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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

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 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

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.

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 is a nice synopsis of key moments in history that have triggered the growth and development of the NP role in the US.

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While this article is not specific to the FNP specialty, I find it interesting because it discusses the evolving global role of APRNs.

This article provides a brief history of the APRN role and the advancement from a CRNA, to midwives, then to FNPs. The focus is the family nurse practitioner role. The author shows the connection with Erik Ericsson's stages of development and provides examples of how the role of the NP progressed through those stages. Examples are also provided from a world development perspective, as each country has also had to move through the same phases of development before moving on to the next. The author concludes that we (the U.S.) are still in the final stage of development (Integrity-older adult).

This resource provides a brief history of APRN and outlines the developmental steps in advanced practice roles that can be helpful know for countries where the role of APRN are being established or growing.

In this article, author Lugo discusses the findings of her study relating limits on full practice authority for APRNs to issues of gender equality. She investigated the link between state support of the Equal Rights Amendment (ERA) and laws in these states allowing APRNs full scope of practice and prescribing rights. Her study showed that states that have historically and currently supported the ERA in fact allow greater APRN scope of practice, and thus she draws conclusions about attitudes towards women's equality and the regulation of advanced practice nursing, which remains to be a woman-dominated profession.

In this May 2016 article published in the Online Journal of Issues in Nursing, Dr. Nancy Rudner Lugo argues that advanced practicing nursing viewed through a gendered perspective due to nursing's history as a predominantly female profession; because of this, APRNS in states that are less accepting of women's equality have a more narrow scope of practice. There is not currently a national-level evidence based method used to determine APRN scope, and is instead decided at the state level. The author seeks to explain the cause of the discrepancy between differing APRN scopes of practice in different states by comparing the APRN scope of practice between states that did and did not vote to pass the Equal Right Amendment, positing that states with cultural attitudes that are more equitable between genders reflect this at the legislative level, thus explaining the wider or full practice authority given to APRNs in these states. In conclusion, Lugo advocates for increasing the number of women in legislative positions, forming relationships between women's equality organizations and groups working towards expanded health care access, and emphasizing the skills and competency of APRNs in achieving positive patient health outcomes.

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 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!

This article present a gap in research regarding advocacy at the APRN level, despite the large amount of evidence surrounding advocacy at the RN level. The article calls for more research regarding if and how advocacy may differ at the APRN level and how exactly institutions are preparing APRN students for the advocacy 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.

For fifty years, health care teams have been a misunderstood, undervalued, and neglected part of health care. Yet, as Drinka and Clark make clear, well functioning interdisciplinary health care teams (IHCTs) have the potential to help the health care system face its demons--financial constraints and comprehensive error-free care. Because of misunderstandings, administrators, funders, and policy makers keep the potential for interdisciplinary teams hidden. IHCTs have characteristics and problems that are unique to health care settings and the health providers who work in them. Drinka and Clark present a groundbreaking attempt to develop a comprehensive framework for IHCTs.

This article discusses the barriers to NP practice with the current healthcare reform by addressing the shortage of primary care providers and the limitations of APRN practice. Barriers that were emphasized include state practice and licensure, physician related issues, education, and role perception. This article stresses that an APRN should be able to practice to the fullest extent of their training.

This is an excellent overview of common barriers to APRN practice that effect the Triple Aim for healthcare: better care (individuals), better health (populations), and lower cost.

This article first provides a brief history on APRNs. It also discusses barriers to the APRN scope of practice.

The role of APRNs continues to expand when current gaps in patient care management and outcomes are identified. Central Arkansas Veteran Healthcare System created the role of Abnormal Radiology Findings APRN with the aim of improving patient outcomes by decreasing the length of time between abnormal radiology findings and decrease of care for our veterans. During the year of research since the advent of this position, the days until decision dropped on average from 38 to 7 demonstrating the efficacy of the role and the ways APRN are well placed within the health care system to provide patient-centered care.

This book highlights the development of the nurse practitioner movement. The current state of practice is defined and the potential growth of the role is explored.

Here is another brief, yet insightful read on the evolution of midwifery in the US.

This is a brief summary of the history of midwifery and beginnings of nurse-midwifery in the United States.Though the statistics are a bit dated, the article also has some recent data on the positive impact of the recent resurgence of midwifery practice since it began declining in the late 19th and early 20th centuries. It also discusses the profession of nurse-midwifery's close ties with public health and under served communities.