Saturday, February 25, 2023

Do Nurse Practitioners Really Help Emergency Department Care?  Yes! if Coordinated Well!

Research on the effectiveness of Nurse Practitioners in Hospitals appears mixed.

Some studies indicate improvements in cost, patient care and throughput outcomes...

In Primary Care Settings:

And in the Emergency Department:

This coincides with our experience working with Emergency and Inpatient departments.

We have found that Advanced Practice RNs, in a well-coordinated team approach optimizes their strengths, reduces LWOT, Elopement, Length of Stay, and Readmissions; and raises Patient Satisfaction. Indeed, in the right model, their presence improves Physician outcomes.

However, recent research at Stanford using three years of VNA data indicates worse clinical and throughput outcomes by Advanced Practice RNs who had sole clinical responsibility for patients, compared to Emergency Physicians:

The actual paper can be downloaded here:

And there is some precedent for these findings:

Here is our take on the difference:

The problem can be found in this sentence from the new Stanford study: " In December 2016, the VHA granted full practice authority to NPs, allowing them to practice without physician supervision."

In every high functioning Emergency Department no one works without collaboration and supervision. The Charge RN functionally supervises all the professionals when things work, including the APRN and the MD. The APRN doesn't provide a lesser function but a different one.

The Emergency Physician is often the Clinical Specialist. But often times a more experienced RN better fills the role of the primary Clinician.

Effective Emergency care is a synthesis of talent, a synergy of different skills, and a synchronization of professions who collaborate in real time patient by patient. APRNs actually fill a skill gap that the Emergency Physician Specialist cannot, and in part that is because their practice has changed in Emergency Medicine from initial eyes-on-patient assessment to post-labs assessment. They created a gap in an effort to be efficient. That's OK. Because APRNs are filling it, assuring patient safety. The problem is assuming anyone is above supervision and collaboration.

What is the short course conclusion? If you aren't going to develop the management of your teams, you will need more Physicians, and even there quality is no guarantee. And your staffing will continue to be unreliable.

If you are willing to develop your people, analyze the work, and help them synchronize their collaboration, create systems of accountability and transparency, then skyrocketing patient satisfaction and dramatically improved quality outcomes are yours.

#hospitals #hospitalmanagement #nursingleaders #emergencymedicine #criticalcare

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