Trauma Nurse Practitioners Research Articles

Improving efficiency within a trauma nurse practitioner team.

Clinicians, including nurse practitioners (NPs), face a number of challenges in delivering high-quality care including frequent interruptions that can potentially compromise patient safety and job satisfaction. Trauma NPs voiced frustration with their efforts to provide efficient, high-quality care with frequent interruptions, most commonly pager alerts. The purpose of this quality improvement (QI) initiative was to increase trauma NPs' perceptions of patient safety and improve NPs' job satisfaction by reducing workflow interruptions. The Model for Improvement guided this initiative. The aims of this initiative were to reduce the percentage of nonurgent workflow interruptions via pager alerts by 20% and to increase the utilization of a standardized trauma NP patient rounding process from 0% to 50%. Use of the standardized rounding process improved from 0% to 87%. Interruptions via pager alerts decreased by 36.2%. All nine (100%) trauma NP survey responses revealed an improvement in NP perception of patient safety and job satisfaction. The QI initiative found that increasing communication during rounds by using a standardized rounding process involving the bedside registered nurse can minimize interruptions and improve the efficiency of a trauma NP team. The key to the success of the QI initiative was the implementation of a standardized rounding process.

Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model.

The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews of nonsurgical admissions when rates of allocation to this service exceed 10% of all inpatient traumas. Nonsurgical admission rates at the study institution, which is a Level I trauma center, historically exceeded this ACS criterion. In an effort to decrease nonsurgical admissions, the study institution recruited trauma nurse practitioners (TNPs) who began managing low acuity patients with oversight from trauma attending physicians. This study examines the impact of TNPs on the rate of nonsurgical admissions. A retrospective cohort study was conducted with 1,400 patients between January 2017 and October 2018. Two cohorts examined in this study included trauma patients whose care was managed by the TNPs versus those admitted under the care of hospitalists. The rate of admission to nonsurgical services (NSS) was 19.6% in 2017 and 13.9% in 2018, which yielded a significant decrease from previous years' percentages (p < .001). The average hospital length of stay was 1.17 days shorter in the TNP group, which translated into a savings of approximately $876,330 in hospital charges for the study period. Additional significant findings noted in favor of the TNP cohort were for discharge orders placed prior to noon, discharge location, and reduced time to the operating room. This TNP model proved to be successful in significantly reducing admissions to NSS and substantiated the quality of patient care provided by TNPs. Hospitals struggling to meet the ACS criterion for NSS admissions may consider implementing a similar TNP model.

Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model

Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model

Nurse Practitioners' Role in Improving Service for Elderly Trauma Patients.

Preexisting conditions and decreased physiological reserve in the elderly frequently complicate the provision of health care in this population. A Level 1 trauma center expanded its nurse practitioner (NP) model to facilitate admission of low-acuity patients, including the elderly, to trauma services. This model enabled NPs to initiate admissions and coordinate day-to-day care for low-acuity patients under the supervision of a trauma attending. The complexity of elderly trauma care and the need to evaluate the efficacy of management provided by NPs led to the development of the current study. Accordingly, this study endeavored to compare outcomes in elderly patients whose care was coordinated by trauma NP (TNP) versus nontrauma NP (NTNP) services. Patients under the care of TNPs had a 1.22-day shorter duration of hospitalization compared with that of the NTNP cohort (4.38 ± 3.54 vs. 5.60 ± 3.98, p = .048). Decreased length of stay in the TNP cohort resulted in an average decrease in hospital charges of $13,000 per admission ($38,053 ± $29,640.76 vs. $51,317.79 ± $34,756.83, p = .016). A significantly higher percentage of patients admitted to the TNP service were discharged home (67.1% vs. 36.0%, p = .002), and a significantly lower percentage of patients were discharged to skilled nursing facilities (25.7% vs. 51.9%, p = .040). These clinical and economic outcomes have proven beneficial in substantiating the care provided by TNPs at the study institution. Future research will focus on examining the association of positive outcomes with specific care elements routinely performed by the TNPs in the current practice model.

Increasing Awareness of Compartment Syndrome amongst Orthopaedic Nurses and Trauma Nurse Practitioners at a District General Hospital: A Complete Audit Loop

Increasing Awareness of Compartment Syndrome amongst Orthopaedic Nurses and Trauma Nurse Practitioners at a District General Hospital: A Complete Audit Loop

Assessing the Academic and Professional Needs of Trauma Nurse Practitioners and Physician Assistants

Because of multiple changes in the health care environment, the use of services of physician assistants (PAs) and nurse practitioners (NPs) in trauma and critical care has expanded. Appropriate training and ongoing professional development for these providers are essential to optimize clinical outcomes. This study offers a baseline assessment of the academic and professional needs of the contemporary trauma PAs/NPs in the United States. A 14-question electronic survey, using SurveyMonkey, was distributed to PAs/NPs at trauma centers identified through the American College of Surgeons Web site and other online resources. Demographic questions included trauma center level, provider type, level of education, and professional affiliations. Likert scale questions were incorporated to assess level of mentorship, comfort level with training, and individual perceived needs for academic and professional development. There were 120 survey respondents: 60 NPs and 60 PAs. Sixty-two respondents (52%) worked at level I trauma centers and 95 (79%) were hospital-employed. Nearly half (49%) reported working in trauma centers for 3 years or less. One hundred nineteen respondents (99%) acknowledged the importance of trauma-specific education; 98 (82%) were required by their institution to obtain such training. Thirty-five respondents (32%) reported receiving $1000 per year or less as a continuing medical education benefit. Insufficient mentorship, professional development, and academic development were identified by 22 (18%), 16 (13%), and 30 (25%) respondents, respectively. Opportunities to network with trauma PAs/NPs outside their home institution were identified as insufficient by 79 (66%). While PAs/NPs in trauma centers recognize the importance of continued contemporary trauma care and evidence-based practices, attending trauma-related education is not universally required by their employers. Financial restrictions may pose an additional impediment to academic development. Therefore, resource-efficient opportunities should be a prime consideration for advanced practitioners education, especially since half of the reported workforce has 3 years or less experience. The Eastern Association of Trauma and other organizations can provide an ideal venue for mentorship, academic development, and networking that is vital to PA/NP professional development and, ultimately, quality patient care.

Trauma Nurse Practitioners

Trauma Nurse Practitioners

Detraumatizing Nurse Practitioner Orientation

Health care reform and legislation of restricted resident work hours lead to the evaluation and the changes in health care delivery. In the early 1990s, the Acute Care Nurse Practitioner role evolved to fill the care gaps created by these changes. As the numbers and opportunities for nurse practitioners (NPs) in tertiary settings continue to increase, how to successfully integrate these providers into the health care setting becomes more of a challenge with limited published assimilation models to provide guidance. With few role models, the responsibility of integration is left in the hands of novice NPs, hospital administrators, or physician colleagues. The purpose of this article was to outline orientation, implementation, and evaluation strategies to optimize the transition of trauma NP into the inpatient setting.

Utilizing Trauma Nurse Practitioners to Decrease Length of Stay

This article describes a nurse practitioner model utilized to decrease the length of stay and improve the quality of discharge planning for hospitalized trauma patients between 1999 and 2006. An observational method employing nurse practitioners to decrease length of stay for the trauma population during these years is described. Adding nurse practitioners to the trauma team has resulted in decreasing the length of stay in all 4 of the injury severity score groups. Adding nurse practitioners to the trauma team provides a core member in a revolving trauma service. Consequently, length of stay and discharge planning have been positively impacted.

Core Competencies for a Trauma Subspecialty Nurse Practitioner

The role of a trauma nurse practitioner (TNP) is not a new one. Trauma facilities around the nation are continually finding ways to incorporate and expand upon the role of the TNP within their infrastructure to better utilize resources while simultaneously providing comprehensive care. While this is the case, there is a dearth of information on the core competencies required for a TNP to practice efficiently. Having concise information on the core competencies for a TNP will be of great benefit to graduate nurse practitioners as well as seasoned nurse practitioners looking to change specialties.

Preparation for negotiating scope of practice for acute care nurse practitioners

Journal of the American Academy of Nurse PractitionersVolume 19, Issue 12 p. 627-634 Preparation for negotiating scope of practice for acute care nurse practitioners Richard McLaughlin MS, RN, CNP, ACNP, Corresponding Author Richard McLaughlin MS, RN, CNP, ACNP (Clinical Coordinator and Trauma Nurse Practitioner) ACNP program, UIC School of Nursing, Chicago, Illinois and Trauma Services, Rockford Health System, Rockford, IllinoisRichard McLaughlin, MS, RN, CNP, ACNP, Rockford Health Systems, Suite 310, RMB, 2350 North Rockton Avenue, Rockford, IL 61103. Tel: (815) 971-5550; Fax: (815) 971-6825; E-mail: rhamcmc@aol.comSearch for more papers by this authorColumn Editor Ruth M. Kleinpell PhD, RN, FAAN, FAANP, FCCM, Column Editor Ruth M. Kleinpell PhD, RN, FAAN, FAANP, FCCM ACNP program, UIC School of Nursing, Chicago, Illinois and Trauma Services, Rockford Health System, Rockford, IllinoisSearch for more papers by this author Richard McLaughlin MS, RN, CNP, ACNP, Corresponding Author Richard McLaughlin MS, RN, CNP, ACNP (Clinical Coordinator and Trauma Nurse Practitioner) ACNP program, UIC School of Nursing, Chicago, Illinois and Trauma Services, Rockford Health System, Rockford, IllinoisRichard McLaughlin, MS, RN, CNP, ACNP, Rockford Health Systems, Suite 310, RMB, 2350 North Rockton Avenue, Rockford, IL 61103. Tel: (815) 971-5550; Fax: (815) 971-6825; E-mail: rhamcmc@aol.comSearch for more papers by this authorColumn Editor Ruth M. Kleinpell PhD, RN, FAAN, FAANP, FCCM, Column Editor Ruth M. Kleinpell PhD, RN, FAAN, FAANP, FCCM ACNP program, UIC School of Nursing, Chicago, Illinois and Trauma Services, Rockford Health System, Rockford, IllinoisSearch for more papers by this author First published: 26 November 2007 https://doi.org/10.1111/j.1745-7599.2007.00271.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume19, Issue12December 2007Pages 627-634 RelatedInformation

Discharge Rounds in the 80-Hour Workweek: Importance of the Trauma Nurse Practitioner

Daily multidisciplinary discharge rounds have been shown to decrease length of stay (LOS), increase patient volumes, and virtually eliminates "bypass" (inability to accept admissions). Originally, these were attended by senior house staff from each trauma team. Implementation of the 80-hour workweek precluded house staff participation, raising concerns that these rounds would loss their benefits. Certified nurse practitioners (CRNPs) were added to the trauma teams to assist in patient care and represent the team on discharge rounds, replacing the fellows. We hypothesized that this would offset any potential negative effects. A senior trauma physician leads discharge rounds, focusing on each patient's plan of care. Rounds cover 90 inpatient beds and last approximately 60 minutes. CRNPs from each trauma team, orthopedics, and neurosurgery as well as the teams' discharge planner, hospital bed manager, unit nursing staff, and physical, occupational, and speech therapists participate in discharge rounds. The results are stratified by time period: June 1998 to May 1999 is before discharge rounds, June 1999 to May 2001 is during the house staff period, and June 2001 to May 2004 is when CRNPs replaced fellows and residents. During the 5-year period, 1999 to 2004, daily discharge rounds maintained their efficacy. We have increased admissions, whereas LOS has remained the same. Admissions of greater than 24 hours have increased, whereas average injury severity score has statistically remained the same. Bypass has virtually been eliminated. Adding CRNPs to discharge rounds has allowed us to have the continued benefits of decreased LOS and increased patient volume. Bypass remains rare. CRNPs can effectively replace some house staff functions.

Top 10 Reasons to Become a Trauma Nurse Practitioner

Nurse practitioners have played a pivotal role in both advances in patient care and healthcare policy over the last 40 years. As the healthcare environment continues to change, so too does the role of the nurse practitioner. Nurse practitioners are becoming the norm instead of the exception in the critical care setting and, more recently, have been welcomed as valuable members to trauma teams around the country. As the role continues to evolve and grow, the growing pains will multiply. This article will discuss one nurse's experience of being the new nurse practitioner in a new role and the challenges, both positive and negative, that have grown out of that experience.

Pediatric Trauma Nurse Practitioners Increase Bedside Nurses' Satisfaction With Pediatric Trauma Patient Care

Our Level I Pediatric Trauma Center employs pediatric nurse practitioners (PNP) to manage inpatients. We hypothesized that the involvement of a PNP would lead to increased nursing staff satisfaction with patient care. Children admitted to the trauma service were randomized to PNP or resident care groups. Nurses caring for these children were asked to fill out a satisfaction survey regarding the care that the child received. Sixty-five nurses participated. Nurses scored the PNP group significantly higher in human qualities, information given about the tests, management of the child's pain, and response time to pages/questions. Involvement of the PNP leads to higher nursing satisfaction scores compared with residents while providing equivalent care for injured children.

Improved Quality of Care and Reduction of Housestaff Workload Using Trauma Nurse Practitioners

The University of California, Davis, Medical Center introduced the use of nurse practitioners (NPs) to the trauma service in fiscal year 1986-87 to alleviate the increasing burdens placed on the surgical housestaff in their attempt to accommodate the rising patient volume and acuity. The use of NPs was associated with a decrease in average length of stay for the seriously injured patients from 8.10 to 7.05 days while the length of stay for other patients in the hospital remained unchanged. Documentation of quality of care in the medical record increased substantially. For example, discharge summaries that were dictated by the NPs were judged complete in all aspects in at least 95% of sampled records compared with approximately 75% of records that were dictated by the residents. With introduction of the NPs, outpatient clinic waiting times decreased from 41 to 19 minutes. Patient complaints regarding the trauma team decreased from 16 to seven/year. Time saved for the housestaff averaged 352 minutes/day while the NPs were on duty. The NPs were well received by the hospital nurses, hospital quality assurance personnel, and ancillary services. They have proved to be of great value to the patients, the patients' families, the hospital, and the trauma team.