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Interdisciplinary Teamwork article

Interdisciplinary team work is a complex process in which different types of staff work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education [ 1], there is little evidence as to the most effective way of delivering interdisciplinary team work [ 2].

Interdisciplinary team work is a complex process in which different types of staff work together to share expertise, knowledge, and skills to impact on patient care. Despite increasing emphasis on interdisciplinary team work over the past decade, in particular the growth of interdisciplinary education [ 1], there is little evidence as to the most effective way of delivering interdisciplinary team work [ 2].

The examination of inter-professional relationships and the effect these have on teams and teamwork is extensive. In much of the literature, concepts have been studied separately, and so the linkages to contexts and the broader socio-historical background were notable for their absence. The picture of teams, their work and process is skewed, as emphasis on one topic is often at the expense of another. Conceptual rigour is required if we are to understand what we are talking about.

The examination of inter-professional relationships and the effect these have on teams and teamwork is extensive. In much of the literature, concepts have been studied separately, and so the linkages to contexts and the broader socio-historical background were notable for their absence. The picture of teams, their work and process is skewed, as emphasis on one topic is often at the expense of another. Conceptual rigour is required if we are to understand what we are talking about.

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The purpose of this hermeneutic phenomenology (van Manen, 1990) was to gain insight into the meaning and lived experience of nurse practitioners (NP) with at least one year of work experience regarding their initial transition from new graduate to hospital-based practitioner. This study provided information regarding NP hospital-based transition experience that had not been revealed in the nursing literature. The meaning of transitioning into hospital-based practice was discovered through analysis of nurse practitioner letters and interviews in this phenomenological study. Six themes emerged from this research including: Going from expert RN to novice NP; system integration; "Don't Give Up"; Learning "On the Fly"; They Don't Understand my NP Role; and Succeeding Through Collaboration.   Master's prepared, board-certified NPs in North Carolina (NC) with between one and three years of NP practice experience in a hospital setting comprised the population of interest for this study. Twelve participants were purposefully sampled from nine hospitals in NC. Individual, voice-recorded, in-depth, open-ended telephone interviews were conducted with each participant.   The majority of the participants indicated a timeframe that ranged from six to 18 months regarding how long it took them to feel more comfortable in their NP role, the lack of comfort was most intense during the first nine months of practice. Participants confronted multiple obstacles and challenges as new NPs. These challenges included navigating and negotiating a new health care provider role; becoming integrated into a hospital system in what was a new role for them and sometimes for the system; learning how to function effectively as a NP while simultaneously working to re-establish themselves as proficient clinicians with a newly expanded practice scope; building key relationships; and educating physicians, hospital leaders, clinical staff, patients, and families about the NP

BACKGROUND: The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program. METHODS: LOS data from December 1, 2011 through December 1, 2012 was compared with data from the same months from the previous two years and estimated hospital charges and patient days were extrapolated. Physician and nursing surveys were performed. Data from 2010 (n = 2,559) and 2011 (n= 2,671) were averaged and the mean LOS for the entire trauma service was 7.2 days. After adding an experienced ACNP, the average LOS decreased to 6.4 days, a 0.8 day reduction. Per patient, there was a $ 9,111.50 savings in hospital charges, for a reduction of $27.8 million dollars in hospital charges over the 12 month pilot program. RESULTS: A confidential survey administered to attending physicians showed that 100% agreed that a nurse practitioner in the stepdown area was beneficial and helped throughput. Dayshift nurses were surveyed, and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the patient's plan of care, experienced in the care of trauma patients, and improved patient care overall. CONCLUSION: The addition of experienced ACNPs resulted in the decrease of overall trauma service LOS, saving almost $9 million in hospital charges

I really liked this article because it focused on crisis resource management in Emergency Medicine. Seven perceived barriers to effective team performance in the ED were listed with the number one barrier being communication between disciplines. Further, of 81 (nurses, physicians, and residents) 100% felt that effective communication and effective leadership were very important team management skills that could effect the outcome of a resuscitation. Additionally, the number one contributing factor to adverse resuscitation outcomes was poor communication (96.2% out of 79 participants). Though other barriers and contributing factors to adverse outcomes were identified, communication was reported as the most contributory. Coming from an emergency room myself, I totally love the aspect of interdisciplinary collaboration. In resuscitation you are working with the physician, the nurses, the techs, pharmacy, the lab, the radiology department--and following a successful resuscitation, you are collaborating with the intensivist/pulmonolgist, cardiologist, and potentially other specialists, as well as the ICU staff members. The patient is relying on effective communication and collaboration to obtain the best outcome possible. And this communication and collaboration is not the sole responsibility of the provider, but EVERYONE on the team!

This article looks at the impact APRNs in the Emergency Department have on cost, quality of care, satisfaction and wait times. The study concludes that Emergency Nurse Practitioners have a positive influence on quality of care, satisfaction and wait times in the ER, but is inconclusive on their impact on cost.

NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice

This article details the age and scope of practice for Pediatric Nurse Practioners based on NAPNAP guidelines. This helps to guide both institutions and practioners with an age related scope of practice.

A 5 year study on ACNP's on the role in practice and how it was established.

I found this research article enlightening on Physician's views and APRN's views on the APRN's role and scope of practice in the primary care setting. In 2010, the Institute of Medicine published an article that stated "advanced practice registered nurses should be able to practice to the full extent of their education and training." The link I posted givens results to a survey given randomly to Physicians and APRNs working in direct patient care on how they view they scope of practice of APRNs.

In 2006, APRNS gained legal authority to write prescriptions in Georgia. It has been shown that nearly 40% of APRNS are still not writing prescriptions. Georgia is one of the most restrictive states in terms of APRN scope of practice. Policy changes are recommended to enhance the practice environment of APRNs to support the delivery of quality care

This article discusses APRN's in Georgia and their prescriptive authority. Georgia is one of the most restrictive states regarding APRN scope of practice. After a lengthy battle, APRN's were granted prescriptive rights in 2006; although, many are still not practicing to their full scope.

This article discusses the evolution of APRN practice in the state of Georgia, the barriers to practice, and the implications. As many of us know, the south, and Georgia specifically, is one of the most restrictive states in regards to practice.

This article entry conveys the importance of APRNs and the need for our country to better understand and use APRNs as they were trained to be used. It also includes a link to an article discussing the dissatisfaction among the profession due to various States' limitations placed on the profession's scope of practice.

This article reviewed several different studies on interdisciplinary care and looked for ways that we can improve on health care and implement better teamwork. What I found most interesting is that the article talks about how educating staff on the benefits of teamwork is seriously lacking. Two issues are emerging in health care as clinicians face the complexities of current patient care: the need for specialized health professionals, and the need for these professionals to collaborate. Interdisciplinary health care teams with members from many professions answer the call by working together, collaborating and communicating closely to optimize patient care.

This article finds two emerging issues that must be addressed to optimize patient care: "the need for specialized health professionals, and the need for these professionals to collaborate." In nursing we talk a lot about "continuity of care" and that a seamless transition between PCPs, specialists, in-patient, and out-patient services is not only good-practice but vital for thorough health care delivery and improving long term outcomes.

Systematic review of literature on the impact of Nurse Practitioners in Emergency Departments. Limited evidence of high quality. Most high quality evidence conducted in English speaking countries outside the U.S. Evidence suggests NPs in EDs associated with quality care, improved patient satisfaction, reduced wait times. Insufficient evidence related to cost-effectiveness. #BecomingAPRN16

This article chronicles the history of nursing and how expanding the role of nurses was initially justified. It discusses how this expanded role eventually became the role of the nurse practitioner that we are familiar with today.

I found this article to be completely fascinating as I was almost completely unaware of the history of the APRN role. I have heard of Lillian Wald and Mary Breckenridge but didn't know the full extent of their backgrounds. I enjoyed the history provided in this article and feel that it was a perfect reading to begin my APRN transition. It provided some important information on how the role of the nurse changed and was diminished by ourselves (ANA) before being re-expanded in the 1960s with the role of the NP. I'd love to hear what others think and if you have other interesting historical articles on the background of the APRN role!

When I typed in "APRN history" into Google, this was the first item to populate. The article is from the American Association of Nurse Practitioners website and is a timeline of significant events that have occurred over the course of APRN history. I was surprised to see that one of the first NP programs was created at Boston College. My mother is a graduate from their BSN program! The AANP was developed in 1985 and has since helped pioneer the career. Enjoy!

This site breaks down the role of a nurse, how much they've grown, and organizations that have developed, decade by decade.

This was a great overview of the nurse practitioner role. There was also a very interesting infographic on the website as well.