To Reach the Future, NPs Must Eliminate Obsolete Acute Care Rules

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

An increasing number of countries are exploring the option of introducing Advanced Practice Nurses (APN), such as Nurse Practitioners (NP), as part of the health care workforce. This is particular relevant in light of the increase of the elderly and chronically ill. It is crucial that this introduction is preceded by an in depth understanding of the concept of advanced practice nursing as well as an analysis of the context. Firstly, a conceptual clarification of Advanced Practice Nurses and Nurse Practitioners is provided. Secondly, a framework is introduced that assists in the analysis of the introduction and development of Advanced Practice Nurse roles in a particular health care system. Thirdly, outcomes research on Advanced Practice Nursing is presented. Argumentation developed using data based papers and policy reports on Advanced Practice Nursing. The proposed framework consists of five drivers: (1) the health care needs of the population, (2) education, (3) workforce, (4) practice patterns and (5) legal and health policy framework. These drivers act synergistically and are dynamic in time and space. Outcomes research shows that nurse practitioners show clinical outcomes similar to or better than those of physicians. Further examples demonstrate favourable outcomes in view of the six Ds of outcome research; death, disease, disability, discomfort, dissatisfaction and dollars, for models of care in which Advanced Practice Nurses play a prominent role. Advanced Practice Nurses such as Nurse Practitioners show potential to contribute favourably to guaranteeing optimal health care. Advanced Practice Nurses will wield the greatest influence on health care by focusing on the most pressing health problems in society, especially the care of the chronically ill.

Increasing Families' Health Care Access and Choice Through Full Practice Authority

Obama, Physicians Prepare for Health Reform

Congress and MedPAC Weigh Options for Medicare Physician Payment Reform

Collective Genius

Review question/objective This review asks “What is the experience and effectiveness of nurse practitioners in orthopaedic settings”? The objective of the quantitative component of this review is to synthesise the best available evidence on effectiveness of orthopaedic nurse practitioner specific care on patient outcomes and process indicators. The objective of the qualitative component of this review is to synthesise the best available evidence on the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The objective of the text and opinion component of this review is to synthesise the best available evidence of the contemporary discourse on the effectiveness and experience of nurse practitioners in orthopaedic settings. Types of participants Nurse practitioner is an expanded form of advanced practice.11 For the purpose of this systematic review the International Council of Nurses (ICN) definition20 of nurse practitioner will apply whereby a Nurse Practitioner/Advanced Practice Nurse is defined as a Registered Nurse with expert knowledge, complex decision making skills and possessing competency for expanded practice. Importantly the practice of nurse practitioner/advanced practice nurse is characterised further by the “context and/or country” that they practice within.20 Therefore an ‘orthopaedic’ nurse practitioner is defined in accordance with the above definition and with a specific scope of practice (as authorised) within a relevant and specific ‘orthopaedic’ setting. The quantitative and qualitative components of this review will consider studies that include orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings. The textual component of this review will consider publications that pertain to orthopaedic nurse practitioners in acute care or sub-acute orthopaedic settings, where there exists a particular focus on the ‘orthopaedic’ aspect of nurse practitioner practice. Types of intervention(s)/phenomena of interest The quantitative component of this review will examine interventions of orthopaedic nurse practitioner specific care. For this systematic review, orthopaedic nurse practitioner specific care refers to those aspects of care the orthopaedic nurse practitioner is responsible for and/or records as performance outcomes such as: occasions of service/numbers seen; time to and length of nurse practitioner consultation; time to nurse practitioner intervention; referral patterns and other measures of intervention effectiveness. The qualitative component of the review will examine as phenomena of interest the experience of becoming or being an orthopaedic nurse practitioner in relation to role development, role implementation and (ongoing) role evaluation. The text and opinion component of the review will examine opinions on the effectiveness and experience of nurse practitioners in orthopaedic settings including role development, implementation and evaluation of nurse practitioners in orthopaedic settings. Types of outcomes The quantitative component of this review will consider as primary outcomes the following patient outcomes: • patients’ level of pain • pressure injury • urinary tract infection • patient satisfaction • in-hospital patient mortality • hospital readmission • patients’ health-related quality of life • functional status • malnutrition score • constipation • wound care/complications • other clinical complications • morbidity • other patient encounter data that characterise orthopaedic nurse practitioner practice • other relevant nurse-sensitive outcome data The quantitative component of this review will consider as secondary outcomes the following nurse related outcomes or process indicators/outcomes: • orthopaedic nurse practitioner satisfaction • key stakeholder (health professional) satisfaction • specialised knowledge/skill translation • hospital length of stay • cost benefit

2011 Medicare Fees Are Mostly Uncertain

‘Fiscal Cliff’ Deal Halts SGR Cut—For Awhile

Nursing Home Physicians Could Get Fee Hike

Australian research investigating the role of nurse practitioners: A view from implementation science

The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, challenges the nursing profession to take a key role in redesigning the health care system. Intended to shape the future of nursing in the United States, the IOM report has implications for nursing worldwide. While individual states and nursing organizations are developing initiatives to implement the IOM recommendations in the United States, there must be a concomitant effort to examine the ripple effect on global health and the nursing community. This article addresses four IOM recommendations that are directly relevant to internationally educated nurses who practice across borders: nurse residency programs, lifelong learning, leading change to advance health, and interprofessional health care workforce data. The article discusses the IOM recommendations through a global perspective and offers policy implications for legislators, health care organizations and nurse educators, regulators and administrators.

Should Nurse Practitioner Programs Share Courses?

Nursing Programs Could Sharpen LTC Focus

Invest in nursing: the backbone of health care systems.