Nurse practitioner hospitalists in the 21st century
Friday, February 17, 2017
Not long ago, nurse practitioners seemed mostly to be employed in physician offices, community and university health centers, and so-called "minute clinics." In the midst of a growing shortage of primary care physicians, there is much in the news these days about NPs moving even more deeply into primary care, especially with the Veterans Administration granting full autonomy to NPs — with the exception of Certified Registered Nurse Anesthetists — throughout its system as of Jan. 13.
Concurrently, the growing presence of APRNs in the acute care setting is raising eyebrows among physicians and providing patients with more opportunities to receive hospital-based care from highly qualified nurse practitioners. Some readers may have already noted this sea change within the wider healthcare system.
At Thomas Jefferson University Hospital, hospitalist teams include physicians, nurse practitioners, and physician assistants. In a description of their innovative nurse practitioner hospitalist program, the facility states:
"Multiple studies demonstrate that nurse practitioner-physician collaboration can offer improved continuity of care for inpatients, enhanced multi-disciplinary team planning, decreased length of stay, as well as readmissions, and reduced hospital costs. As this role expands for nurse practitioners, more research is needed with different patient populations, different hospitalist models, and different kinds of acute care settings in order to systematically assess and evaluate best practices for nurse practitioner hospitalist care."
In the acute care setting, NPs may perform routine physical assessments and procedures, order diagnostic tests and studies, order medications and treatments, and participate in care coordination, patient transfers, and organizational committees.
The presence of highly trained nurse practitioners allows physicians to expand their ability to cover large numbers of patients, with NPs able to handle most routine workups and assessments independently.
MD-NP Collaboration is Key
The Society of Hospital Medicine (SHM) has published articles highly supportive of physician-nurse practitioner collaboration in the acute care setting. The following statement makes this clear:
"Literature supports equivalent outcomes in both primary care and inpatient settings when PAs and NPs are implemented to handle responsibilities within their scope of practice. Using a PA or NP to handle uncomplicated pneumonia cases, to conduct a stress test, or assemble data for patient rounding, for example, can have a physician multiplier effect."
In terms of physician worries regarding NP scope of practice, SHM offers this advice:
"To hospitalists who express anxiety about an NP or PA overstepping bounds and putting the physician’s license at risk…she, too, has a license that is at risk. When roles are clearly delineated for tasks that NPs and PAs will perform, jeopardizing a license will not be an issue."
Stemming the Tide
While much is made of nursing shortages that occur regularly in certain regions of the country, shortages of physicians are also making news. Physicians are retiring at a growing rate, and the impact of changes in U.S. immigration policies has the potential to decrease the number of foreign doctors who regularly make up the difference in medically underserved areas like rural and inner city communities.
Primary healthcare may be one area hurting for providers, but nurse practitioners can also help stem the tide in the acute care setting.
With some defining APRNs as "physician extenders," a team of one physician and four acute care nurse practitioners can provide highly effective acute care while also saving the facility money due to the relatively lower salaries paid to APRNs as compared to physician hospitalists.
APRNs in Acute Care
The increasing presence of nurse practitioners and APRNs in the acute care setting is the shape of things to come. With studies demonstrating positive outcomes for NPs as compared to physicians, and the job outlook for NPs being extremely positive through 2024, we can only expect this conversation to continue.
Physicians will no doubt be forced to become more comfortable with nurse practitioners being active members of the acute care team, and some facilities will likely follow the VA’s example and grant greater autonomy to APRNs within their systems.
The wave of nurse practitioners in acute care has not yet crested, and we can fully expect that wave to continue to rise. For nurses interested in both acute care and advanced practice, opportunities are increasing; and for those hospital facilities ready to make greater use of NPs, positive patient outcomes and cutting-edge NP-MD collaboration can produce enormous benefits for all concerned.
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