Nurse Practitioners as Most Responsible Provider: Impact on Care for Seniors Admitted to an Ontario Hospital

Abstract

Background and Significance: Evidence for Nurse Practitioners (NP) hospital based roles positively impacting patient care exist. Information on the NP in the Most Responsible Pronder (MRP) role exists in pockets of primary care in Canada and the United States. NP hospital roles have only been evaluated in the context of consultation and shared care. There is limited understanding of the NP role from the MRP lens during care across the hospital trajectory. Aim: To examine patient, family and staff experience with the quality of NP care delivered as the MRP from admission to discharge. Methodology: A mixed methods pilot study examined qualitative NP satisfaction surveys and quantitative data related to the total number of admissions and discharges in a community hospital in Ontario. Data Analysis Results: A total of 602 admissions, 555 discharges, 25 deaths and 45 transfers occurred with NPs practicing as MRPs. The average senior was 78 years old. Survey response rates for patients were 69%, families 41%, and staff 72%. Satisfaction surveys revealed staff worked with NPs for an average of 4 years. Chronbach alpha demonstrated high internal consistency across all groups (a .943). ANOVA analysis showed statistical significance with Question 6 NP approachability (p< .001). Bonferroni post hoc analysis revealed that staff responses statistically differed from family responses (P <.001). Correlation matrix of questions found significance at both 0.05 and 0.01 levels (two tailed). Conclusion: Nurse Practitioners are able to function as most responsible provides delivering hospital care from admission through discharge with high patient, family and staff satisfaction and quality caring. A critical research opportunity exists to fully explore NP role contributions as the MRP for hospitalized populations in both community and academic hospitals. Implications for practice: Enabling, empowering and embracing NP maximal scope of practice contributions as the MRP can be valuable across the continuum of hospital experiences. NP care to meet complex senior care is a timely, safe and an innovative quality caring solution. Full implementation and sustainability for the model of care is a research rich area for exploration.