Expanding RN Scope of Practice to Include Lumbar Puncture

Abstract

: The competing demands of caring for high-acuity patients, reducing health care costs, and improving access to specialty care are complex challenges facing all health care providers. One approach-empowering nurses to expand their scope of practice-has been successfully employed for two decades by the nurse and physician leadership of a neurology department in an urban academic medical center. This article discusses the department's implementation of a quality improvement initiative to enhance access to neurology services in an ambulatory clinic by extending nursing practice to include lumbar puncture. Outcomes data from 2005 to 2016 demonstrate that through the department's comprehensive instructional program, RNs have competently and safely acquired new skills that have led to an expansion of their traditional roles, improved patient access to specialty care, and reduced costs.

The Supply of Surgical Specialists and Subspecialists to the U.S. Medicare Population: National Trends from 2013 to 2019

“…Many surgical practices already use APPs to lessen the clinical workload of surgeons, assist in operations, and coordinate care 43–46 . In these settings, APPs appear to have similar clinical and patient-centered outcomes to surgeons 44,46–48 . Physician assistants are able to function as primary surgeons for certain procedures when physicians are unavailable 48–51 .…”

“…[43][44][45][46] In these settings, APPs appear to have similar clinical and patient-centered outcomes to surgeons. 44,[46][47][48] Physician assistants are able to function as primary surgeons for certain procedures when physicians are unavailable. [48][49][50][51] In 2021, approximately 125,000 physician assistants were in clinical practice, and 11,000 physician assistant students graduated from U.S. programs.…”

State‐of‐the‐art of lumbar puncture and its place in the journey of patients with Alzheimer's disease

“…If the existing evidence that there is no significant clinical benefit with post‐LP rest was corroborated, the overall time of LP could be drastically cut, thus facilitating patient turnover. Furthermore, with appropriate training, LP can be performed safely and effectively by nursing staff, 100 thus reducing the demand for physician time and optimizing time and resource investment 101 . Regardless of specialization, the personnel that perform LP should have sufficient technical training and practice, and ideally perform the procedure in a frequent and consistent manner, rather than an ad hoc and sporadic manner.…”

Nursing Approaches in Post Dural Puncture Headache

“…8,10 Amerika Birleşik Devletleri'nde LP işlemini registered nurse olarak adlandırılan lisanslı hemşirelerin yaptığı, işlemin başarı oranının %95 civarında, PDPB görülme oranının %6,8 olduğu ve herhangi bir yan etki görülmediği bildirilmiştir. 9 LP işlemi 1980 yılı itibariyle Arizona, Florida ve Minnesota'da kapsamlı eğitim, sınav ve gözlemler sonucunda lisanslı hemşireler (RN=registered nurse) tarafından da bağımsız olarak yapılmaktadır. 7,9 LP, hastanın yoğun şekilde anksiyete ve stres yaşamasına neden olan bir işlemdir.…”

“…9 LP işlemi 1980 yılı itibariyle Arizona, Florida ve Minnesota'da kapsamlı eğitim, sınav ve gözlemler sonucunda lisanslı hemşireler (RN=registered nurse) tarafından da bağımsız olarak yapılmaktadır. 7,9 LP, hastanın yoğun şekilde anksiyete ve stres yaşamasına neden olan bir işlemdir. 8,16 Hemşireler LP işlemi öncesi, sırası ve sonrasında hasta ve ailesini desteklemeli, komplikasyonları en aza indirmeli ve hastanın rahatsızlığını minimum düzeye getirmeye çaba göstermelidir.…”