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Yamaguchi Y, Matsunaga-Myoji Y, Fujita K. Advanced practice nurse competencies to practice in emergency and critical care settings: A scoping review. Int J Nurs Pract 2023:e13205. [PMID: 37735934 DOI: 10.1111/ijn.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/16/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
AIM Advanced Practice Nurses are expected to provide lifesaving care to patients with complex acute illnesses in emergency and critical care settings. However, little is known about their competencies and barriers to practice in emergency and critical care settings. This review investigated these nurses' competencies to practice. METHODS A scoping review was conducted in accordance with Arksey and O'Malley's framework. Extensive research searches were conducted using seven electronic databases: MEDLINE, CINAHL, Scopus, Web of Science, Ichushi Web, Mednar and GreyNet International. Definitions and explanations of Advanced Practice Nurse competencies were categorized into elements and grouped according to similarity. RESULTS The database searches identified 2,483 studies, and data were extracted for 23 studies. Analysed studies were published between 2000 and 2021 and conducted in eight countries. Seven competencies were identified: performing advanced practice nursing, acute patient care, diagnostic assessment, interdisciplinary collaboration and consultation, leadership and system management, documenting patient care and supporting patient and family decision-making. CONCLUSION This review identified competencies unique to Advanced Practice Nurses in emergency and critical care settings. Further research is required to facilitate understanding of the crucial roles of advanced care nurses among healthcare providers.
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Affiliation(s)
- Yu Yamaguchi
- Department of Nursing, Kyushu University Hospital, Fukuoka, Japan
| | - Yuriko Matsunaga-Myoji
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kimie Fujita
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Workload in the Cardiac ICU: You Down With APPs? Pediatr Crit Care Med 2021; 22:753-755. [PMID: 34397990 DOI: 10.1097/pcc.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Busl KM, Bleck TP, Varelas PN. Neurocritical Care Outcomes, Research, and Technology: A Review. JAMA Neurol 2020; 76:612-618. [PMID: 30667464 DOI: 10.1001/jamaneurol.2018.4407] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Neurocritical care has grown into an organized specialty that may have consequences for patient care, outcomes, research, and neurointensive care (neuroICU) technology. Observations Neurocritical care improves care and outcomes of the patients who are neurocritically ill, and neuroICUs positively affect the financial state of health care systems. The development of neurocritical care as a recognized subspecialty has fostered multidisciplinary research, neuromonitoring, and neurocritical care information technology, with advances and innovations in practice and progress. Conclusions and Relevance Neurocritical care has become an important part of health systems and an established subspecialty of neurology. Understanding its structure, scope of practice, consequences for care, and research are important.
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Affiliation(s)
- Katharina Maria Busl
- NeuroIntensive Care Unit, University of Florida Health Shands Hospital, Gainesville.,Department of Neurology, Division of Neurocritical Care, College of Medicine, University of Florida, Gainesville
| | - Thomas P Bleck
- Rush University Medical Center, Rush Medical College, Chicago, Illinois
| | - Panayiotis N Varelas
- Neurosciences Critical Care Services, Neuro-Intensive Care Unit, Henry Ford Hospital, Wayne State University, Detroit, Michigan
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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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Neurointensive (NCCU) Care Business Planning. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs. Crit Care Med 2017; 45:e132-e137. [PMID: 27632677 DOI: 10.1097/ccm.0000000000002055] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare usage patterns and outcomes of a nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. DESIGN Retrospective chart review of 1,157 medical ICU admissions from March 2012 to February 2013. SETTING Large urban academic university hospital. SUBJECTS One thousand one hundred fifty-seven consecutive medical ICU admissions including 221 nurse practitioner-staffed medical ICU admissions (19.1%) and 936 resident-staffed medical ICU admissions (80.9%). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data obtained included age, gender, race, medical ICU admitting diagnosis, location at time of ICU transfer, code status at ICU admission, and severity of illness using both Acute Physiology and Chronic Health Evaluation II scores and a model for relative expected mortality. Primary outcomes compared included ICU mortality, in-hospital mortality, medical ICU length of stay, and post-ICU discharge hospital length of stay. Patients admitted to the nurse practitioner-staffed medical ICU were older (63 ± 16.5 vs 59.2 ± 16.9 yr for resident-staffed medical ICU; p = 0.019), more likely to be transferred from an inpatient unit (52.0% vs 40.0% for the resident-staffed medical ICU; p = 0.002), and had a higher severity of illness by relative expected mortality (21.3 % vs 17.2 % for the resident-staffed medical ICU; p = 0.001). There were no differences among primary outcomes except for medical ICU length of stay (nurse practitioner-resident-staffed 7.9 ± 7.5 d vs resident-staffed medical ICU 5.6 ± 6.5 d; p = 0.0001). Post-hospital discharge to nonhome location was also significantly higher in the nurse practitioner-ICU (31.7% in nurse practitioner-staffed medical ICU vs 23.9% in resident-staffed medical ICU; p = 0.24). CONCLUSIONS We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.
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Abstract
OBJECTIVES Educational demands coupled with restricted hours reduce residents' availability to provide care at academic hospitals. Physician assistants (PAs) may address this issue. This study assessed the effect of PAs on patient discharges, resident workload, and resident perceptions of PAs on a surgical team. METHODS Two PAs were employed on teams caring for complex surgical patients. Measures included time of discharge order entry, hours residents spent on the electronic medical record (EMR), and resident opinions of PA effectiveness. RESULTS The teams with PAs had a 0.5% late discharge and 16% early discharge rate. Junior residents with a PA on the team spent fewer hours on the EMR. Residents reported PAs significantly improved their rotation and quality care. CONCLUSIONS PAs reduce resident workload and improve care on surgical teams in a tertiary hospital.
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Abstract
Implementation of the Affordable Care Act (2010) enabled more than 30 million people to have new access to primary care services. On the basis of current utilization patterns, demand for primary care providers is expected to grow more rapidly than physician supply. This imbalance is expected to worsen, as the aging population requires more health care resources. In addition, more patients are requiring critical care services and physician numbers are not keeping with this growing need. Restrictions on resident physician practice hours have impacted inpatient care as well. Revisiting outdated state practice laws, and considering Full Practice Authority (FPA) for nurse practitioners (NP), is needed for improving access to care while creating greater flexibility for development of patient-centered health care homes and other emerging models of care delivery. Currently, 21 states and the District of Columbia have adopted FPA for NPs, with 15 more states planning legislation in 2016. Allowing FPA and Prescriptive Authority (PA) enables NPs to become more efficient and effective patient care team members. However, physician resistance to FPA and PA presents barriers to implementation.
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Affiliation(s)
- Deborah Dillon
- University of Virginia School of Nursing, Charlottesville (Dr Dillon); and Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Dr Gary)
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Optimizing Team Dynamics: An Assessment of Physician Trainees and Advanced Practice Providers Collaborative Practice. Pediatr Crit Care Med 2016; 17:e430-6. [PMID: 27464890 DOI: 10.1097/pcc.0000000000000881] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The presence of advanced practice providers has become increasingly common in many ICUs. The ideal staffing model for units that contain both advanced practice providers and physician trainees has not been described. The objectives of this study were to evaluate ICU staffing models that include physician trainees and advanced practice providers and their effects on patient outcomes, resident and fellow education, and training experience. A second aim was to assess strategies to promote collaboration between team members. DATA SOURCES PubMed, CINAHL, OVID MEDLINE, and Cochrane Review from 2002 to 2015. STUDY SELECTION Experimental study designs conducted in an ICU setting. DATA EXTRACTION Two reviewers screened articles for eligibility and independently abstracted data using the identified search terms. DATA SYNTHESIS We found 21 articles describing ICU team structure and outcomes. Four articles were found describing the impact of advanced practice providers on resident or fellow education. Two articles were found discussing strategies to promote collaboration between advanced practice providers and critical care fellows or residents. CONCLUSIONS Several articles were identified describing the utilization of advanced practice providers in the ICU and the impact of models of care on patient outcomes. Limited data exist describing the impact of advanced practice providers on resident and fellow education and training experience. In addition, there are minimal data describing methods to enhance collaboration between providers. Future research should focus on determining the optimal ICU team structure to improve patient outcomes, education of trainees, and job satisfaction of team members and methods to promote collaboration between advanced practice providers and physicians in training.
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A description of Canadian epilepsy monitoring units: An initial step toward developing nursing practice consensus guidelines. Epilepsy Behav 2016; 57:145-150. [PMID: 26953844 DOI: 10.1016/j.yebeh.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The epilepsy monitoring unit (EMU) is a well-established resource for investigating patients' seizures but is known to be heterogeneous in organization and clinical practice. The purpose of this study was to gain a better understanding of similarities and differences in EMU characteristics across Canada, with specific emphasis on EMU organization and nursing resources, which were currently unknown. Results would be used to develop a consensus on best nursing practice guidelines in EMUs with the goal to improve patient care and safety during epilepsy monitoring admissions. METHODS An 18-item survey was developed addressing EMU locations, types, nursing ratios, nursing roles, and other allied health resources. Surveys were distributed to lead nurses, physicians, and administrators in 29 EMUs across Canada. Results were tabulated and presented for each question in the survey. CONCLUSION All EMUs were located in urban, teaching centers and divided similarly by patient age. The survey demonstrated considerable variability in EMU bed location and organization with the majority of EMUs being smaller, open units embedded in wards rather than larger, closed units. Independent of patient acuity, variability also existed in nurse-to-patient ratios, nursing skill level, specialty nursing support, and EEG technician availability. These findings highlight that EMU heterogeneity contributes to the challenges in the development of standardized safe care practices and that nursing education and nursing best practice recommendations need to be developed with baseline EMU nursing competencies, skills, and knowledge in mind.
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Abstract
PURPOSE OF REVIEW Growth in critical care services has led to a dramatic increase in the need for ICU physicians. The supply of intensivists is not easily increased and there is pressure to solve this problem by increasing the number of patients per intensivist. There is a scarcity of published data addressing this issue, and until recently, there were no guidelines on appropriate ratios of intensivists to patients. RECENT FINDINGS In 2013, the Society of Critical Care Medicine formed a task force to address this issue and published written guidelines to aid hospitals in determining their intensivist staffing. This study reviews the published data which can aid these decisions and summarize the SCCM Taskforce's recommendations. SUMMARY The complex nature of critical care patients and ICUs make it difficult to provide one specific maximum intensivist-to-patient ratio, but common-sense rules can be applied. These recommendations are predicated on the principles that staffing can impact patient care as well as staff well-being and workforce stability. Also, that worsening patient outcomes, teaching, and workforce issues can be markers of inappropriate staffing. Finally, if the predicted daily workload of an intensivist exceeds the time of a work shift, then adjustments need to be made.
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Costa DK, Wallace DJ, Barnato AE, Kahn JM. Nurse practitioner/physician assistant staffing and critical care mortality. Chest 2015; 146:1566-1573. [PMID: 25167081 DOI: 10.1378/chest.14-0566] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND ICUs are increasingly staffed with nurse practitioners/physician assistants (NPs/PAs), but it is unclear how NPs/PAs influence quality of care. We examined the association between NP/PA staffing and in-hospital mortality for patients in the ICU. METHODS We used retrospective cohort data from the 2009 to 2010 APACHE (Acute Physiology and Chronic Health Evaluation) clinical information system and an ICU-level survey. We included patients aged ≥ 17 years admitted to one of 29 adult medical and mixed medical/surgical ICUs in 22 US hospitals. Because this survey could not assign NPs/PAs to individual patients, the primary exposure was admission to an ICU where NPs/PAs participated in patient care. The primary outcome was patient-level in-hospital mortality. We used multivariable relative risk regression to examine the effect of NPs/PAs on in-hospital mortality, accounting for differences in case mix, ICU characteristics, and clustering of patients within ICUs. We also examined this relationship in the following subgroups: patients on mechanical ventilation, patients with the highest quartile of Acute Physiology Score (> 55), and ICUs with low-intensity physician staffing and with physician trainees. RESULTS Twenty-one ICUs (72.4%) reported NP/PA participation in direct patient care. Patients in ICUs with NPs/PAs had lower mean Acute Physiology Scores (42.4 vs 46.7, P < .001) and mechanical ventilation rates (38.8% vs 44.2%, P < .001) than ICUs without NPs/PAs. Unadjusted and risk-adjusted mortality was similar between groups (adjusted relative risk, 1.10; 95% CI, 0.92-1.31). This result was consistent in all examined subgroups. CONCLUSIONS NPs/PAs appear to be a safe adjunct to the ICU team. The findings support NP/PA management of critically ill patients.
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Affiliation(s)
- Deena Kelly Costa
- Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - David J Wallace
- Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Amber E Barnato
- Division of General Internal Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
| | - Jeremy M Kahn
- Clinical Research, Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; University of Pittsburgh School of Medicine; and Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
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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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Davies J, Lynch F, Nyman A, Riphagen S. The role and scope of retrieval nurse practitioners in the UK. Nurs Crit Care 2015; 21:243-51. [DOI: 10.1111/nicc.12167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/13/2015] [Accepted: 01/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Jo Davies
- Sister and Paediatric Retrieval Nurse Practitioner, Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Fiona Lynch
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Andrew Nyman
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
| | - Shelley Riphagen
- Paediatric Intensive Care, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust; London UK
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Strategies for Reducing Hospitalization Costs and Improving Health Care Access for Veterans. Prof Case Manag 2015; 20:43-9. [DOI: 10.1097/ncm.0000000000000075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A systematic review of advance practice providers in acute care: options for a new model in a burn intensive care unit. Ann Plast Surg 2014; 72:285-8. [PMID: 24509138 DOI: 10.1097/sap.0000000000000106] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Accreditation Council for Graduate Medical Education mandated work-hour restrictions have negatively impacted many areas of clinical care, including management of burn patients, who require intensive monitoring, resuscitation, and procedural interventions. As surgery residents become less available to meet service needs, new models integrating advanced practice providers (APPs) into the burn team must emerge. We performed a systematic review of APPs in critical care questioning, how best to use all providers to solve these workforce challenges? METHODS We performed a systematic review of PubMed, CINAHL, Ovid, and Google Scholar, from 2002 to 2012, using the key words: nurse practitioner, physician assistant, critical care, and burn care. After applying inclusion/exclusion criteria, 18 relevant articles were selected for review. In addition, throughput and financial models were developed to examine provider staffing patterns. RESULTS Advanced practice providers in critical care settings function in various models, both with and without residents, reporting to either an intensivist or an attending physician. When APPs participated, patient outcomes were similar or improved compared across provider models. Several studies reported considerable cost-savings due to decrease length of stay, decreased ventilator days, and fewer urinary tract infections when nurse practitioners were included in the provider mix. CONCLUSIONS Restrictions in resident work-hours and changing health care environments require that new provider models be created for acute burn care. This article reviews current utilization of APPs in critical care units and proposes a new provider model for burn centers.
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Kannampallil TG, Jones LK, Patel VL, Buchman TG, Franklin A. Comparing the information seeking strategies of residents, nurse practitioners, and physician assistants in critical care settings. J Am Med Inform Assoc 2014; 21:e249-56. [PMID: 24619926 PMCID: PMC4173183 DOI: 10.1136/amiajnl-2013-002615] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Critical care environments are information-intensive environments where effective decisions are predicated on successfully finding and using the 'right information at the right time'. We characterize the differences in processes and strategies of information seeking between residents, nurse practitioners (NPs), and physician assistants (PAs). METHOD We conducted an exploratory study in the cardiothoracic intensive care units of two large academic hospitals within the same healthcare system. Clinicians (residents (n=5), NPs (n=5), and PAs (n=5)) were shadowed as they gathered information on patients in preparation for clinical rounds. Information seeking activities on 96 patients were collected over a period of 3 months (NRes=37, NNP=24, NPA=35 patients). The sources of information and time spent gathering the information at each source were recorded. Exploratory data analysis using probabilistic sequential approaches was used to analyze the data. RESULTS Residents predominantly used a patient-based information seeking strategy in which all relevant information was aggregated for one patient at a time. In contrast, NPs and PAs primarily utilized a source-based information seeking strategy in which similar (or equivalent) information was aggregated for multiple patients at a time (eg, X-rays for all patients). CONCLUSIONS The differences in the information seeking strategies are potentially a result of the differences in clinical training, strategies of managing cognitive load, and the nature of the use of available health IT tools. Further research is needed to investigate the effects of these differences on clinical and process outcomes.
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Affiliation(s)
- Thomas G Kannampallil
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, USA
| | - Laura K Jones
- Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Vimla L Patel
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, USA
| | - Timothy G Buchman
- Department of Surgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Amy Franklin
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, USA
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Abstract
The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology.
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The Acute Care Nurse Practitioner and the Transition to Pay for Performance. J Nurse Pract 2013. [DOI: 10.1016/j.nurpra.2013.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Before integrating nurse practitioners into a critical care environment, it is important to understand the infrastructure and support necessary to guide clinical practice and utilization. NP practice teams should be structured with a cohesive strategy to provide 24/7 patient coverage and consistency in evidence-based care.
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Squiers J, King J, Wagner C, Ashby N, Parmley CL. ACNP intensivist: a new ICU care delivery model and its supporting educational programs. J Am Assoc Nurse Pract 2012; 25:119-25. [PMID: 24218198 DOI: 10.1111/j.1745-7599.2012.00789.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purposes of this article are to describe a physician (MD)/acute care nurse practitioner (ACNP) intensivist model for delivery of critical care services in a tertiary academic medical center and to describe an innovative nurse practitioner educational program developed to support the model. In an effort to address the current shortage of intensivists, Vanderbilt Medical Center has developed and refined a multidisciplinary intensivist MD/ACNP teams to provide expanded critical care services. The ACNPs, in collaboration with intensivist MDs, function as intensivist teams and are responsible for developing and executing the daily medical plan, bedside procedures, and emergency response. These teams provide 24-h a day coverage of tertiary level ICUs, and provide several unique benefits over traditional resident ICU staffing models. As the concept of the MD/ACNP intensivist team has developed, Vanderbilt University School of Nursing ACNP Program has expanded its curriculum to provide graduates with the knowledge, skills, and experiences to safely manage unstable critically ill patients. Multidisciplinary critical care teams of MD intensivists who work in collaboration with ACNP intensivists address the current shortfall of intensivists and represent a cost-effective means for expanding ICU coverage and increasing ICU bed availability while maintaining Leap Frog ICU staffing compliance.
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Affiliation(s)
- Joshua Squiers
- Vanderbilt University School of Nursing, Nashville, Tennessee; Division of Anesthesiology-Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Gershengorn HB, Johnson MP, Factor P. The use of nonphysician providers in adult intensive care units. Am J Respir Crit Care Med 2011; 185:600-5. [PMID: 22135345 DOI: 10.1164/rccm.201107-1261cp] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States there are not currently enough critical care-trained practitioners to provide care to all critically ill patients. With calls for "high-intensity" staffing and 24-hour coverage of our intensive care units, the board-certified intensivists we do have are being stretched ever more thin. Nonphysician providers (physician assistants and nurse practitioners) are being used with increasing frequency in critical care settings to provide care to critically ill patients. In this review, we explore the impact of introducing nonphysician providers into the adult intensive care unit.
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Affiliation(s)
- Hayley B Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Medical Center, and Albert Einstein College of Medicine, New York, NY 10003, USA.
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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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Morris DS, Rohrbach J, Rogers M, Thanka Sundaram LM, Sonnad S, Pascual J, Sarani B, Reilly P, Sims C. The Surgical Revolving Door: Risk Factors for Hospital Readmission. J Surg Res 2011; 170:297-301. [DOI: 10.1016/j.jss.2011.04.049] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/29/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
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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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Midlevel Health Providers Impact on ICU Length of Stay, Patient Satisfaction, Mortality, and Resource Utilization. J Trauma Nurs 2011. [DOI: 10.1097/jtn.0b013e31822b7faf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Abstract
The changing health care environment and provider shortage have required acute care pediatric nurse practitioners (AC PNPs) to play a vital role in hospital-based, subspecialty surgical services. The AC PNP is part of a multidisciplinary team providing care for children with congenital heart disease after heart surgery. The AC PNP provides high-quality, cost-effective care to acute and critically ill children, optimizing hospital throughput while ensuring patient safety. This article focuses on the history and emerging role of the AC PNP in the context of the Magnet component of transformational leadership, the physician/nurse practitioner collaborative practice, and the development of the AC PNP role in cardiothoracic surgery at the Children's Hospital Los Angeles.
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Papathanassoglou ED. Advanced critical care nursing: a novel role with ancient history and unprecedented challenges worldwide. Nurs Crit Care 2011; 16:55-7. [DOI: 10.1111/j.1478-5153.2011.00446.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Achieving "meaningful use" of electronic health records through the integration of the Nursing Management Minimum Data Set. J Nurs Adm 2010; 40:336-43. [PMID: 20661064 DOI: 10.1097/nna.0b013e3181e93994] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To update the definitions and measures for the Nursing Management Minimum Data Set (NMMDS). BACKGROUND Meaningful use of electronic health records includes reuse of the data for quality improvement. Nursing management data are essential to explain variances in outcomes. The NMMDS is a research-based minimum set of essential standardized management data useful to support nursing management and administrative decisions for quality improvement. METHODS The NMMDS data elements, definitions, and measures were updated and normalized to current national standards and mapped to LOINC (Logical Observation Identifier Names and Codes), a federally recognized standardized data set for public dissemination. RESULTS The first 3 NMMDS data elements were updated, mapped to LOINC, and publicly disseminated. CONCLUSIONS Widespread use of the NMMDS could reduce administrative burden and enhance the meaningful use of healthcare data by ensuring that nursing relevant contextual data are available to improve outcomes and safety measurement for research and quality improvement in and across healthcare organizations.
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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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Shin JJ, Randolph GW, Rauch SD. Evidence-based medicine in otolaryngology, part 1: The multiple faces of evidence-based medicine. Otolaryngol Head Neck Surg 2010; 142:637-46. [DOI: 10.1016/j.otohns.2010.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 12/24/2009] [Accepted: 01/13/2010] [Indexed: 11/26/2022]
Abstract
Evidence-based medicine, with its capacity to improve patient outcomes, has grown prominent throughout the medical field. Otolaryngology is at a crucial stage in the expansion of evidence-based medicine, with its impact seen in many arenas. As the evidence continues to shape our field, we hope to serve our otolaryngology community through this invited series, which is dedicated to the exposition of evidence-based medicine and its applications. This first installment examines evidence-based medicine itself and its multiple interpretations, including a purist view, a population-based view, and a view centered on the individual. Strengths and weaknesses of each are discussed, as well the potential for unification and evolution of these concepts. We also place evidence-based medicine in the context of the mindset of traditional medicine and anticipate future developments.
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Affiliation(s)
- Jennifer J. Shin
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA
- Division of Head and Neck Surgery, Southern California Permanente Medical Group, Los Angeles Medical Center, Los Angeles, CA
| | | | - Steven D. Rauch
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA
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Yeager S. The neuroscience acute care nurse practitioner: role development, implementation, and improvement. Crit Care Nurs Clin North Am 2010; 21:561-93. [PMID: 19951771 DOI: 10.1016/j.ccell.2009.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the number and opportunities for acute care nurse practitioners (ACNPs) continue to increase, the successful integration of these providers into the health care setting becomes more of a challenge. This article outlines strategies for role development, implementation, and evaluation to optimize the performance of the neuroscience ACNP role. The concepts presented are applicable across all acute-care specialties that use ACNPs.
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Affiliation(s)
- Susan Yeager
- Critical Care Trauma and Burn, The Ohio State University Medical Center, 410 West 10th Avenue, Columbus, OH 43210-1228, USA.
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Summers D, Leonard A, Wentworth D, Saver JL, Simpson J, Spilker JA, Hock N, Miller E, Mitchell PH. Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient. Stroke 2009; 40:2911-44. [DOI: 10.1161/strokeaha.109.192362] [Citation(s) in RCA: 158] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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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Maier E, Jensen L, Sonnenberg B, Archer S. Interpretation of exercise stress test recordings: concordance between nurse practitioner and cardiologist. Heart Lung 2008; 37:144-52. [PMID: 18371507 DOI: 10.1016/j.hrtlng.2007.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 05/10/2007] [Accepted: 05/14/2007] [Indexed: 10/22/2022]
Abstract
AIM Cardiology nurse practitioners (NPs) conduct exercise stress tests (ESTs) for diagnosis of cardiac disease. The diagnostic concordance of NPs to cardiologists has not been assessed. The hypothesis was that an NP is as reliable as a cardiologist in determining ST-segment depression, detecting arrhythmias, and making a diagnostic assessment. METHODS An NP and two cardiologists (C1 and C2) were provided with 100 consecutive, anonymized ESTs, consisting of three 10-second, 12-lead tracings obtained at baseline, peak-exercise, and recovery. Interpretation was based on baseline rhythm, baseline and maximal exercise ST levels, arrhythmias, and global diagnosis (positive, negative, or inconclusive for ischemia). Raters used uniform criteria to interpret ESTs and were blinded to prior EST interpretation and computerized ST-segment analysis. RESULTS There was similar concordance between the NP and cardiologists as between the cardiologists, measured by Kappa coefficients (rhythm: NP vs. C1 = .92, NP vs. C2 = .84, C1 vs. C2 = .84; arrhythmias: NP vs. C1 = .77, NP vs. C2 = .73, C1 vs. C2 = .75; EST diagnosis: NP vs. C1 = .75, NP vs. C2 = .73, C1 vs. C2 = .75). Pearson correlations demonstrated concordance for baseline ST levels (NP vs. C1 = .86, NP vs. C2 = .86, C1 vs. C2 = .90) and peak exercise ST levels (NP vs. C1 = .58, NP vs. C2 = .48, C1 vs. C2 = .67). CONCLUSIONS Concordance among raters, and with the computer-generated algorithm, was moderate to high for all parameters of EST interpretation. This study lends support to NPs interpreting ESTs.
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Affiliation(s)
- Evelyn Maier
- Division of Cardiology, University of Alberta Hospital, Edmonton, Canada
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Bahouth M, Esposito-Herr MB, Babineau TJ. The expanding role of the nurse practitioner in an academic medical center and its impact on graduate medical education. JOURNAL OF SURGICAL EDUCATION 2007; 64:282-288. [PMID: 17961886 DOI: 10.1016/j.jsurg.2007.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 06/19/2007] [Accepted: 08/09/2007] [Indexed: 05/25/2023]
Abstract
PURPOSE Academic medical centers (AMCs) have used nurse practitioners (NPs) for the provision of direct patient care for many years. However, as more NPs are hired to fill in the void created by both the 80-hour work week and the increased demands on attendings' time, their role has evolved in terms of patient care and graduate medical education. We sought to evaluate the expanded role of the NP in our large tertiary AMC to help clarify the interrelationships with the patient care delivery model and GME. METHODS Data were collected through interviews of NPs, nurses, attendings, and residents. Data were analyzed to identify trends contributing to successful models of practice and their impact on patient care and graduate medical education (GME). RESULTS Interviews were completed with 58/74 (78%) NPs employed at our medical center. Anonymous written surveys were completed by 41 (55%) providers. In terms of perceived impact on the role NPs played in GME, 77% of NPs surveyed felt that their role complimented the resident training; 9% felt that their role competed with resident training; and 14% felt that their role had no impact on resident training. CONCLUSION We believe that the presence of an experienced NP on a care deliver team can enhance the educational experience of residents as well as provide continuity of patient care in the era of the 80-hour work week.
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Affiliation(s)
- Mona Bahouth
- University of Maryland Medical Center, Baltimore, Maryland 21201, USA
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Abstract
On a daily basis, advanced practice nurses in acute and critical care settings impact outcomes for patients, families, and evidence-based practice.
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46
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Caserta FM, Depew M, Moran J. Acute care nurse practitioners: the role in neuroscience critical care. J Neurol Sci 2007; 261:167-71. [PMID: 17568614 DOI: 10.1016/j.jns.2007.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In order to meet the needs of the high acuity population in today's critical care environment, the role of the Acute Care Nurse practitioner (ACNP) has been adopted by many intensive care units (ICU's) across the country, including specialized neurocritical care units. In this chapter we will provide a brief historical review of the ACNP as well as their function in various ICU settings. Lastly, we will describe the current role of the ACNP in the Neurosciences Critical Care Unit at the Johns Hopkins Hospital as well as future plans and challenges of the role.
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Affiliation(s)
- Filissa M Caserta
- Acute Care Nurse Practitioner Program, Neurosciences Critical Care Unit, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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47
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Verschuur EML, Kuipers EJ, Siersema PD. Nurses working in GI and endoscopic practice: a review. Gastrointest Endosc 2007; 65:469-79. [PMID: 17321249 DOI: 10.1016/j.gie.2006.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Accepted: 11/07/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Over the last 10 years, nurses increasingly perform tasks and procedures that were previously performed by physicians. OBJECTIVE In this review, we investigated what types of GI care and endoscopic procedures nurses presently perform and reviewed the available evidence regarding the benefits of these activities. DESIGN Review of published articles on nurses' involvement in GI and endoscopic practice. RESULTS In total, 19 studies were identified that evaluated performance and participation of nurses in GI and endoscopic practice. Of these, 3 were randomized trials on the performance of nurses in flexible sigmoidoscopy (n = 2) and upper endoscopy (n = 1). Fourteen nonrandomized studies evaluated performance in upper endoscopy (n = 2), EUS (n = 1), flexible sigmoidoscopy (n = 7), capsule endoscopy (n = 2), and percutaneous endoscopic gastrostomy placement (n = 2). In all studies, it was found that nurses accurately and safely performed these procedures. Two further studies demonstrated that nurses adequately managed follow-up of patients with Barrett's esophagus and inflammatory bowel disease. Four of the 19 studies showed that patients were satisfied with the type of care nurses provided. Finally, it was suggested that costs were reduced if nurses performed a sigmoidoscopy and evaluated capsule endoscopy examinations compared with physicians performing these activities. CONCLUSIONS The findings of this review support the involvement of nurses in diagnostic endoscopy and follow-up of patients with chronic GI disorders. Further randomized trials, however, are needed to demonstrate whether this involvement compares at least as favorably with gastroenterologists in terms of medical outcomes, patient satisfaction, and costs.
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Affiliation(s)
- Els M L Verschuur
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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Howie-Esquivel J, Fontaine DK. The evolving role of the acute care nurse practitioner in critical care. Curr Opin Crit Care 2007; 12:609-13. [PMID: 17077696 DOI: 10.1097/mcc.0b013e32800ff256] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The newest nurse practitioner role is the acute care nurse practitioner. This paper presents the latest data on the role from both a US and international perspective. RECENT FINDINGS Now present in the USA for at least 15 years, the acute care nurse practitioner role has become well established in critical care settings and is moving into international healthcare. The few outcome studies conducted to date demonstrate the acute care nurse practitioner provides quality patient and family care, improves patient satisfaction, is cost effective, and is an answer to the hospital's shortage of medical residents with new restrictions on working hours. SUMMARY The role of acute care nurse practitioners in critical care is increasing worldwide. Most countries are experimenting with this latest nurse practitioner as an extended-role healthcare provider with many potential benefits to patients and their families, as well as the healthcare system.
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Affiliation(s)
- Jill Howie-Esquivel
- School of Nursing, University of California, San Francisco, California 94143-0604, USA
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Yeager S, Shaw KD, Casavant J, Burns SM. An Acute Care Nurse Practitioner Model of Care for Neurosurgical Patients. Crit Care Nurse 2006. [DOI: 10.4037/ccn2006.26.6.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Susan Yeager
- Susan Yeager works as an acute care nurse practitioner for the neurological critical care unit at Riverside Methodist Hospitals in Columbus, Ohio
| | - Katherine Dale Shaw
- Katherine Dale Shaw is an advanced practice nurse in acute care neurosurgery at the University of Virginia Health System in Charlottesville
| | - Jennifer Casavant
- Jennifer M. Casavant is an acute care nurse practitioner in neurosurgery at the University of Virginia Health System in Charlottesville and a doctoral candidate at the University of Virginia School of Nursing
| | - Suzanne M. Burns
- Suzanne M. Burns is a professor of nursing in the acute and specialty care division and an advanced practice nurse in the medical intensive care unit at the University of Virginia Health System in Charlottesville
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Reigle J, Molnar HM, Howell C, Dumont C. Evaluation of In-patient Interventional Cardiology. Crit Care Nurs Clin North Am 2006; 18:523-9. [PMID: 17118307 DOI: 10.1016/j.ccell.2006.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ACNP service in this study decreased the TA, TC, and LOS for patients transferred from outlying hospitals for cardiac catheterization or PCI. Patients on the ACNP service were provided prescription for appropriate discharge medications including beta-blockers, aspirin, ACE inhibitors, and lipid-lowering agents more often than patients on the housestaff service. Other aspects of care, including follow-up appointments and elements of patient education, were documented more often for patients on the ACNP interventional cardiac service and expand the role of ACNPs into other areas of acute-care cardiology practice.
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Affiliation(s)
- Juanita Reigle
- University of Virginia Health System, Charlottesville, VA 22908, USA.
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