Care Nurse Practitioners Research Articles

C19TM: A nurse practitioner and physician assistant-led telemonitoring initiative ensures timely transfer of critically ill coronavirus disease 2019 patients.

The coronavirus disease 2019 (COVID-19) pandemic has required swift implementation of innovative practices in health care across the globe. We describe a nurse practitioner (NP) and physician assistant (PA)-led initiative to implement telemonitoring (TM) of noncritical patients with COVID-19 by critical care NPs and PAs (C19TM) for early detection of decompensation and early transfer to the intensive care unit (ICU). Every hospitalized patient with suspected or confirmed COVID-19 received an initial telemedicine consult with a critical care NP or PA. Patients were subsequently monitored via electronic health record once every 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability. If signs of decompensation were noted, the NP/PA would remotely reassess the patient, provide recommendations to the hospital internal medicine team, and transfer the patient to the ICU. The primary goal was to avoid cardiopulmonary deterioration requiring aerosol-generating procedures outside of the ICU. Over 65 days, 113 patients (86 suspected and 27 confirmed) were enrolled in C19TM. As a result, there were 13 transfers to the ICU, none of which required an aerosol-generating procedure outside of the ICU.

The Growing Primary Care Nurse Practitioner Workforce: A Solution for the Aging Population Living With Dementia

Redesigning the healthcare workforce to meet the needs of the growing population of persons living with dementia (PLWD), most of whom reside in the community and receive care from primary care providers, is a national priority. Yet, the shortage of adequately trained providers is raising concerns that the primary care system is not equipped to care for PLWD. The growing nurse practitioner (NP) workforce could bridge this gap. In this review, the authors synthesized the existing evidence from fourteen studies on the utilization of NPs to care for PLWD in primary care. Although the authors found that most NPs were engaged in co-management roles, emerging evidence suggests that NPs also serve as primary care providers for PLWD. Findings describe the impact of NP care on the health system, PLWD, and caregiver outcomes. The authors conclude that the optimal utilization of NPs can increase the capacity of delivering dementia-capable primary care.

Use of Long-Term Care Facilities for Primary Care Nurse Practitioner Students.

Family and adult-gerontology primary care nurse practitioner (NP) students must obtain patient clinical hours caring for older adults. Primary care occurs in a variety of settings, including long-term care (LTC) facilities. Anecdotal reports indicate that faculty in some primary NP academic programs do not recognize the robust primary care opportunities that exist in LTC settings. This article describes a professional nursing organization's process of researching the appropriateness of designating LTC clinical hours as allowable primary care clinical experiences for NP students. The NP serves as an integral member of the LTC team, providing the same elements of primary care provided in traditional ambulatory care settings. Older adults receiving primary care in LTC settings have a variety of health care needs, including assessment and management of acute and chronic conditions. A position statement was developed for primary care NP students and endorsed by 22 professional organizations and NP programs. [J Nurs Educ. 2021;60(2):99-102.].

Use of multifunctional electronic health records and burnout among primary care nurse practitioners

Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients. This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout. This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items-computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout. Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13-0.71, p = .01). With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout.

Objective Structured Clinical Examinations as a Method of Competency Evaluation in a Primary Care Nurse Practitioner Program.

Objective structured clinical examinations (OSCEs) are an effective method of instruction and evaluation. Their use in nurse practitioner (NP) programs as a means of evaluation warrants further exploration. The purpose of this project was to test the applicability and feasibility of implementation of OSCEs as a means of formative evaluation in a primary care NP program and to determine student feedback about the experience. This project evaluated the implementation of an educational intervention using 2 previously developed and tested OSCE scenarios with standardized patients. Mean scores were computed for the subcategories, as well as for global rating scores on the OSCE. Strong correlations were found across categories within the scenario; no correlations were found between scenarios. Moderate intraclass correlation coefficients were achieved. Student feedback about the experience, including perceived competence and confidence, was overwhelmingly positive. This project demonstrates success of a pilot OSCE program.

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Should Pediatric Behavioral Health Issues be Treated by Primary Care Providers?

Origin and Outcomes of Acute Care Nurse Practitioner Practice.

Acute care nurse practitioners (NPs) are educated, clinically trained, and board certified to care for acutely and critically ill patients, largely in hospital settings. Acute care NPs can positively impact patient care outcomes and are often added to acute care teams to drive optimal, reliable, efficient, and safe care, often referred to as "high value" care.

Use of a State Registry to Compare Practices of Physicians and Nurse Practitioners in Completing Physician Orders for Life-Sustaining Treatment Forms.

Background: Understanding the role of nonphysicians in Physician Orders for Life-Sustaining Treatment (POLST) completion is limited. Objectives: To examine the role that nurse practitioners (NPs) play in POLST completion and differences between NPs and physicians in POLST orders. Design: Retrospective observational study. Setting/Subjects: A total of 3829 POLST forms submitted to the West Virginia (WV) e-Directive Registry between July 1, 2018 and June 30, 2019, which was completed by 98 NPs and 511 physicians. Measurements: POLST forms completed and orders in POLST Section A and Section B by all physicians and NPs according to practice (primary care, palliative care, hospital, and nursing home) and by palliative care physicians and NPs only. Results: NPs completed almost twice as many forms on average as physicians (9.54 ± 20.82 vs. 5.66 ± 17.18, p = 0.0064). NPs constituted 16.10% (98/609) of the clinicians writing POLST forms but completed 24.40% (935/3829) of the forms (p < 0.001). Compared with physicians' orders, a greater percentage of NP's orders was for do-not-resuscitate in Section A (87.20% vs. 72.60%, p < 0.001) and comfort measures in Section B (42.90% vs. 33.10%, p < 0.001). There was a greater percentage of NPs in palliative care practice than physicians (23.50% vs. 6.07%, p < 0.001), and palliative care NPs completed 64.20% (600/935) of the forms submitted by NPs compared with palliative care physicians who completed 17.90% (517/2894) of the forms submitted by physicians (p < 0.001). Conclusions: In WV, physician and NP POLST completion differs based on practice. NPs completed significantly more POLST forms on average and more often ordered comfort measures. NPs can play a significant role in POLST completion.

Integrating nurse practitioners into primary care: policy considerations from a Canadian province

BackgroundThe integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons.MethodsFifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method.ResultsStakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized.ConclusionsIn general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

Surveying Primary Care Nurse Practitioners: An Overview of National Sampling Frames.

Nurse practitioners (NPs) represent the fastest growing segment of the U.S. primary care workforce. Surveys of primary care NPs can help to better understand the care NPs deliver across different health care settings, the factors that impact NP job satisfaction and burnout, and the structural capabilities required to support their practice. The purpose of this article is to provide an overview of national sampling frames that can be used by researchers interested in surveying or studying the U.S. primary care NP workforce. We conducted an environmental scan and review of published literature on the NP workforce to identify data sources that can be used to sample primary care NPs. In this article, we (a) identify the data elements needed to develop an NP sampling frame and (b) describe national data sets that can be used to sample primary care NPs, including the strengths and weaknesses of each. This information is intended to facilitate research on the primary care NP workforce to inform practice and policy.

Practice Patterns, Work Environments, and Job Outcomes of Rural and Urban Primary Care Nurse Practitioners.

As nurse practitioners (NPs) are increasingly relied on to deliver primary care in rural communities, it is critical to understand the contexts in which they work and whether they are characterized by work environments and infrastructures that facilitate the provision of high-quality patient care. This study compares urban and rural NPs using data from a survey of 1,244 primary care NPs in Arizona, California, New Jersey, Pennsylvania, Texas, and Washington. While rural and urban NPs have a number of similarities in terms of demographic characteristics, practice patterns, and job outcomes, they also have noteworthy differences. Rural NPs report higher levels of independent practice, fewer structural capabilities that facilitate quality care, and poorer relationships with physicians. Health care organizations in rural communities may need to invest in work environments and infrastructures that facilitate high-quality care and autonomous practice for NPs.

Evaluation of two academic practice partnerships for chronic disease management in nursing education

More clinical sites are essential to meeting the learning needs of nursing students who will care for patients with chronic disease after graduation. Partnerships between schools of nursing and academic practices can increase clinical training capacity, allow future nurse practitioners (NPs) to apply knowledge and skills in the context of care delivery, and potentially improve patient outcomes with little associated risk. This article describes the experiences of primary care NP students (n=37), NP faculty (n=2), and clinic providers (n=2) in an academic practice partnership performing home visits with complex pediatric asthma and adult heart failure (HF) patients. A 14-item postexperience survey was used to obtain student feedback. Over 75% (n=28) of student participants responded. Most respondents, 80% assigned to pediatric asthma patients and 90% assigned to adult HF patients, reported the home visit experience prepared them to care for patients with chronic diseases. Clinic providers indicated the extra attention to both patient groups reduced barriers to care and improved care continuity. This partnership offers a model for developing clinical skills in advanced practice nursing students and enhancing scarce clinical placement resources. Findings were used to refine the program and expand to include all 150 students in the subsequent academic year.

Characteristics and perceptions of the US nurse practitioner hospitalist workforce.

The use of nurse practitioners (NPs) as hospitalists has grown over the last two decades. Based on current educational preparation, certification, and scope of practice, the acute care NP is considered by professional standards the best prepared to care for the needs of acutely and critically ill patients. Little is known about this sector of the NP workforce. The study was designed to identify the NP hospitalist workforce's characteristics and describe the NP hospitalist workforce's perception of the work environment. We deployed five questions in the 2019 American Association of Nurse Practitioners National NP Sample Survey. Of 880 respondents working in an eligible inpatient setting, 366 responded that they work as hospitalists caring for adult patients. Most respondents (n = 275, 74.7%) were certified in primary care. On-the-job training was the most common qualification to be an NP hospitalist (n = 274, 75%). The majority (n = 252, 68.9%) had a collaborative relationship with a physician at their site. Job satisfaction was significantly correlated with full utilization of one's education and practicing to the fullest extent of the state's scope of practice with an r(360) = .719, p = .00 (two-tailed). The prevalence of on-the-job training as the most common preparation for the hospitalist role suggests a need to evaluate the effectiveness and outcomes of NPs not initially educated as acute care NPs who work as hospitalists. Nurse practitioner educators should address the evolving workforce needs of both primary and acute care practice when planning and implementing educational programs.

Evaluating Patient Satisfaction of Nurse Practitioner Care in the Hospital Setting: A Qualitative Pilot Study

Aim: The purpose of this study is to develop a tool and assess patient satisfaction with inpatient Nurse Practitioner (NP) care.Design: A 10 item questionnaire was administered to hospital inpatients cared for directly by one of two NP’s.Methods: Patients were given a point of care tablet to answer the survey questions with yes or no. The primary outcomes measured were satisfaction with the hospital NP in quality of care, effective communication, and discharge planning.Results: A total of 19 patients participated in this study. 100% of patients felt that nurse practitioners communicated the plan of care effectively, clearly communicated medication information, answered all questions effectively, and knew what to expect when they went home. Between 80-89.5% of patients understood their discharge goals, what they may need after discharge, and understood what signs and symptoms to look for after discharge. Only 36% reported that they had a primary care provider appointment upon discharge.Conclusions: Results of the questionnaire showed a high level of satisfaction with NP care and identified specific discharge barriers among these hospitalized patients. Determining patient satisfaction with NP care can help direct important performance and improvement activities for healthcare institutions.

Hiring and Credentialing of Nurse Practitioners as Hospitalists: A National Workforce Analysis

Introduction The majority of hospitals in the United States employ hospitalists who provide clinical care to hospitalized patients; however, gaps in hiring, credentialing, and privileging nurse practitioners (NPs) as hospitalists caring for adult patients exist. Purpose To evaluate factors influencing hiring and credentialing of NPs as hospitalists working with adult patients. Methods A 26-item mixed-mode survey was distributed to a sample of members of the Society of Hospital Medicine (SHM), National Association Medical Staff Services (NAMSS), and chief nurse officers (CNOs) with Magnet recognition (n = 1,902) with 592 (31%) responding. Respondents rated factors used in evaluating NPs as hospitalists. Mean comparisons analyzed differences based on respondent role in hiring or credentialing and characteristics including state practice authority. Results Overall, respondents viewed adult NPs (ANPs) as more favorable hires for hospitalists than acute care NPs (ACNPs). However, CNOs rated certification as an ACNP (p Conclusions Little familiarity with regulatory and legal factors could impact hiring and practice of NP hospitalists. Although preference for ACNP certification was expressed, this certification lacked preference beyond ANP certification. The Consensus Model, which focuses on appropriate licensing, accreditation, certification, and education of advanced practice registered nurses, should be further aligned with practice while engaging those who hire and credential as partners.

Communication, leadership and organizational support facilitate successful transition into practice for nurse practitioners in the emergency department.

Postgraduate programs, specialized academic programs, and national health organizations such as the Institute of Medicine (IOM) have identified and begun addressing the gap in knowledge, skills, and factors for successful transition into practice. The purpose of this study is to examine the relationships and differences among the personal and community resources that promote successful transition for nurse practitioners (NP) who practice in the emergency department (ED) and the skills or procedures they find difficult to perform independently. A descriptive, correlational, comparative study design was conducted using an online survey administered to a convenience sample of NPs with 6 months to 5 years of experience as an NP. Findings from this study identified factors associated with successful and unsuccessful transition into practice and help support positive outcomes for health care institutions, ED patients, and NPs practicing in this specialty area. Support in transition recognizes recommendations set by health care organizations in promoting professional development, safe clinical practice, job satisfaction, and retention. Further study will provide clarity in financial gains and improved patient health outcomes during a time in which complex disease processes and provider shortages continue to weigh heavily on society.

Impact of nurse practitioner care on patients with chronic conditions.

A previous study found that care provided by a nurse practitioner (NP) during oncological or palliative care was highly regarded. These patients, however, were considered a special population due to suffering from life-threatening illnesses. It remains unclear whether the results are transferable to patients with chronic conditions. Patient's perceptions of the quality of NP care have reflected that it equals or exceeds that of physicians, but the root causes of these remarks remain unclear. To describe the difference in perception of NP care by patients suffering from chronic heart failure (CHF) or inflammatory bowel disease (IBD) in contrast with NP oncological or palliative care. A qualitative study from a phenomenological perspective was conducted. Data were analyzed using Colaizzi's seven-step method and the Metaphor Identification Procedure. In 2018 and 2019, 16 outpatients receiving CHF or IBD care were interviewed. Although chronic and life-threatening diseases may differentiate patients' perspectives, it can be generally stated that patients value NPs to be reliable, helpful, and empathic. Patients feel empowered, at peace and in control thanks to integrated care by dedicated experts. Outpatients highly appreciate the "communicator role" and "skilled companionship" performed by NPs, to fulfill their needs for attention to the "complete picture." Therefore, further consideration of these competencies is recommended.

Curbside Consultation for the Nurse Practitioner: Qualitative Inquiry for Education, Policy, and Practice.

Curbside consultation (CC), defined as pursuing information or recommendation regarding patient care, without request for formal consultation is a favored information source for nurse practitioners (NPs) when making clinical decisions in practice settings. Research and education concerning CC among NPs is lacking. The purpose of this study was to obtain an understanding of NP perceptions of interpersonal aspects of the CC process to inform NP clinical practice and education. Qualitative descriptive design and inductive content analysis was used. Twenty primary care and specialty care NP were recruited using purposive sampling for conduct of individual interviews. Content analysis identified themes describing interpersonal components of the CC process. NP practiced in collaboration with physicians in variable roles within primary care and specialty care settings. These collaborations varied dependent upon supervisory relationships with physicians. Additional themes concerned NP professional experience and characteristics of experts desired for CC. These characteristics included NP perceptions of colleague experience and expertise, trust, and interpersonal relationship dynamics. CC processes for NPs are multidimensional, including interpersonal themes as components of this communication exchange. Given CC is a highly utilized resource for NPs, further inquiry is critical for understanding of its implications for NP practice, policy, and education internationally.

Effectiveness for introducing nurse practitioners in six long-term care facilities in Québec, Canada: A cost-savings analysis

BackgroundInternationally, most studies have focused on quality and safety in long-term care. However, studies focusing on the economic evaluation of quality and security in long-term care are sparse. Moreover, the economic evaluation of nurse practitioner care in long-term care is lacking, particularly in Québec Canada where roles are new. PurposeTo evaluate the effectiveness of introducing nurse practitioners in six long-term care facilities in Québec using a cost-savings analysis in terms of reduction of nurse practitioner sensitive events (NPSEs). MethodsA cost savings analysis was completed using a prospective observational study. All residents (n = 538) under the care of teams that included nurse practitioners who experienced at least one of the following NPSEs: falls, pressure ulcers, short-term transfers, and a change in the time needed to administer the medications consumed were included. Data were collected from September 1st 2015 to August 31st 2016. Descriptive statistics identified numbers of cases for falls, pressure ulcers, short-term transfers, and the number of medications consumed. A literature analysis was used to estimate excess median long-term care facility related costs of these NPSEs. Costs were calculated in 2016 Canadian dollars. The cost savings with the reductions that occurred for falls, pressure ulcers, short term transfers, and the time needed to administer medications after the implementation of a primary healthcare nurse practitioner role in the six long term care facilities were also estimated. FindingsThe median cost of 341 cases of falls, 32 cases of pressure ulcers and 53 cases of short-term transfers in the six long-term facilities would range between CAD 4,516,337.8 and CAD 5,281,824.4. Moreover, the total costs savings from the reduction of adverse events including the reduction of nursing administration time for medications would be between CAD 1,942,533.6 and CAD 3,254,403.4. DiscussionThis is the first study to present the financial consequence of adverse events sensitive to nurse practitioner care in long-term care. Important cost savings were generated from the reduction of adverse events after the implementation of nurse practitioner roles in long-term care. Government should consider these results for prevention and improvements in quality and safety in long-term care.

Recent evidence of nurse practitioner outcomes in a variety of care settings.

When nurse practitioners (NPs) work to expand their scope of practice through state legislatures, the opposing lobbying groups are often physician-led organizations. The main argument against NP independence and limited scope of practice is that NP care is inherently inferior to that of physicians. However, more than three decades of research demonstrates quality and cost outcomes to be equal to or better than that of physicians. This article reviews a wide range of evidence documenting NP competency, satisfaction, and safety, as well as the challenges and consequences when limiting NP scope of practice. The evidence is clear and has not changed in over 30 years, NPs provide access to effective primary care in a variety of settings, equal in quality outcomes, safety, and cost-effectiveness compared with physicians.