A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs

Scherzer, Rachel; Dennis, Marie P.; Swan, Beth Ann; Kavuru, Mani S.; Oxman, David

doi:10.1097/ccm.0000000000002055

Cited by 30 publications

(25 citation statements)

References 15 publications

(18 reference statements)

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“…This review included 15 studies with 23 681 participants across five countries including Australia [ 28 – 30 ], Canada [ 31 , 32 ], New Zealand [ 33 ], UK [ 34 ], and USA [ 35 – 41 ], where the nomenclature for nurses in advanced practice was “NP.” A total of 14 studies [ 28 – 41 ] were published while one was an unpublished manuscript (Roche T, Gardner GE, Jack L: The effectiveness of emergency nurse practitioner service in the management of patients presenting to rural hospitals with chest pain: a multisite prospective longitudinal nested cohort study. In preparation.)…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were conducted between 2006 and 2016. As regards the setting, six studies [ 28 – 30 , 32 , 33 ] focused on the EDs, six [ 31 , 34 , 35 , 37 , 38 , 41 ] on the ICU, two [ 36 , 40 ] on the trauma centers, and one on the stroke center [ 39 ]. The sample sizes ranged from 103 [ 31 ] to 9066 [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

“…The ENP delivered and coordinated care in diagnosis, investigation, therapeutic treatment, and referral. Adherence to guidelines; diagnostic accuracy of ECG interpretation; waiting times; LOS; LWOT; diagnostic accuracy as measured by unplanned representation rates; patient satisfaction; quality-of-life; functional status Scherzer et al (2016), USA [ 41 ] Medium To compare usage patterns and outcomes of a NP-staffed MICU and a resident-staffed physician MICU MICU of a large urban university hospital Retrospective cohort study Patients admitted to the adult MICU ( n = 1 157) Intervention ( n = 221): NP-staffed MICU. Mean age 62.3; 53.8% male; 64.3% White; 39.4% respiratory failure.…”

Section: Resultsmentioning

confidence: 99%

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The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review

2017

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BackgroundThe prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes.ObjectivesThe objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings.Review methodsA comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools.ResultsNarrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.ConclusionsCapitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.Electronic supplementary materialThe online version of this article (10.1186/s12960-017-0237-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review

2017

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“…However, the workflow is similar and Scherzer et al found no significant difference in patient mortality between the two MICUs at our institution. 19 Despite these limitations, the study provided unique insight into caregivers' perspectives on specific team behaviors, which is necessary to inform quality improvement initiatives.…”

Section: Discussionmentioning

confidence: 99%

Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers’ Perspectives

et al. 2018

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“…Scope-of-practice laws for NPs are a contentious policy issue in the US, with some states allowing independent practice for NPs without physician oversight and others requiring physician oversight for all APRN practice [26]. There is substantial evidence that increasing NP scope of practice is not only safe and effective, but also increases access to care for underserved populations [27][28][29]. For RNs, the key law affecting their practice is the Nurse Licensure Compact.…”

Section: Introductionmentioning

confidence: 99%

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

Choi

Takada

Saadi

et al. 2020

BMC Health Serv Res

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Background: Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States. Methods: This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes. Results: Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates.Conclusions: Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.

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A Comparison of Usage and Outcomes Between Nurse Practitioner and Resident-Staffed Medical ICUs

Abstract: We found no difference in mortality between an nurse practitioner-staffed medical ICU and a resident-staffed physician medical ICU. Our study adds further evidence that advanced practice providers can render safe and effective ICU care.

Cited by 30 publications

References 15 publications

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review

The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review

Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers’ Perspectives

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016

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