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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

Very interesting read. This article provides evidence on why healthcare organizations should hire nurse practitioners based upon the education and training that they receive within their speciality as opposed to their previous RN experience. Many hospitals are struggling with this dilemma: Do we hire the APRN who has previous nursing experience in this area (who is not certified in this area) or do we hire the APRN who is certified to work in this area based on their formal training/education but is a new graduate? This article describes how prior nursing experience with a specific population does not qualify a nurse practitioner to practice without the population-focused education and certificate.

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

An interesting article that opines about the DNP. Here's a fairly provocative quote: "When viewed together, doctorally prepared nurses do not spend the majority of their time in direct patient care, but rather in research (11%), education (32%), and administration (30%). With these demanding roles, they cannot be expected to maintain expert levels of clinical competence required for teaching APN students. While research and practice are critical components of nursing, each requires a different skill set and education."

This is a handy article for a quick and dirty explanation of the differences in scope, education, etc. between APRNs and PAs. I'm asked questions like this a lot by curious family members as well as patients.

On several occasions, we get asked, "So what exactly is the difference between an NP and a PA?" This article is very recent and does a really nice job of breaking down the key differences between an NP and a PA on a deeper level.

This article does a great job defining the role, education, and scope of the APRN compared to Physician Assistants. This is a great resource to be able understand the distinction for ourselves and to use to educate others about our unique role in health care as APRNs.

I found this article very interesting. It talks about the current challenges in midwifery in regards to legislation, reimbursement, physician restrictions, and many other restricting factors. It also discusses the challenges of the education required to become an APRN.

Interesting viewpoint of the history of nurse midwifery education in the US, as well as a brief history on the speciality in general.

This article describes the results of a survey conducted of nurse leaders in Latin America and the Caribbean about their perception and knowledge of advance practice nursing. The results show that the majority of nurse leaders recognize a need for APRNS in order to create better access to care, however, the nursing education and legislation in the majority of the countries does not support APRN practices. This is an interesting introduction of APRNs in Latin America and the Caribbean for anyone who has interest of working in these areas.

This article discusses the challenge that educators have in assessing competency in APRN students, particularly with simulation.

Guidance on which PNPs (AC vs. PC) are educated for certain roles and acute care locations.

The article provides a good comprehensive timeline of the history of Advanced Practice Nurse specialties.

This link shows all the certifying bodies available and has links to those websites The American Association of Nurse Practitioners (AANP) is the largest and only full-service national professional membership organization for nurse practitioners (NPs) of all specialties.

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 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.

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

This article discusses the merger of the adult and gerontology specialties.

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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.