Empowering Nurses for High-Value Healthcare: A Call for Legislative and Systemic Change.

ABSTRACT: Recognizing the positive impact of clinical data outcomes and patient care experiences, coupled with the growing preference for advanced practice RNs among patients, it is imperative that nurse leaders propel legislative reforms and infrastructure support from health systems. This strategic approach is crucial for maximizing the potential of nurses in improving patient care experience and outcomes, as well as increasing accessibility to healthcare in every community.

Health System and University Leader Learning Collaboratives: Advancing Education, Regulation, and Advanced Practice Nursing Care Across the World.

ABSTRACT: This month's column proposes advanced practice nurse (APN), health system, and university leader roundtable discussions to understand and address global healthcare challenges and the evolving role of the APN. Forming international learning collaboratives focused on gaining a comprehensive understanding of the use of APNs and related education, regulatory frameworks, and models for practice can lead to greater utilization and impact to global healthcare. The "PEPPA" framework is discussed as 1 tool to enhance discussion in these collaboratives.

Supporting Advanced Practice Nurses to Work at the Top of Their License: A Partnership With Nurse Executives.

This month's column highlights the value of nurse executive leaders in leveraging their experience, role, and partnership in empowering advanced practice RNs to work at the top of their education, clinical training, and license, optimizing the triple aim, even quadruple aim, in healthcare.

Health System-Academic Partnerships: Essential to Increasing the APRN Workforce.

This month's column highlights the importance of established health system academic partnerships in strengthening the advanced practice RN workforce.

Nurse Practitioners Are Stepping Up to Meet Access to Primary Care Services Across the United States: A Time for Policy Change.

This month's column highlights the need for access to primary care services across the United States and how nurse practitioners (NPs) have risen to meet this need. The authors discuss the modernization of licensure laws that will remove unnecessary barriers to full and direct access to NP healthcare services.

Choosing the Ideal Advanced Practice Leader for Your Organization.

This month's column highlights the attributes, competencies, and qualifications for consideration when selecting the ideal advanced practice leader, one that is collaborative and skilled in providing leadership at the executive or health systems level.

PEARL: Keeping Focus on Practice, Education, Advocacy, Research, and Leadership for Nurse Practitioners in 2023.

This column highlights 5 key categories in which nurse practitioners continually strive for excellence: practice, education, advocacy, research, and leadership, also known as "PEARL."

Beyond the Pandemic: Top 10 Priorities for Health System Advanced Practice Leadership.

This month's column highlights health system priorities for advanced practice leaders and advanced practice infrastructure and support.

Nurse Practitioner Leadership Essential: Ensuring a Positive Onboarding Experience for New Nurse Practitioners.

This month's column highlights the importance of a comprehensive employee onboarding program for newly hired nurse practitioners and 6 essential components for a successful program.

Encouraging and Facilitating Research Opportunities for Advanced Practice Registered Nurses: The Role of the Chief Nursing Officer.

ABSTRACT: This month's column highlights the value contribution of advanced practice registered nurses (APRNs) to research and the importance of chief nursing officer development of health system infrastructure to engage APRNs in research.

Patients are Choosing Nurse Practitioners as Their Primary Care Provider in Many Communities Across the US.

This month's column highlights why patients are choosing to see nurse practitioners (NPs) as primary care providers, for both urgent and chronic care needs. Nurse practitioners are 1 type of advanced practice RN. Advanced practice RNs are inclusive of NPs, nurse midwives, nurse specialists, and nurse anesthetists. Primary care NPs see patients in the ambulatory and community settings, focusing on disease prevention and health maintenance. Primary care NPs often work in rural communities, providing access to care for many underserved populations.

Origin and Outcomes of Acute Care Nurse Practitioner Practice.

Acute care nurse practitioners (NPs) are educated, clinically trained, and board certified to care for acutely and critically ill patients, largely in hospital settings. Acute care NPs can positively impact patient care outcomes and are often added to acute care teams to drive optimal, reliable, efficient, and safe care, often referred to as "high value" care.

Today's Advanced Practice Leader: Value Contribution to Healthcare Systems and Delivery of Accessible, High-Quality Patient Care.

This month's column highlights organizational, practice, and patient care advantages to adding advanced practice leaders to health systems' leadership teams and ideal characteristics of effective, executive advanced practice leaders.

The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives.

BACKGROUND: High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. PURPOSE: This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. METHOD: An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. FINDINGS: A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. DISCUSSION: A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.

Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008-2018.

OBJECTIVES: To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings. DATA SOURCES: Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018. STUDY SELECTION: Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting. DATA EXTRACTION: Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice. DATA SYNTHESIS: Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes. CONCLUSIONS: Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.

Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review.

OBJECTIVES: To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN: Data were synthesized from monthly expert consensus and literature review. SETTING: Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS: Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS: Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.

Advanced Practice Providers' Perceptions of Patient Workload: Results of a Multi-Institutional Survey.

OBJECTIVE: This study examines data collected from a survey of advanced practice providers' (APPs') perceptions of reasonable versus actual APP-to-patient ratios and other factors that affect workload burden in both inpatient and outpatient clinical settings. BACKGROUND: Advanced practice providers provide accessible, cost-effective, and quality care in a growing number of specialty practices across multiple patient care settings. They are caring for higher volumes of patients and assuming more responsibilities while continuing to navigate highly complex healthcare systems. Limited evidence or benchmark data exist that would assist in determining optimal workload and staffing models that include APPs. METHODS: A group of advanced practice leaders developed and distributed a 43-question survey of workload factors to a highly diverse APP workforce. RESULTS: There were 1466 APPs across 37 areas of practice who responded to the survey distributed in 14 separate organizations. The perceived reasonable workload was lower than the actual workload for 22 specialty practice areas. The analysis included years of experience as an APP, work hours, on-call commitment, nonclinical responsibilities, and time spent in documentation, direct patient care, and performing procedures. CONCLUSIONS: There is a consensus among APPs, within their practice area, about what constitutes a reasonable patient assignment, despite the variability in APP experience, organizational culture, processes, and patient acuity.

Quality and financial impact of adding nurse practitioners to inpatient care teams.

OBJECTIVE: The purpose of this project was to examine the financial impact of adding nurse practitioners (NPs) to inpatient care teams at Vanderbilt University Hospital. BACKGROUND: National initiatives targeting quality, safe, and cost-effective healthcare have created the optimal environment for NPs to showcase their abilities and contributions. Identifying outcomes that are directly affected by NPs and quantifying data in terms of dollars can be affirmation for the contribution of the NP practice. Value can be garnered in terms of revenue generation and cost-effectiveness of hiring NP providers; however, a considerable financial impact can be in cost avoidance and cost savings through NP-associated outcomes of care. METHODS: This was a retrospective, secondary analysis of return on investment after adding NPs to 5 teams. Software was used to abstract billing, acuity, and length of stay (LOS) data and NP-associated quality metrics. Billing data, LOS, and risk-adjusted LOS data for designated years before and after adding NPs were compared. RESULTS: Gross collections compared with expenses for 4 NP-led teams for 2 year time periods were 62%, 36%, and 47%, and +32%. Average risk-adjusted LOS for the 5 time periods after adding NPs decreased and charges decreased, thus demonstrating less resource use. Most clinical outcomes improved beyond preproject baselines. CONCLUSION: This project demonstrated the value of adding NPs to inpatient care teams by means of generated revenue, reduction in LOS, and standardization of quality care.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes.

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.