Emergency Nurse Practitioners Research Articles

Practice Standards for the Emergency Nurse Practitioner Specialty.

THE EMERGENCY NURSE PRACTITIONER (ENP) specialty in the United States has grown rapidly since its origins during the 1980s following the establishment of the emergency medicine specialty. Initially, ENPs were prepared on the job with direct mentoring by emergency medicine physicians. Since then, in

Proposed standardized educational preparation for the emergency nurse practitioner

The dynamic climate within health care policy-making and academia, in conjunction with updated Emergency Nurse Practitioner (ENP) competencies and a recent role delineation study, supports development of standardized curricula to ensure appropriate preparation for practice. Emergency NP curricular content should align with the updated ENP Practice Standards and National Organization of Nurse Practitioner Faculties' competencies for the Core and Family NP. This article provides rationale for establishing standardized educational curricula for ENP programs, delineates core specialty curricular content for inclusion, and discusses applicability of ENP specialty competencies within graduate academic education and postgraduate fellowship programs. As national ENP program curricula are standardized, clarity of the ENP specialty role will be enhanced and educational outcomes can be uniformly evaluated.

Appraisal of the emergency nurse practitioner specialty role.

The role of the Emergency Nurse Practitioner (ENP) has evolved as a specialty and is appreciated within the context of the 2008 Consensus Model document (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee, 2008). The first in a series of five articles, this article describes the appraisal of the ENP role as well as the specialty and the distinctive role of the ENP. The second article, Emergency Nurse Practitioner Practice Analysis: Report and Implications of the Findings, presents research to support the scientific basis of emergency specialty practice and content validity for a national certification program. Article 3, Beyond Competencies; Practice Standards for Emergency Nurse Practitioners: A Model for Clinicians, Educators, and Employers, introduces a new conceptual model that defines the specialty of emergency care's knowledge, skills, and abilities identified by the ENP practice analysis as practice standards not traditional competencies. In Article 4, Proposed Standardized Educational Preparation for the Emergency Nurse Practitioner, essential content for ENP preparation within graduate, postgraduate, and doctoral programs. The fifth article, Envisioning the Future for ENPs: Implications for Clinical Practice, Education, Research, and Health Policy, describes how ENPs are envisioning and impacting the future of emergency care and how their evolution can serve as a model for development of other advanced practice nursing specialties.

Emergency nurse practitioner practice analysis: Report and implications of the findings.

A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination. In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs). Evidence from the validation survey was used to create a test content outline for the ENP examination. The delineation of ENP practice validated by the survey (Cronbach alpha = 0.86-0.94 across rating scales) included 5 ENP practice domains: medical screening, medical decision-making/differential diagnoses, patient management, patient disposition and professional, legal and ethical practices. There were 22 job tasks across domains, 10 types of patient conditions/emergency types, 42 knowledge areas, and 68 procedures performed by ENPs. These resulted in a test blueprint providing the foundation for the ENP certification examination content validity. Beyond certification, the practice analysis has the potential to further inform the scientific basis of emergency specialty practice. Additional uses include refining professional scope and standards of practice, job descriptions, performance appraisals, research, and policy development.

Embracing the future for emergency nurse practitioners and specialty practice: Implications for research, clinical practice, education, and health policy.

The emergency nurse practitioner (ENP) specialty has grown rapidly, responding and adapting to changes within emergency care. Designation and advancement of nurse practitioner (NP) specialties follows a systematic process as defined by the profession. This includes establishment of scope and standards of practice, educational standards, and policy initiatives to ensure quality and safety within the profession. This article describes how the ENP specialty has used evidence to meet health system needs and chart a transformational future. Current recommendations for advancing health care transformation, as described by the American Association of Colleges of Nursing-Manatt Report, inform and frame the processes by which the ENP specialty has collaborated with diverse stakeholders to create a research and policy agenda to ensure that ENPs are appropriately prepared to lead and provide access to safe, affordable, quality health care. These processes provide a future-oriented model that promotes advancement of the NP profession through provision of new NP specialty designations as they emerge to meet changing health care system needs.

Synthesis of Research Articles to Examine Reporting of the Educational Preparation and Practice Parameters of Emergency Nurse Practitioners.

It has been reported that the outcomes of care are affected not only by the educational preparation and experience of the practitioner but also by the parameters of his or her practice. Given differences that exist internationally in the enactment of the emergency nurse practitioner (ENP) role, a synthesis of research articles was conducted to examine the educational preparation and experience of ENPs, the role(s) they assume as determined by their patient population, and the outcomes used to evaluate their practice. The synthesis was informed by Sidani and Irvine's (1999) conceptual framework for evaluating the nurse practitioner role in acute care settings. The synthesis included 43 research articles, which were retrieved following a search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) bibliographic database. Approximately 60% of the articles were descriptive or qualitative studies, whereas only 7% were randomized controlled trials. Findings suggest that although many outcomes of care have been evaluated, no outcomes have been evaluated consistently and many are not specific to the intervention or actions of nurse practitioners. In addition, few research articles provide information on the educational preparation and experience of the ENPs or the parameters of their practice. Such information is needed to explain the variability observed in the outcomes achieved and to build a body of evidence supporting the role of nurse practitioners in the emergency department.

Emergency Nurse Practitioners State by State

Emergency Nurse Practitioners State by State

Exploring emergency nurse practitioners' perceptions of their role.

To explore ENPs' perceptions of their changing role, including their educational requirements and whether their training needs are being met. This qualitative phenomenological study examined the views of six ENPs using semi-structured interviews. The study identified four themes: inadequate protected time for continuing professional development (CPD); importance of senior medical support in role expansion and CPD; inconsistent educational preparation for expanded roles; and the ENPs' perceived reasons for role expansion. Although all the participants stated that it was challenging to find time for CPD when working in busy clinical environments, this was regarded as less important than the positive effect of senior medical support for advanced roles. Over the past three decades, the ENP role has become well established, which has led to increased confidence, and the development of collaborative ways of working, among ENPs and their colleagues. However, while ENPs have embraced the challenges of their changing role, educational support has not been consistent. There are still disparities in ENPs' scope of practice, expectations of the role between services, and the educational preparation required to undertake the role.

Primary care professionals providing non-urgent care in hospital emergency departments.

In many countries emergency departments (EDs) are facing an increase in demand for services, long waits, and severe crowding. One response to mitigate overcrowding has been to provide primary care services alongside or within hospital EDs for patients with non-urgent problems. However, it is unknown how this impacts the quality of patient care and the utilisation of hospital resources, or if it is cost-effective.This is the first update of the original Cochrane Review published in 2012. To assess the effects of locating primary care professionals in hospital EDs to provide care for patients with non-urgent health problems, compared with care provided by regularly scheduled emergency physicians (EPs). We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library; 2017, Issue 4), MEDLINE, Embase, CINAHL, PsycINFO, and King's Fund, from inception until 10 May 2017. We searched ClinicalTrials.gov and the WHO ICTRP for registered clinical trials, and screened reference lists of included papers and relevant systematic reviews. Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies that evaluated the effectiveness of introducing primary care professionals to hospital EDs attending to patients with non-urgent conditions, as compared to the care provided by regularly scheduled EPs. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We identified four trials (one randomised trial and three non-randomised trials), one of which is newly identified in this update, involving a total of 11,463 patients, 16 general practitioners (GPs), 9 emergency nurse practitioners (NPs), and 69 EPs. These studies evaluated the effects of introducing GPs or emergency NPs to provide care to patients with non-urgent problems in the ED, as compared to EPs for outcomes such as resource use. The studies were conducted in Ireland, the UK, and Australia, and had an overall high or unclear risk of bias. The outcomes investigated were similar across studies, and there was considerable variation in the triage system used, the level of expertise and experience of the medical practitioners, and type of hospital (urban teaching, suburban community hospital). Main sources of funding were national or regional health authorities and a medical research funding body.There was high heterogeneity across studies, which precluded pooling data. It is uncertain whether the intervention reduces time from arrival to clinical assessment and treatment or total length of ED stay (1 study; 260 participants), admissions to hospital, diagnostic tests, treatments given, or consultations or referrals to hospital-based specialist (3 studies; 11,203 participants), as well as costs (2 studies; 9325 participants), as we assessed the evidence as being of very low-certainty for all outcomes.No data were reported on adverse events (such as ED returns and mortality). We assessed the evidence from the four included studies as of very low-certainty overall, as the results are inconsistent and safety has not been examined. The evidence is insufficient to draw conclusions for practice or policy regarding the effectiveness and safety of care provided to non-urgent patients by GPs and NPs versus EPs in the ED to mitigate problems of overcrowding, wait times, and patient flow.

The Specialty of Emergency Nurse Practitioner Practice: Erratum.

The Specialty of Emergency Nurse Practitioner Practice: Erratum.

Highlighting the Invisible Work of Emergency Nurse Practitioners

Abstract This study sought to quantify and qualify the hidden work practices of emergency nurse practitioners (ENPs). A prospective multicenter study design was employed using 12 ENPs across 4 hospital emergency departments (ED) in Sydney, Australia. Using a Delphi technique, an electronic medical record template was developed to capture the hidden activities of ENPs defined as secondary consultations. Approximately one-quarter of ENP consultations are spent providing expertise to other ED clinicians. ED re-presentation rates are lower when an ENP provides a secondary consultation. This study highlights the invisible and valuable work of ENP contribution to emergency care.

The Emergency Nurse Practitioner Board Certification Examination: The Purpose, Process, and Eligibility

In January 2017, the American Academy of Nurse Practitioners Certification Board (AANPCB), in collaboration with the American Academy of Emergency Nurse Practitioners (AAENP), began to offer a new board certification examination for the emergency nurse practitioner (ENP). This new certification examination provides a standardized evaluation of ENP knowledge base across the lifespan. The certification examination was developed in accordance with the APRN Consensus Model. Prior to this board certification examination, the only certification option for ENPs was a portfolio review process offered through the American Nurses Credentialing Center (ANCC) in August 2013. 1 Certification Through Portfolio Application Requirements. American Nurses Credentialing Center website. http://www.nursecredentialing.org/CertificationPortfolioRequirements.pdf Google Scholar Courtney J. Cook is Assistant Professor, Vanderbilt School of Nursing, Nashville, TN

Postgraduate Emergency Nurse Practitioner Fellowships: Opportunities for Specialty Education.

Specialty trained emergency nurse practitioners (ENPs) can meet the demands of an unpredictable emergency care environment within an overburdened health care system. Although existing literature supports fellowship training as a method for bridging academic knowledge with clinical experiences for the novice nurse practitioner, the currently available emergency care postgraduate fellowship programs are inconsistent in approach. Building upon descriptive data provided by the existing 9 postgraduate ENP fellowship programs, a comparison and gap analysis of program content was conducted to identify perceived standards for ENP specialty education and the congruence with published ENP competencies. Standards to curricula, didactics, clinical rotations, and measures of competency were identified in the currently established ENP fellowships. A national ENP fellowship curriculum has the potential to afford consistency among programs, support attainment of competency, and provide clarity to the role and general education of advanced practice registered nurses seeking employment in emergency care.

Change and challenge the expected: “Nurse practitioner emergency department vulnerable patients model of care”

A new innovative approach and model to the Emergency Nurse Practitioner. By challenging and changing tradition of Emergency NP role the model closes the gap and addresses deficits that vulnerable patients are exposed to in the emergency care setting.

When It’s More Than Positional Vertigo: Cerebellar Stroke

A 50-year-old woman with a medical history of controlled hypertension and tobacco abuse presented to the emergency department with sudden-onset vertigo. The patient described feeling like the room was spinning. The symptoms began while she was sitting at the table eating. In addition to feeling dizzy and lightheaded, she also experienced heart palpitations. The patient denied having chest pain, dyspnea, nausea, vomiting, diarrhea, visual changes, hearing changes, paresthesia, or focal neurologic deficit. Her husband called emergency medical services, who transported her to the emergency department. Her prehospital glucose check en route was 110 mg/dL, and her 12-lead electrocardiogram (ECG) showed normal sinus rhythm. David Warren is Emergency Nurse Practitioner, Questcare Partners, Dallas, TX.

Emergency Nurse Practitioner Core Educational Content.

Increasing numbers of patients are presenting to national emergency departments (EDs). This is occurring simultaneously with reductions in providers along with ED closures, creating a significant gap in emergency care. According to the advanced practice registered nurse consensus model, specialty-specific knowledge and practice build upon generalist nurse practitioner (NP) population foci. Although the National Organization of Nurse Practitioner Faculties provides guidelines for educational programs at the NP population level, determination of core specialty knowledge lies with specialty organizations. Emergency nurse practitioners (ENPs) require additional specialty-specific education to manage patients spanning age and acuity continuums. Although certification mechanisms are now in place to recognize NP specialty knowledge, a nationally standardized curriculum remains to be proposed. This article proposes core educational content for ENP specialty education; the utility of this content may serve as the foundation for the development of standardized ENP academic and postgraduate fellowship programs.

An Exemplar Interprofessional Academic Emergency Nurse Practitioner Program: A Blueprint for Success.

Emergency department census rates and manpower gaps have continued to rise over the past decade, creating a demand for well-prepared emergency nurse practitioners (ENPs). The implementation of the consensus model for advanced practice nurses has brought acknowledgment by leading health care, physician, and nursing organizations of the ENP specialty as critical to building a high-quality emergency care workforce. Recognition of the ENP's unique skill set, and therefore need of specialty certification, has led to a growing interest in the expansion of nurse practitioner curricula in emergency care. This article describes a novel approach for ENP education based on an interprofessional training model, with an in-depth discussion of curriculum development and clinical placement, as well as program outcomes and implications.

Integrity and Transparency in Reporting Clinical Trials.

Integrity and Transparency in Reporting Clinical Trials.

CONCUSSION IN THE EMERGENCY DEPARTMENT; UNCONSCIOUSLY INCOMPETENT?

Objectives & BackgroundSports related concussion is an increasingly common occurrence. Outside professional sport it is typically managed within Emergency Departments. The objective was to assess the level of knowledge and...

Practical Guidelines for the Use of Electronic Applications by Advanced Practice Nurses in the Emergency Department

Although numerous electronic applications are available to health care providers on enabled devices such as smartphones and tablets, these resources remain underutilized. Available literature suggests that utilizing electronic applications provides a number of benefits, including improved rapid decision making, reduced error rates, increased quality management and accessibility, improved practice efficiency, and knowledge. These benefits translated into a reduction in adverse events and hospital lengths of stay. Despite the vast number of available applications and known benefits of their use (Table 1), limited data exist regarding overall efficacy and individual safety. Recommendations for routine use of electronic references have been developed (see Table 2). Table 1Electronic application usage benefits •Reduction in adverse events •Reduction in hospital lengths of stay •Improved efficiency •Enhanced patient safety •Rapid decision making •Improved practice efficiency Open table in a new tab Table 2Daily practice recommendations •Utilize reference applications in daily practice to reduce errors and increase knowledge. •Ensure that all applications are peer reviewed or from professionally developed sources such as Medscape or EMRA. •Validate calculators and scoring tools prior to routine utilization. •Utilize new or nonprofessionally developed sources cautiously. •Utilize electronic resources to improve decision making, not substitute for it. Open table in a new tab Victoria A. Morgan is Nurse Practitioner, Poquoson, VA. Joanna Jhant is Emergency Nurse Practitioner, Harker Heights, TX. Justin Ellison is Emergency Nurse Practitioner, Atlanta, GA. Armando Varela is Nurse Practitioner, Prescott, AZ. Will Carpenter is Nurse Practitioner, San Francisco, CA.