Nurse practitioner roles in pediatric emergency departments: a national survey.

OBJECTIVE: Emergency department (ED) visits continue to climb in the United States despite numerous primary care initiatives. A variety of staffing models including the utilization of nurse practitioners (NPs) and physician assistants (PAs) and the use of fast-track or express care are alternative methods of caring for the ED patients with less acute illness. Our objectives were to determine the prevalence of NPs in pediatric EDs (PEDs) and fast-track areas and to identify common procedures performed by NPs in PEDs. METHODS: Two telephone surveys were conducted. The first survey was performed with the ED charge nurse at all 205 hospitals in the United States participating in the National Association of Children's Hospitals and Related Institutions. The second survey consisted of an interview with NPs working in those PEDs. Both descriptive data as well as the procedures performed by NPs in the PED were collected. RESULTS: A total of 198 hospitals completed the first survey (97% response rate), representing 41 states. Fifty-one percent of respondents reported using NPs in the ED, contrasted with only 36% who reported using PAs (P < 0.01). The use of NPs was found to be distributed across all geographical regions, whereas the use of PAs was statistically more likely in the Northeast and Midwest regions (P < 0.01). Freestanding children's hospitals were more likely to use NPs than children's hospital within general hospitals (P < 0.01). Procedures such as fluorescein staining of the cornea were performed by all NPs, whereas only 65% of NPs performed repair of a finger-tip amputation. CONCLUSIONS: The use of NPs in the PED is common. Nurse practitioners in the PED perform a number of different procedures. Future studies analyzing practice patterns and effectiveness of the NP role in the PED are needed.

Retrospective comparison of emergency department length of stay for procedural sedation and analgesia by nurse practitioners and physicians.

OBJECTIVES: To determine if use of nurse practitioners (NPs) for procedural sedation and analgesia (PSA) compared with physicians (MDs) decreased overall length of stay (LOS) in the pediatric emergency department (PED). METHODS: Retrospective chart review was conducted on all children (age <21 years) undergoing procedural sedation and analgesia (PSA) for 36 consecutive months at a tertiary academic children's hospital (n = 690). Data included times values for triage, evaluation by practitioner (NP, MD), sedation, discharge, and total LOS in the PED. Data collected also included medications given, patient diagnosis, and severe airway complications. RESULTS: Results revealed statistically significant time-related advantages to NP-managed sedations. Both PED LOS and time to sedation were significantly lower for NPs versus MDs across diagnoses (P < 0.01). The diagnoses managed by MDs versus NPs were significantly different for 3 diagnoses: fracture, finger, and lacerations. There were no differences between NP and MD for severe airway complication rates. CONCLUSIONS: Overall LOS and time to sedation were significantly improved when NPs independently managed patients requiring PSA without an increase in documented severe airway complication rates.