Abstract 3774: Clinical Nurse Specialists, Nurse Practitioners&Physician Assistants Roles in the care of Stroke Patients

Abstract

Background: The promotion of acute stroke care is stronger now than it has ever been with hospitals being encouraged to become primary and comprehensive stroke centers (PSC & CSC). This is a hardship for some institutions due to the national shortage of American Board of Psychiatry and Neurology certified Vascular Neurologists and Emergency Medicine Physicians’ concern over independent decision making regarding thrombolysis eligibility without neurology collaboration. Hospitals and private physician practices are turning to Clinical Nurse Specialists (CNS), Nurse Practitioners (NP) and Physician Assistants (PA) to provide a continuum and maintain coordination of care in concurrence with vascular neurologists. The aim of this presentation is to identify the CNS-NP-PA roles and responsibilities. Method: An eight question, multiple choice with 3 multiple answer survey, which addressed certification, duration of stroke experience, role with CT reviewing, thrombolysis administration, and duties was sent to community and academic PSC and CSC CNS-NP-PAs from Neurovascular Education and Training in Stroke Management and Acute Reperfusion Therapy (NET SMART) program by means of a URL. Results: There were 44 respondents, NPs 65.9%, PAs 4.9% and CNS 29.2% with experience in stroke care totaling 1 to 2.9 years in 20.5%, 3 to 4.9 years in 15.9% and ≥ 5 years in 63.6%. Acute CT evaluation was completed autonomously by 10%, with radiology collaboration in 47.5%, and with neurology collaboration in 37.5%, with 5% responding “do not review”. Multiple choice with multiple answers pertaining to thrombolysis decision making; 7.3% reported working autonomously, 29.3% with physician collaboration by telephone, 63.4% with physician at bedside, and 17.1% reported no involvement with thrombolysis decisions. Delineation of responsibilities, also completed with multiple answers included acute inpatient stroke care for 95.2%, out patient stroke care for 23.8%, discharge planning 45.2%, stroke coordinator role 71.4%, core measure database extraction for 50.0% with input of database completed by 47.6%. Education conducted for patients at 81%, for nursing was 90.5%, for peers at 57.1%, for medical residents 40.5%, for neurology residents 16.7% and for community education 73.8% of responders. Conclusion: Although individual responsibilities may vary, the survey illustrates the CNS-NP-PA are valuable roles in the assessment, diagnosis, management, coordination and continuum of stroke care. More research is warranted to further evaluate these roles and quality stroke patient outcomes.