Experience with a nurse practitioner program in the surgical department of a children's hospital

Abstract

Manpower limitations are occurring in residency programs because of fewer residency positions and increasing governmental regulations. This limitation prompted the development of a program to utilize pediatric nurse practitioners (PNPs) in our Department of Surgery. Two began in September 1989. Their role was similar to that of the junior resident and included collaborative management of patients, admission evaluations, discharges, and a variety of procedures. The impact of this program was evaluated by questionnaire to attending surgeons, house staff, and parents. There were 123 surveys mailed (12 attending surgeons, 46 residents, 65 parents). The overall response rate was 51% (100% attending surgeons, 57% residents, and 38% parents). Only two of the attending surgeons had previous experience working with a PNP. All attending surgeons were enthusiastic about the PNP role in managing their patients and felt the PNP had decreased the workload of the resident. Eighty-three percent did not feel the PNP interfered with resident learning; 17% were undecided. Eleven of 12 felt the PNP had helped communication between them and their patients; one was undecided. The resident responses were assessed by level of training. Among senior residents, 82% felt the PNP had decreased the workload of the junior resident and 91% viewed the PNP as a valuable resource, whereas 87% of the junior residents felt the PNP decreased their workload and 100% felt the PNP was a valuable resource. None of the residents felt the PNP interfered with their learning and 73% of the junior residents and 55% of the senior residents felt the PNP contributed to their learning. Forty-seven percent of the junior residents felt the PNPs' availability provided them with more time in the operating suite. Of the parents surveyed, 40% had previous experience with a PNP. Ninety-six percent were pleased with the involvement of the PNP in their child's care and the PNPs' knowledge base; 4% were undecided. Eighty-four percent of parents felt the PNP facilitated communication with their surgeon and 92% felt the PNP kept them well informed about their child's progress. All of the parents felt the PNP was easily accessible to answer their questions. In conclusion, the implementation of the PNP role has been well received by attending staff, resident staff, and parents. The new PNP program has achieved its goals, decreasing resident workload while providing safe, efficient care. The program has been expanded to 4 PNPs and has proven to be an effective measure to improve care of pediatric surgical patients.