Measuring practice patterns among acute care nurse practitioners

Time use of advanced practice nurses in hospitals: A cross-sectional study

AIMS

To examine the use of time by advanced practice nurses and time use differences according to type of healthcare organization, work experience, and supervisor.

DESIGN

A cross-sectional, observational study.

METHODS

Non-participant observations were executed in Belgium (October 2015-January 2016). Time use was categorized in domains (patient/family, team, healthcare organization) and roles (clinical expert, educator/coach, change agent/innovator, researcher, leader, collaborator, and ethical decision-making facilitator). Proportional working time in domains and roles was calculated. Chi-squared tests identified differences in time use according to type of healthcare organization, number of years of work experience, and type of hierarchical/functional supervisor.

RESULTS

Participants mainly devoted time to the patient/family domain (30.78%) and the clinical expert role (34.19%). The role of leader and ethical decision-making facilitator covered, respectively, 4.84% and 0.07% of participants' time. Time distribution in domains and roles differed between participants in university and peripheral hospitals.

CONCLUSION

Activities were executed in all domains and roles, except for the ethical decision-making facilitator role. Further research could uncover barriers and facilitators for role execution, especially about leadership and ethical decision-making.

IMPACT

Advanced practice nurses, supervisors and policymakers could act to optimize advanced practice nurses' scope of practice.

Advanced registered nurse practitioners and physician assistants in the practice of pediatric neurosurgery: a clinical report

OBJECTIVE

This report addresses the clinical experience of the Division of Pediatric Neurosurgery with dedicated nurse practitioners and a physician assistant (PA) in outpatient and inpatient health care delivery, including surgical activities, as well as participation with the neurosurgery call schedule, quality improvement, teaching, and clinical research activities.

METHODS

We report on the activities of allied health personnel in the Division of Pediatric Neurosurgery for the purpose of identifying the current and future role for health care delivery, related to the care of the child with a neurosurgical condition. This addresses the participation of 2 advanced registered nurse practitioners (ARNPs) and a PA in the outpatient and inpatient setting, call schedule, interventions in and out of the operating room, quality improvement sessions, continuing medical education, clinical research, clinical databases, presentations in meetings, teaching, and scientific publications.

RESULTS

This report covers the period from September 2003 (when the division was initiated) to February 2011. The division currently consists of 3 pediatric neurosurgeons, 2 ARNPs and 1 PA. The ARNPs/PA have participated in the pediatric neurosurgery clinic held 5 half-days per week, the monthly multidisciplinary clinics (Spinal Defects Clinic, Pediatric Neurosciences Clinic, and the Fetal Diagnosis and Therapy Center working group), and inpatient care, as well as assisting in operative interventions. They participated in the on-call schedule and attended the monthly quality improvement sessions of the division in addition to presenting papers and topics in the monthly continuing medical education session. The PA maintained a computerized database of operative interventions, coding, morbidities, and outcomes. All were involved in teaching activities. They prepared preoperative and postoperative orders and practice guidelines, and they were also involved in the preparation of the database of institutional clinical research projects. They have presented posters in a total of 9 national and 2 international meetings, and have co-authored 8 manuscripts published in peer review journals.

CONCLUSION

The ARNP/PA members have been active participants in all functions of the Division of Pediatric Neurosurgery. They have facilitated the work of the faculty in day-to-day activities and enhanced the scope of divisional activities, providing a team approach for the care of the patients, families, and caretakers.

Determination of standard times of nursing activities based on a Nursing Minimum Dataset

AIM

This paper is a report of a study conducted to determine the standard time per nursing activity and the proportion of nursing time covered by the nursing activities of the Belgian Nursing Minimum Dataset compared to the total time of a nurse shift, and to evaluate the correlation between hospital size and standard times of nursing activities.

BACKGROUND

Because of a shrinking workforce and rising workload, nursing managers need tools that help them to allocate their staff to the wards. Such tools should be based on objective time measurements.

METHODS

The study was performed in surgical, internal medicine and elder care wards in an acute hospital care setting. In the first phase, a two-round Delphi-procedure was used to operationalize the definitions of nursing activities. In the second phase, the standard time for each nursing activity was determined, based on data collected over a 6-month period during 2006-2007. A combination of 13,292 work sampling observations by external observers, 3000 recordings of direct time measurement by self-recording and subjective time assessments yielded times that were used to analyse the duration of the nursing activities.

RESULTS

A standard time for 102 nursing activities was established. The coverage of the Belgian Nursing Minimum Dataset in the surgical, internal medicine and elder care wards was 47.5%, 46.4% and 51.0% respectively. The Belgian Nursing Minimum Dataset was found to cover almost 70% of direct and indirect nursing care.

CONCLUSION

Further research is needed to assess the impact on the standard times of nursing activities of inefficient organizational structures and different cultural interpretations of the way an activity is conducted.

The neuroscience acute care nurse practitioner: role development, implementation, and improvement

As the number and opportunities for acute care nurse practitioners (ACNPs) continue to increase, the successful integration of these providers into the health care setting becomes more of a challenge. This article outlines strategies for role development, implementation, and evaluation to optimize the performance of the neuroscience ACNP role. The concepts presented are applicable across all acute-care specialties that use ACNPs.

Levels of autonomy of nurse practitioners in an acute care setting

PURPOSE

The purpose of this descriptive study was to determine the level of autonomy of nurse practitioners (NPs) providing care to an adult patient population in an acute care setting.

DATA SOURCES

Data were collected from 54 NPs in different specialty areas currently working in a large metropolitan hospital. The Dempster Practice Behaviors Scale was used to measure the autonomy of the NPs.

CONCLUSIONS

The overall mean autonomy score of 117.37 (SD = 14.55) indicates a high level of autonomy of the NPs in this study. Forty-one percent of the participants had very high levels of autonomy, 31.5% had extremely high levels of autonomy, and 19% had moderate levels of autonomy. Demographic variables of age; years worked as an NP, as an RN, and at current job; highest educational level; basic nursing preparation; NP certification; and specialty had no statistically significant relationship with autonomy scores.

IMPLICATIONS FOR PRACTICE

The results of this study provided preliminary evidence of the level of autonomy of NPs providing inpatient care to adult patients in an acute care setting. The findings could lead to future research on the impact of NP services on patient outcomes and clinical productivity in acute care settings.

Innovations in Care: The Nurse Practitioner in the PACU

Recognizing the advantages of the advanced practice nurse (APN), an urban medical center of 500+ beds created an innovative position. The decision was made to hire a nurse practitioner to manage patients seen in the busy PACU. This article is a description of the program. The article includes background, objectives, qualifications of the practitioner, collaborative practice agreement, delineation of privileges, and educational plan. The role description and daily practice plan of the practitioner are also discussed.

Peer Review for Advanced Practice Nurses

Peer review has multiple manifestations and purposes. Two stated purposes are the demonstration of professionalism and clinical competency. The American Nurses Association (ANA) defines nursing peer-review as a process for evaluating the care provided by an individual according to accepted standards. Further, the ANA proposes that nurses with similar rank and clinical expertise should conduct these evaluations. Some local jurisdictions may also mandate that advanced practice nurses (APNs) review one another's care. Therefore, APNs should become familiar with sources for evaluation criteria and tool formats for APN peer review. The advantages and limitations of the various formats and processes of peer review should also be considered.

Clinical nurse specialist care managers' time commitments in a disease-management program for bipolar disorder

OBJECTIVES

As part of a cost-effectiveness analysis for Department of Veterans Affairs Cooperative Studies Program #430, 'Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder,' we conducted a time and motion study to quantify the time psychiatric clinical nurse specialist (CNS) care managers spent providing care for patients.

METHODS

Clinical nurse specialist care managers completed activity logs in which they recorded time spent implementing the Bipolar Disorders Program (BDP) during a 1-week period in spring, summer, fall and winter over a 1-year period when caseloads were at steady state. Mean service time was estimated by use of univariate analysis of means and by multivariable regression analysis.

RESULTS

On average CNS care managers spent 40% of their clinical time in activities that typically are reimbursed (e.g. clinic visits) and spent the remaining 60% of their time in activities that are typically unreimbursed. Total clinic time increased as the number of visits per day increased; however, this increase got smaller with each additional visit per day.

CONCLUSIONS

As with other chronic illness management programs, CNS care managers expend a substantial portion of their clinical effort for the BDP in activities that are typically unreimbursed. Their activities have a fixed component per day as well as a component that systematically varies with the number of visits per day. These findings should be considered when costing out and disseminating psychiatric and other medical chronic illness management programs.