10.1097/anc.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The need for neonatal advanced practice providers (APPs) has been described. Hospital training programs for neonatal physician assistants (PAs) have been developed by physicians. No publications exist about programs administered by neonatal APPs for both new graduate neonatal nurse practitioners (NNPs) and neonatal PAs. PURPOSE The purpose of this work was to mentor, train, and hire neonatal APPs in a program administered by neonatal APPs. METHODS We developed a 2-pronged approach to attract PAs and new graduate NNPs. Marketing strategies included receptions, information, and mentorship. A 12-month neonatal PA fellowship program included clinical mentorship and weekly didactics. Case-based presentations were provided by neonatal APPs, neonatologists, and allied professionals. The new graduate NNP program included clinical mentorship and monthly meetings with peer support, lectures, and case presentations. Neonatal APPs were clinical mentors. Team-building activities supported mentorship and collaboration among all care providers. FINDINGS In less than 5 years, 10 PAs and 11 new graduate NNPs have been trained and hired, as well as experienced neonatal APPs hired for this regional neonatology program. For the first time in years, locum tenens neonatal APPs are not required. We have developed a "tool kit" of content, activities, exercises, and evaluations to support successful attainment of expected competencies. IMPLICATION FOR RESEARCH Future studies can measure retention, satisfaction, and clinical outcomes. IMPLICATION FOR PRACTICE A successful training program has been implemented to meet the growing demand. We support the values of integrity, collaboration, and equity to facilitate this successful paradigm shift among all neonatal professional team members.
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Do We Nurture Our Young? Qualitative Conceptual Analysis of Worst and Best Mentorship Experiences Among Neonatal Advanced Practice Providers. Adv Neonatal Care 2021; 21:E129-E137. [PMID: 33675304 DOI: 10.1097/anc.0000000000000843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is increasing demand for neonatal advanced practice providers (APPs) and a shortage of neonatal nurse practitioners (NNPs). In many neonatal intensive care units, neonatal physician assistants are trained and hired, as well as new graduate NNPs. Neonatal APPs are utilized as mentors in a regional neonatology program in the Pacific Northwest. As part of a long-term goal to develop an educational program for neonatal APP mentors, an initial survey was administered. PURPOSE The purpose of this survey was to raise personal insight and identify themes about 51 neonatal APP mentors' recollections of one's own worst and best mentorship experiences. METHODS The design used in this content analysis of survey responses included a phenomenological, qualitative approach. The participants received an online survey consisting of 2 questions asking them to describe their worst and best mentorship experiences. The blinded results were analyzed via content analysis by 2 coinvestigators. RESULTS Consistent themes about worst experiences include "Eat our young," "I am better than you," "Thrown under bus," and "Unwanted." Consistent themes about best experiences include "Validation," "Empowerment," "Positivity," and "Inclusion." IMPLICATIONS FOR PRACTICE Recommendations for successful neonatal APP mentorship based upon the recurrent themes include use of consistent, engaged, trained, and supported mentors, provision of on-time constructive feedback, avoidance of public criticism, private and public praise, focus on the learner, preparation for tasks, and semiautonomy, with adequate support. IMPLICATIONS FOR RESEARCH Absenteeism, recruitment, retention, and satisfaction data may be measured to determine whether structured mentorship programs are beneficial.
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Abstract
This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future.
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Affiliation(s)
- Erin L Keels
- National Association of Neonatal Nurses, Chicago, Illinois.,Nationwide Children's Hospital, Columbus, Ohio; and
| | - Jay P Goldsmith
- Department of Pediatrics, Tulane University, New Orleans, Louisiana
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Moote M, Krsek C, Kleinpell R, Todd B. Republished: Physician Assistant and Nurse Practitioner Utilization in Academic Medical Centers. Am J Med Qual 2019; 34:465-472. [DOI: 10.1177/1062860619873216] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to collect information on the utilization of physician assistants (PAs) and nurse practitioners (NPs) in academic health centers. Data were gathered from a national sample of University HealthSystem Consortium member academic medical centers (AMCs). PAs and NPs have been integrated into most services of respondent AMCs, where they are positively rated for the value they bring to these organizations. The primary reason cited by most AMCs for employing PAs and NPs was Accreditation Council for Graduate Medical Education resident duty hour restrictions (26.9%). Secondary reasons for employing PAs and NPs include increasing patient throughput (88%), increasing patient access (77%), improving patient safety/quality (77%), reducing length of stay (73%), and improving continuity of care (73%). However, 69% of AMCs report they have not successfully documented the financial impact of PA/NP practice or outcomes associated with individual PA or NP care.
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Affiliation(s)
- Marc Moote
- University of Michigan Hospitals and Health Centers, Ann Arbor, MI
| | | | | | - Barbara Todd
- University of Pennsylvania Health System, Philadelphia, PA
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Abu Jawdeh EG, Hardin-Fanning F, Kinnard TB, Cunningham MD. Neonatal postgraduate training program for physician assistants: meeting a need in neonatal care. J Perinatol 2019; 39:746-753. [PMID: 30858612 DOI: 10.1038/s41372-019-0350-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/26/2018] [Accepted: 01/18/2019] [Indexed: 11/09/2022]
Abstract
There is a growing need for advanced practice providers in the NICU. Physician assistants (PAs) with postgraduate training in neonatology can help meet these demands. The premise of training PAs to work in the NICU is being adopted by multiple centers nationwide. Unfortunately, there are no standardized curricula for neonatal PA training that can be utilized to initiate residencies. Since our program is the longest running neonatal PA residency in the nation, we are in a unique position to share the accumulated experiences of our curriculum development. In this article, we describe our neonatal PA residency as it exists today with selected lessons learned. In addition, we present mixed qualitative and quantitative assessments of graduates. We believe that neonatal PA residency graduates become ideal candidates to fill the growing national need. We propose that our model program can be a stepping stone to enhance the role of PAs in neonatal care.
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Affiliation(s)
- Elie G Abu Jawdeh
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
| | | | - Tria B Kinnard
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA.
| | - M Douglas Cunningham
- Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, USA
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11
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Abstract
No consensus definition exists for postgraduate physician assistant (PA) training. This report from the AAPA Task Force on Accreditation of Postgraduate PA Training Programs describes the types of clinical training programs and their effects on hiring and compensation of PAs. Although completing a postgraduate program appears to have no effect on compensation, PAs who complete these programs may be favored in the hiring process and frequently report greater confidence in their skills. More research is needed and program accreditation is key to monitoring the effectiveness of these programs.
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Dovlo D, King-Harry II, Ousman K. Non-physician Clinicians - A Gain for Physicians' Working in Sub-Saharan Africa Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians". Int J Health Policy Manag 2017; 6:119-121. [PMID: 28812789 PMCID: PMC5287929 DOI: 10.15171/ijhpm.2016.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
The changing demands on the health sectors in low- and middle-income countries especially sub-Saharan African countries continue to challenge efforts to address critical shortages of the health workforce. Addressing these challenges have led to the evolution of "non-physician clinicians" (NPCs), that assume some physician roles and thus mitigate the continuing shortage of doctors in these countries. While it is agreed that changes are needed in physicians' roles and their training as part of the new continuum of care that includes NPCs, we disagree that such training should be geared solely at ensuring physicians dominated health systems. Discussions on the workforce models to suit low-income countries must avoid an endorsement of a culture of physician focused health systems as the only model for sub-Saharan Africa (SSA). It is also essential that training for NPCs be harmonized with that of physicians to clarify the technical roles of both.
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Affiliation(s)
- Delanyo Dovlo
- World Health Organization (WHO) Africa Region Office, Brazzaville, Congo
| | | | - Kevin Ousman
- Department of Health System Policies and Operations, World Health Organization Regional Office for Africa (AFRO) Brazzaville, Congo
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Schell GJ, Lavieri MS, Jankovic F, Li X, Toriello A, Martyn KK, Freed GL. Strategic modeling of the neonatal nurse practitioner workforce. Nurs Outlook 2016; 64:385-394. [DOI: 10.1016/j.outlook.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 11/25/2022]
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Journey to Becoming a Neonatal Nurse Practitioner: Making the Decision to Enter Graduate School. Adv Neonatal Care 2016; 16:E3-11. [PMID: 26945281 DOI: 10.1097/anc.0000000000000256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal nurse practitioners (NNPs) play an important role in caring for premature and ill infants. Currently, there is a shortage of NNPs to fill open positions. Understanding how nurses decide to become NNPs will help practicing nurse practitioners, managers, and faculty encourage and support nurses in considering the NNP role as a career choice. PURPOSE To describe how nurses decide to enter graduate school to become nurse practitioners. METHODS A qualitative study using semistructured interviews to explore how 11 neonatal intensive care unit nurses decided to enter graduate school to become NNPs. RESULTS Key elements of specialization, discovery, career decision, and readiness were identified. Conditions leading to choosing the NNP role include working in a neonatal intensive care unit and deciding to stay in the neonatal area, discovering the NNP role, deciding to become an NNP, and readiness to enter graduate school. Important aspects of readiness are developing professional self-confidence and managing home, work, and financial obligations and selecting the NNP program. IMPLICATIONS FOR PRACTICE Neonatal nurse practitioners are both positive role models and mentors to nurses considering the role. Unit managers are obligated to provide nurses with opportunities to obtain leadership skills. Faculty of NNP programs must be aware of the impact NNP students and graduates have on choices of career and schools. IMPLICATIONS FOR RESEARCH Exploring the decision to become an NNP in more geographically diverse populations will enhance understanding how neonatal intensive care unit nurses decide to become NNPs.
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Moote M, Krsek C, Kleinpell R, Todd B. Physician assistant and nurse practitioner utilization in academic medical centers. Am J Med Qual 2011; 26:452-60. [PMID: 21555487 DOI: 10.1177/1062860611402984] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to collect information on the utilization of physician assistants (PAs) and nurse practitioners (NPs) in academic health centers. Data were gathered from a national sample of University HealthSystem Consortium member academic medical centers (AMCs). PAs and NPs have been integrated into most services of respondent AMCs, where they are positively rated for the value they bring to these organizations. The primary reason cited by most AMCs for employing PAs and NPs was Accreditation Council for Graduate Medical Education resident duty hour restrictions (26.9%). Secondary reasons for employing PAs and NPs include increasing patient throughput (88%), increasing patient access (77%), improving patient safety/quality (77%), reducing length of stay (73%), and improving continuity of care (73%). However, 69% of AMCs report they have not successfully documented the financial impact of PA/NP practice or outcomes associated with individual PA or NP care.
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Affiliation(s)
- Marc Moote
- University of Michigan Hospitals and Health Centers, Office of Clinical Affairs, 1500 E.Medical Center Drive, Ann Arbor, MI 48109-0825, USA.
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Abstract
BACKGROUND Data on the perfomance of physician assistants in a medical intensive care unit are scarce. OBJECTIVE To compare clinical outcomes between patients admitted to a resident-run MICU and a PA-run MICU. METHODS Retrospective analysis of prospectively collected MICU data was performed for 5,346 patients admitted to an MICU from January 2004 through January 2007; 3,971 patients were admitted to a resident-run MICU (resident group) and 1,375 to a PA-run MICU (PA group). RESULTS The groups were relatively similar, though the resident group had a higher rate of renal insufficiency (25% vs. 22%, P = .05) and the PA group had a higher rate of cerebrovascular accidents (5.6% vs. 4%, P = .02). Hospital length of stay (LOS) was similar, with a median of 9 days in the PA group and 8 days in the resident group (P = .59). MICU LOS was slightly longer for the PA group: a median of 2.58 days (1.55-4.86) vs. 2.33 days (1.39-4.16) in the resident group. After matching by propensity score, we could not confirm this increased LOS. There was no difference in hospital mortality or in ICU mortality between the two groups either in uncontrolled or controlled analyses. Survival analyses showed no difference in 28-day survival between the two groups. CONCLUSION A PA-run MICU has similar outcomes when compared to a resident-run MICU.
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Freed GL, Dunham KM, Loveland-Cherry C, Martyn KK. Family nurse practitioners: roles and scope of practice in the care of pediatric patients. Pediatrics 2010; 126:861-4. [PMID: 20956411 DOI: 10.1542/peds.2010-2157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to characterize the pediatric role and scope of practice of family nurse practitioners (FNPs). METHODS A mail survey of a random national sample of 1000 FNPs, stratified according to states that license nurse practitioners to practice independently, was performed. Frequencies were calculated and bivariate analyses were performed to determine the level of association between practice characteristics and practice state, practice location (urban versus rural), and type of care provided (primary versus specialty). RESULTS The overall response rate was 75.9%. Sixty-six percent of respondents (n = 416) reported that they currently provided care to children, and 18% (n = 110) reported that they had never provided care to children. Fifty-four percent of FNPs who provided care to children (n = 222) reported that children represented ≤ 25% of their current patient populations. Few FNPs (9% [n = 39]) reported that children represented >75% of their total patient populations. CONCLUSIONS Among FNPs who provide care to children, pediatric patients represent only a small fraction of their patient populations. FNPs are unlikely to have a significant impact on the availability of either primary or subspecialty care for children in the near future.
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Affiliation(s)
- Gary L Freed
- University of Michigan, School of Public Health, Child Health Evaluation and Research Unit, 300 North Ingalls Building, Ann Arbor, MI 48109-0456, USA.
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Freed GL, Dunham KM, Moote MJ, Lamarand KE. Pediatric physician assistants: distribution and scope of practice. Pediatrics 2010; 126:851-5. [PMID: 20956413 DOI: 10.1542/peds.2010-1586] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Physician assistants (PAs) are licensed to practice with physician supervision. PAs do not specialize or subspecialize as part of their formal standard training; consequently, their license is not limited to a specific specialty. As such, PAs can, and do, change their practice settings at will. Some researchers have projected plans for the future use of the pediatric PA workforce. However, the information on which those projections have been based is limited. OBJECTIVE To provide information regarding the current status of pediatric PAs and to inform future workforce deliberations, we studied their current distribution and scope of practice. METHODS Data from the American Association of Physician Assistants and the US Census Bureau were used to map the per-capita national distribution of pediatric PAs. We conducted a mail survey of a random sample of 350 PAs working in general pediatrics and 300 working in pediatric subspecialties. RESULTS Most states have <50 pediatric PAs, and there is significant variation in their distribution across the nation. The overall survey response rate was 83.5%; 82% (n = 359) were female. More than half of the respondents (57% [n = 247]) reported that they currently are working in pediatric primary care, mostly in private-practice settings. CONCLUSIONS PAs can, and do, play an important role in the care of children in the United States. However, the impact of that role is limited by the relative scarcity of PAs currently engaged in pediatric practice.
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Affiliation(s)
- Gary L Freed
- University of Michigan, School of Public Health, Child Health Evaluation and Research (CHEAR) Unit, 300 North Ingalls Building, Ann Arbor, MI 48109-0456, USA.
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Freed GL, Dunham KM, Lamarand KE, Loveland-Cherry C, Martyn KK. Neonatal nurse practitioners: distribution, roles and scope of practice. Pediatrics 2010; 126:856-60. [PMID: 20956408 DOI: 10.1542/peds.2010-1596] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to determine the distribution and scope of practice of the neonatal nurse practitioner (NNP) workforce across the United States. METHODS To determine distribution, we used counts of certified NNPs from the National Certification Corp (Chicago, IL). We calculated state NNP/child population ratios as the number of NNPs divided by the state population 0 to 17 years of age. We calculated NNP/NICU bed ratios as the number of NNPs divided by the total number of NICU beds per state. To characterize roles and scope of practice, we conducted a mail survey of a random national sample of 300 NNPs in states that license nurse practitioners to practice independently and 350 NNPs in states that require physician involvement. RESULTS The greatest concentrations of NNPs per capita were in the Midwest, South, and Mid-Atlantic region. Thirty-one states had <100 total NNPs. The survey response rate was 77.1%. More than one-half of NNP respondents (54% [n = 211]) reported that they spent the majority of their time in a community hospital, whereas more than one-third (37% [n = 144]) were in an academic health center. Only 2% (n = 7) reported that they engaged in independent practice. CONCLUSIONS As with many health care professionals, the supply of NNPs may not be distributed according to need. With increasing concern regarding the availability of NNPs, comprehensive studies that examine the demand for NNPs and the roles of other clinicians in the NICU should provide a greater understanding of appropriate NICU workforce capacity and needs.
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Affiliation(s)
- Gary L Freed
- University of Michigan, School of Public Health, Child Health Evaluation and Research Unit, 300 North Ingalls Building, Ann Arbor, MI 48109-0456, USA.
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Pediatric nurse practitioners in the United States: current distribution and recent trends in training. J Pediatr 2010; 157:589-93, 593.e1. [PMID: 20553842 DOI: 10.1016/j.jpeds.2010.04.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/15/2010] [Accepted: 04/14/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). STUDY DESIGN Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. RESULTS PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. CONCLUSION Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.
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Lee HC, Chitkara R, Halamek LP, Hintz SR. A national survey of pediatric residents and delivery room training experience. J Pediatr 2010; 157:158-161.e3. [PMID: 20304418 PMCID: PMC2886184 DOI: 10.1016/j.jpeds.2010.01.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 12/31/2009] [Accepted: 01/14/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate current delivery room training experience in US pediatric residency programs and the relationship between volume of delivery room training and confidence in neonatal resuscitation skills. STUDY DESIGN Links to a web-based survey were sent to pediatric residency programs and distributed to residents. The survey concerned delivery room attendance during training and comfort level in leading neonatal resuscitation for various scenarios. Comfort level was rated on a 1 to 9 scale. Mixed models accounted for residency programs as random effects. RESULTS For PL-3s, the mean number of deliveries attended was 60 (standard deviation, 43), ranging from 13 to 143 deliveries for individual residency programs. Residents' confidence level in leading neonatal resuscitation was higher when attending more deliveries, with 90.3% of those attending>48 deliveries having average score 5 or greater vs 51.5% of those attending<21 deliveries. Higher attendance also correlated with confidence in endotracheal intubation and umbilical line placement. CONCLUSIONS Wide variability existed within and among residency programs in number of deliveries attended. Volume of experience correlated with confidence in leading neonatal resuscitation and related procedural skills.
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Affiliation(s)
- Henry Chong Lee
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0734, USA.
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Abstract
Neonatal nurse practitioners (NNPs) represent a high-demand specialty practice that is especially targeted for US secondary and tertiary care neonatal intensive care units (NICUs). NNPs make primary decisions about the caregiving of high-risk newborns at the time of admission, throughout hospitalization, at transfer, and at discharge that require an advanced knowledge base in neonatology as well as NICU clinical experience. NNPs prepared at the master's level are currently in very short supply, with some estimates suggesting that for each NNP who graduates, there are 80 positions open across the country. Even with the present shortage, due to the high cost of NNP education, NNP programs are diminishing and those that are remaining are not graduating a sufficient number of new NNPs each year to keep up with the demand. To add to the basic shortage problem, in 2004 the American Association of Colleges of Nursing decided that by 2015, the terminal degree for all nurse practitioners should move from the master's degree to the doctor of nursing practice (DNP) degree. That decision added a minimum of 12 months of full-time education to the advanced education requirements for nurse practitioners. What impact will the decision to require a DNP degree have on NNP specialty practice? Will even more NNP programs close because of faculty shortages of NNPs prepared at the DNP level? If a worse shortage occurs in the number of NNPs prepared to practice in NICUs, will physician assistants or other nonphysician clinicians who meet the need for advanced neonatal care providers replace NNPs? What steps, if any, can nursing take to ensure that NNP specialty practice is still needed and survives after supplementing the DNP requirement to NNP education?
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Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the intensive care unit: An evidence-based review. Crit Care Med 2008; 36:2888-97. [DOI: 10.1097/ccm.0b013e318186ba8c] [Citation(s) in RCA: 202] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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