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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 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

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This article touches on a topic of particular interest to me, specifically how APRN's can help fill a critical shortage of primary care providers in HIV medicine. The article validates that APRN's (NP's) are more than capable of providing high quality care to those living with HIV. Moreover, we are well positioned to fill the provider shortage that is only expected to grow over the next decade and beyond.

As NPs, many of us who have not practiced as nurses, it might be difficult to get your foot in the door of that first job. This is a personal strategy that I came up with to try and help mitigate that for myself, I'm obviously hoping that it works! For those of us who know where we want to work, for me that's in HIV medicine, I think it's important to develop the competencies that your employer will be looking for when you walk in the door. This article does a nice job of laying those out for entry level NPs looking to get into HIV medicine. What I'm trying to do is add as many of these skills to my resume while I'm attending school. My hope is that will give me an edge over NPs that I'm competing with who may not have been in the specialty specific time. If you can identify your desired areas of practice then its just a matter of looking for opportunities to add to your skillset. Look for faculty that have a shared interest, see if you can work on a research project with them. Look for nursing organizations in that specialty. There are two HIV specific organizations for APRNs looking to get into HIV medicine (ANAC and AAHIV). Join them and start networking. Take as much CNE as you can in your specialty topic - much of its free and can be done online at your own pace.

This article shares an experience of an NP in Nevada who had been trying to care for patients in under served areas but was having difficulty finding MDs to sign agreements with in those areas. This inhibited her ability to treat people in need but, thankfully, a new law was passed July 1 that enabled her to treat these people to the full extent her education taught her to, without having to rely on an agreement with an MD. It is important for us to remain aware of our scope of practice but also to fight for our ability to practice to the full extent we're being taught to do.

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.

Article showing an application of teamwork in a primary care setting to develop a behavior health intervention. See the abstract below! J Am Board Fam Med. 2015 Sep-Oct;28 Suppl 1:S21-31. doi: 10.3122/jabfm.2015.S1.150042. Abstract PURPOSE: This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. METHODS: This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States. RESULTS: Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. CONCLUSION: Primary care and behavioral health clinicians, through their interactions, c

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.

The APRN role is one that is continually evolving globally due to health care provider needs. This article looks specifically at barriers APRNs face that hinder them from practicing to the full extent of their scope and how to face these barriers to promote full scope of practice and address healthcare needs.

This is an interesting article that conducted a lit review to see how expanding the scope of practice for APRNs would affect health care delivery and costs in Ohio. Although it is specific to Ohio, the lit review they did highlights many benefits to full practice authority that could be generalized to any state.

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.

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

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

My intended area of practice is in HIV nursing. In my last post I provided a link to the competencies needed to be an advanced practice nurse in the field, and I talked a little bit about steps I'm taking to close that gap. To hopefully move me along the continuum from novice to expert. I thought this article was interesting and provided a broader approach in how nurses might use residency program for exactly that purpose. The article talks about DNPs but it is no different for the MSN prepared nurse. It seems that residencies may become more the norm in the future - and that might be good for all, new nurses and patients alike.

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.

This article explores how APRNs in the state of Iowa, as part of a state-sanctioned task force, identified barriers to practicing at the top of their licensure. Four goals to remove barriers to APRN full-scope practice were identified: 1) Create documents describing APRN roles to educate stakeholders, 2) Initiate discussion and presentations regarding APRN practice with stakeholders, 3) Form guidelines to create change in the existing institutional bylaws, and 4) Disseminate information using common language to the public using social media.