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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

This article looked at the relationship between physician oversight and APRN autonomy and empowerment. It surveyed APRNs in Montana, to determine which factors most influence APRN empowerment and autonomy. Surprisingly, it found that high levels of physician oversight improve APRN empowerment, regardless of whether the oversight is regulatory or simply collaborative. A next step for this study would be to learn more about why physician empowerment increases APRN autonomy - are there certain qualities to the physician/APRN relationship that must be established?

Meant to share this when we did our timelines. This was cited as a pinnacle article for the NP profession. It demonstrates that NPs give just as effective care as physicians in a primary care setting when given equal authority and responsibility. Research from JAMA - Primary Care Outcomes in Patients Treated by Nurse Practitioners or physicians - A Randomized Trial - ContextStudies have suggested that the quality of primary care delivered by nurse practitioners is equal to that of physicians.

Landmark article showing primary care from NP vs MD was not different.

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

This study compares the labor and delivery outcomes of certified nurse-midwives (CNMs) and physicians. For care processes, (e.g., epidural, labor induction, episiotomy), CNMs were found to have lower rates of application/use. For infant outcomes, (e.g., low Apgar, low birth weight, neonatal intensive care unit admission), there were no differences between physicians and CNMs. Perineal lacerations were lower and breastfeeding rates were higher among women cared for by CNMs compared with physicians.

An integrative review analyzed the perception of NPs and physicians working in primary care settings. The aim of this study was to evaluate these relationships in order to understand the success of collaboration and factors that strain these relationships. Multiple barriers were identified partly due to the autonomy of the NP. Furthermore, physicians who have never worked with NPs found more negative attitudes collaborating with NPs. Both NPs and physicians report concerns collaborating, but also value advantages.Unfortunately, a collaboration between NPs and physicians is a slow process, however, more exposure to this collaboration can help overcome these barriers.

This article discusses the benefits and pit-falls to autonomous primary care Nurse practitioner practice and advocates for cost effective improvements to our healthcare system. The research suggests that Nurse practitioners who practice independently report greater job satisfaction, improved patient outcomes and provide low cost, high quality services that are equal or superior to primary care physicians. Unfortunately, current healthcare reimbursement models, policies and reluctant physicians have created barriers to autonomous NP practices. The author suggests that autonomous practice requires further research across the U.S, the establishment of a well-defined model and the evaluation of patient outcomes, in order to determine whether the present day Nurse Practitioner requires future collaborative agreements with physicians, in order to provide quality patient care across the United States.

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.

Great article on nursing residency programs and the opportunities they provide. BONUS- includes insight from an Emory NP Alum who completed a residency program in Washington!!

Faced with a shortage of primary care doctors, more and more clinics are relying on nurse practitioners to fill the gap. But that creates another gap, in the level of training providers bring to the job. Residency programs--once reserved for physicians--are popping up for nurse practitioners as well.

This article asks the question: "Compared to other providers (physicians or teams without APRNs), are APRN patient outcomes of care similar?" The study is specific to USA and includes data regarding NPs, CNRAs, and CNMs. Outcomes were determined by the following: patient satisfaction with provider/care, patient self-assessment of perceived health status, functional status, blood glucose, serum lipids, blood pressure, emergency department visits, hospitalization, duration of ventilation, length of stay, and mortality (p9).

When nurses, physicians and other health professionals overcome professional barriers and work together, patients--and provider--benefit.

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 lengthy piece but has some great perspectives regarding policy for APRN's. Speaks about restrictive physician supervision and scope of practice.

This article focuses on the Nurse Practitioners contribution to primary care. Randomized trials were performed to help us better understand how Nurse Practitioners compare to Primary Care Physicians in the eyes of patients. Conclusions showed that patients outcomes were equivalent in their satisfaction, physical, social and emotional functioning when compared to seeing a Physician versus a Nurse Practitioner. It was also found during the studies that lower costs of care was associated with NP's.

This article describes past and current barriers to APRN prescribing abilities in the state of Georgia. While legislation has been passed in the state to allow APRN's to prescribe medications to their patients under a collaborating physician, Georgia remains one of the most restrictive states for APRN prescribing. A descriptive study was conducted to analyze the efficacy and safety of APRN prescribing and found that out of approximately 8000 prescriptions written by APRNs, only 0.003% of those were changed by the supervising physician. The study recommended that more data be collected to support the argument for full-prescriptive authority for APRNs in Georgia.

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.

This article discusses the Pros and Cons of using APRNs in both outpatient and inpatient settings. One of the positives is that there are more jobs for the APRN and now APRN's can specialize much like physicians. The downside to that is that there are not as many NPs doing primary care, which is leaving a gap.

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.

This article speaks about the future of healthcare - specifically, how primary care is at the foundation of a robust health care system. The author argues that the key to improving the triple aim (health of populations, patient experience, cost of care) is to remove barriers to NP practice, allowing them to practice to their fullest capacity.

This is an older but fascinating article about a midwife working in Gardener, Massachusetts in the 19th century. Hanna continued to attend births of mostly the immigrant population of the city despite being told by courts to cease. She was convicted of "practicing medicine without a license" and had to pay many fines and spend 3 months in a correctional facility. Note that the charges brought against her were never from clients, but from the physicians working in the area.