PICU Provider Supply and Demand: A National Survey

Gigli, Kristin Hittle; Dietrich, Mary S.; Buerhaus, Peter I.; Minnick, Ann F.

doi:10.1097/pcc.0000000000001587

Cited by 5 publications

(9 citation statements)

References 20 publications

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“…We conducted a national, cross-sectional descriptive survey of PICU medical directors and lead (most senior NP or NP serving in a supervisory role among a group of PICU NPs) PICU NPs to report on the PICU workforce and roles of PICU NPs (Gigli et al., 2018b). Survey development has been previously described, but aspects of the survey that examined the influence of SSOP regulations on PICU NP practice are the focus of this article (Gigli et al., 2018b).…”

Section: Methodsmentioning

confidence: 99%

“…We directly contacted institutions that reported a PICU in the 2015 American Hospital Association Annual Survey to confirm the continued operation of a PICU (Gigli et al., 2018b). We sent surveys to a medical director at each operational PICU ( n = 326).…”

Section: Methodsmentioning

confidence: 99%

“…We contacted eligible participants via postal mail between October 2016 and January 2017, up to three mailings were sent to each participant (Gigli et al., 2018b). Participants returned surveys electronically or by postal-mail.…”

Section: Methodsmentioning

confidence: 99%

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Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles

Gigli

Martsolf

2021

Policy, Politics, & Nursing Practice

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Nurse practitioner (NP) advocacy efforts often focus on attaining full practice authority. While the effects of full practice authority in primary care are well described, implications for hospital-based NPs are less clear and may differ because of hospitals’ team-based care and administrative structure. This study examines associations between state scope-of-practice (SSOP) and clinical roles of hospital-based pediatric intensive care unit (PICU) NPs. We conducted a national survey to assess clinical roles of PICU NPs including daily patient care, procedural, and consultation responsibilities as well as hospital-level administrative oversight practices. We classified SSOP as full or limited (reduced or restricted SSOP) practice. We present descriptive statistics and evaluate differences in clinical roles and hospital-level administrative oversight based on SSOP. The final sample included 55 medical directors and 58 lead (senior or supervisory) NPs from 93 of the 140 (66.4%) PICUs with NPs. There were no significant differences in daily patient care, procedural, or consultation responsibilities based on SSOP ( p > .05). However, NPs in full practice authority states were more likely to bill for care than those in limited practice states (66.7% vs. 31.8%, p = .003), while those in limited practice states were more likely to report to advanced practice managers (36.7% vs. 13%, p = .03). For PICU NPs, SSOP was not associated with variation in clinical responsibilities; conversely, there were differences in billing and reporting practices. Future work is needed to understand implications of variation in hospital-level administrative oversight.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles

Gigli

Martsolf

2021

Policy, Politics, & Nursing Practice

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“…Pediatricians, hospital administrators, and pediatric subspecialists have indicated intentions to hire more PNPs (BLS, 2018;Freed, Dunham, Loveland-Cherry, Martyn, & Moote 2011;Freed et al, 2012). A national survey of pediatric subspecialists showed an intention to expand the scope of PNP practice in the acute care setting (Freed et al, 2011;Gigli, Dietrich, Buerhaus, & Minnick, 2018a).…”

Section: Clinical Roles and Value Of Pnpsmentioning

confidence: 99%

White Paper: Critical Shortage of Pediatric Nurse Practitioners Predicted

Gigli¹,

Beauchesne²,

Dirks³

et al. 2019

Journal of Pediatric Health Care

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“…During the last 2 decades many hospitals increased their PICU capacity, increasing the number of PICU beds by 43%, to meet demand 4. These changes are occurring in tandem with complex shifts in health care that strain the critical care workforce, including work hour restrictions for physicians-in-training5 increased expectations for in-house, around-the-clock attending physician presence6 and increased prevalence of burnout-syndrome among ICU clinicians,7 which contribute to concerns about provider shortages 8,9. As a result, in PICUs, innovative care delivery models have been developed to ensure children have access to critical care 10…”

mentioning

confidence: 99%

Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care

et al. 2021

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Background: Pediatric intensive care units (PICUs) are increasingly staffed with advanced practice providers (APPs), supplementing traditional physician staffing models.Objectives: We evaluate the effect of APP-inclusive staffing models on clinical outcomes and resource utilization in US PICUs.Research Design: Retrospective cohort study of children admitted to PICUs in 9 states in 2016 using the Healthcare Cost and Utilization Project's State Inpatient Databases. PICU staffing models were assessed using a contemporaneous staffing survey. We used multivariate regression to examine associations between staffing models with and without APPs and outcomes.Measures: The primary outcome was in-hospital mortality. Secondary outcomes included odds of hospital acquired conditions and ICU and hospital lengths of stay. Results:The sample included 38,788 children in 40 PICUs. Patients admitted to PICUs with APP-inclusive staffing were younger (6.1 5.9 vs. 7.1 6.2 y) and more likely to have complex chronic conditions (64% vs. 43%) and organ failure on admission (25% vs. 22%), compared with patients in PICUs with physician-only staffing. There was no difference in mortality between PICU types [adjusted odds ratio (AOR): 1.23, 95% confidence interval (CI): 0.83-1.81, P = 0.30]. Patients in PICUs with APP-inclusive staffing had lower odds of central line-associated blood stream infections (AOR: 0.76, 95% CI: 0.59-0.98, P = 0.03) and catheter-associated urinary tract infections (AOR: 0.73, 95% CI: 0.61-0.86, P < 0.001). There were no differences in lengths of stay.Conclusions: Despite being younger and sicker, children admitted to PICUs with APP-inclusive staffing had no increased odds of mortality and lower odds of some hospital acquired conditions compared with those in PICUs with physician-only staffing. Further research can inform APP integration strategies which optimize outcomes.

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PICU Provider Supply and Demand: A National Survey

Cited by 5 publications

References 20 publications

Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles

Implications of State Scope-of-Practice Regulations for Pediatric Intensive Care Unit Nurse Practitioner Roles

White Paper: Critical Shortage of Pediatric Nurse Practitioners Predicted

Advanced Practice Provider-inclusive Staffing Models and Patient Outcomes in Pediatric Critical Care

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