The Impact of a ‘Resident Replacement’ Nurse Practitioner on an Academic Pediatric Neurosurgical Service

Abstract

Introduction: The introduction of 80-hour workweek limitations has challenged resident training programs with creative scheduling while maintaining comprehensive training experiences. The work hour restrictions may be more adaptable to a medical service, but have been very challenging to an academic surgical program. The particular challenges include maximizing academic learning opportunities, operating room experiences and direct bedside patient care while adhering to the 80-hour restriction. This paper examines the addition of a pediatric nurse practitioner (NP) to a pediatric neurosurgical academic program in response to the resident work hour restrictions. Method: A survey questionnaire asking for responses to questions on a 1–10 rating scale was distributed to physicians, nurses and allied care providers approximately 1 year after addition of the NP. Participants were asked to rate satisfaction with the service’s availability, responsiveness and assessment of patient clinical satisfaction prior to the addition of the NP and at the time of questionnaire distribution. In addition, the hospital paging log was reviewed over a several-month epoch before and after addition of the NP. Finally, the number of quality assurance sentinel events was reviewed for the year prior to and the year after the initiation of the NP program. Results: The satisfaction scores in all categories, including overall satisfaction, significantly improved (p < 0.001) after the addition of the NP to the neurosurgery service. Also, during the NP on-duty coverage hours, the number of paging calls received by the residents was reduced commensurate to the large number of calls received by the NP. This change was presumed to be due to the confidence of other services in obtaining a timely and appropriate response. Finally, the number of sentinel event reports remained stable. Discussion: The addition of an NP in response to resident training changes has been a positive influence on satisfaction with the pediatric neurosurgical service while reducing the reliance on residents for bedside clinical care. Patient safety appears not to have been affected. Presumably, this response to resident work hour limitations will provide the needed time to enhance resident didactic and intraoperative training experiences.

A delivery room-focused education and deliberate practice can improve pediatric resident resuscitation training

“…[19][20][21][22] With duty hour restrictions, many centers have relied on NNP's or physician's assistants to provide clinical coverage that previously would have been provided by residents. 7,23 The combination of duty hour limits and the utilization of non-trainee clinicians to provide delivery room coverage have decreased resident resuscitation experiences by 50% in one institution. 7 Many residents may not attend enough resuscitations to be comfortable, let alone proficient, in leading a neonatal resuscitation.…”

Advanced Registered Nurse Practitioners and Physician Assistants in the Practice of Pediatric Neurosurgery: A Clinical Report

“…More recently, Holleman et al [5] emphasized the role of the advanced nurse practitioner in a pediatric neurosurgery practice. They highlighted the positive influence and satisfaction that occurred with the pediatric neurosurgery service in their institution.…”

“…They highlighted the positive influence and satisfaction that occurred with the pediatric neurosurgery service in their institution. They also documented a reduction on reliance on neurological surgery residents for bedside care and response to calls from consulting services and nurses [5]. …”

On resident duty hour restrictions and neurosurgical training: review of the literature

“…35 The same has not been true for neurosurgical residents, excepting for programs adopting unusual night float systems, 33 which as a tradeoff may increase patient handoffs and so potentially compromise patient care. It seems that the predicted decrease in technical training due to the 2011 intern guidelines may not be been borne out, but maintaining intern case volume has necessitated new systems of duty hours (night float, naps) and increased use of midlevel providers, 18 which reduces the exposure of residents to practice. These limitations are becoming evident as neurosurgical residents who started under the 2011 DHR are now maturing from junior resident status to senior status.…”