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Introducing a nurse practitioner into an urban Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Ivan P. Steiner ,
Sandra Blitz ,
Darren N. Nichols ,
Dwight D. Harley ,
Leneela Sharma  and
Andrew P. Stagg
Ivan P. Steiner*
Affiliation:
Department of Family Medicine, University of Alberta, Edmonton, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Darren N. Nichols
Affiliation:
Department of Family Medicine, University of Alberta, Edmonton, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Dwight D. Harley
Affiliation:
Division of Studies in Medical Education, University of Alberta, Edmonton, Alta.
Leneela Sharma
Affiliation:
Division of Studies in Medical Education, University of Alberta, Edmonton, Alta.
Andrew P. Stagg
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
*
205 College Plaza, 8215-112 St., Edmonton AB T6G 2C8; ivan.steiner@ualberta.ca

Abstract

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Objective:

Our objective was to compare the emergency care provided by a nurse practitioner (NP) with that provided by emergency physicians (EPs), to identify emergency department (ED) patients appropriate for autonomous NP practice and to acquire data to facilitate the development of the clinical scope of practice recommendations for ED practice for NPs.

Methods:

Using a comprehensive 3-part process, we selected and hired the best NP from 12 applicants. The NP was oriented to the operations of our free-standing community ED and incorporated in the care team, working in real time with EP preceptors during a 6-month, prospective clinical assessment comparing NP care with EP care. ED preceptors reviewed every case in real time with the NP and completed an explicit evaluation form to determine whether NP assessment, investigation, treatment and disposition were “all equivalent to emergency physician care” (AEEPC) or whether they differed. The proportion of AEEPC interactions was determined for 23 patient presentation categories. Our a priori assumption was that a patient presentation category might be suitable for autonomous NP practice if 50% of NP encounters in that category were rated as AEEPC. Descriptive data were presented for patient case mix, teaching domains and time criteria.

Results:

Eighty-three NP shifts and 711 patient encounters were evaluated by 21 EP preceptors. The NP saw a median of 8 patients per shift. In 43% of encounters, NP care was AEEPC. Highest AEEPC rates were found in the patient follow-up categories general follow-up (55.4%), diagnostic imaging (91.7%) and microbiology laboratory results (87.6%). NP scores over 50% were also seen for lacerations (63.6%) and isolated sore throats (53%). With teaching, NP performance improved over time.

Conclusion:

With the exception of follow up–related complaints, simple lacerations and isolated sore throats, NP care differed substantially from EP care. Although NPs with extensive emergency experience and training might ultimately be able to function as autonomous ED care providers, Canadian EDs currently developing job descriptions for emergency NPs should focus on a model of collaborative practice with EPs.

Keywords

nurse practitioneremergency carequality assuranceemergency departmentemergency physician
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 4 , July 2008 , pp. 355 - 363
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

References

1.Sakr, M, Angus, J, Perrin, J, et al. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomized controlled trial. Lancet 1999;345:1321–6.Google Scholar
2.Sakr, M, Kendall, R, Angus, J, et al. Emergency nurse practitioners: a three part study in clinical and cost effectiveness. Emerg Med J 2003;20:158–63.Google Scholar
3.Geolot, D, Alongi, S, Edlich, RF. Emergency nurse practitioner: an answer to an emergency care crisis in rural hospitals. JACEP 1977;6:355–7.CrossRefGoogle Scholar
4.Stafford Hardy, VG. The emergency nurse practitioner: the role and training of an emerging health professional. JACEP 1978;7:372–6.CrossRefGoogle ScholarPubMed
5.Tye, CC, Ross, F, Kerry, SM. Emergency nurse practitioner services in major accident and emergency departments: a United Kingdom postal survey. J Accid Emerg Med 1998;15:31–4.CrossRefGoogle ScholarPubMed
6.Tye, CC. The emergency nurse practitioner role in major accident and emergency departments: professional issues and the research agenda. J Adv Nurs 1997;26:364–70.CrossRefGoogle ScholarPubMed
7.Neades, BL. Expanding the role of the nurse in the accident and emergency department. Postgrad Med J 1997;73:17–22.Google Scholar
8.Meek, SJ, Ruffles, G, Anderson, J, et al. Nurse practitioners in major accident and emergency departments: a national survey. J Accid Emerg Med 1995;12:177–81.CrossRefGoogle ScholarPubMed
9.Saab, M, Birkinshaw, R, O’Gara, P. Twenty-four hour nurse practitioner service in the accident and emergency department. Eur J Emerg Med 1997;4:25–8.Google ScholarPubMed
10.Cooper, MA, Hair, S, Ibbotson, TR, et al. The extent and nature of emergency nurse practitioner services in Scotland. Accid Emerg Nurs 2001;9:123–9.Google Scholar
11.Cole, FL, Ramirez, E. A profile of nurse practitioners in emergency care settings. J Am Acad Nurse Pract 2002;14:180–4.CrossRefGoogle ScholarPubMed
12.Hooker, RS, McCaig, L. Emergency department uses of physician assistants and nurse practitioners: a national survey. Am J Emerg Med 1996;14:245–9.CrossRefGoogle ScholarPubMed
13.Chang, E, Daly, J, Hawkins, A, et al. An evaluation of the nurse practitioner role in a major rural emergency department. J Adv Nurs 1999;30:260–8.Google Scholar
14.Nichols, DN, Yoon, PW, Steiner, IP. Do emergency nurse practitioners provide safe patient care? ISRJEM 2006;6(1). Available: http://isrjem.org/IJEM_Jan06_NursePrac_Proof.Revised.pdf (accessed 2008 May 20).Google Scholar
15.Emergency Nurses Association. 2007 Position Statement on Advanced Practice in Emergency Medicine. Available: http://www.ena.org/about/position/PDFs/7FC38A8AEDA1457E9BC2 78D4C2A16F1E.pdf (accessed 2008 June 2).Google Scholar
16.Marsden, J. Education preparation for ENP roles. Emerg Nurse 2003;10:26–31.CrossRefGoogle ScholarPubMed
17.Dolan, B, Dale, J, Morley, V. Nurse practitioners: the role in A&E and primary care. Nurs Stand 1997;11:33–8.Google Scholar
18.Drummond, AJ, Bingley, M. Nurse practitioners in the emergency department: a discussion paper. CJEM 2003;5:276–9.Google Scholar
19.Canadian Nurse Practitioner Initiative. (2006). Nurse practitioners: the time is now. Integrated report. Available: http://www.cnpi.ca/about_the_cnpi/np_final/index.asp?lang=e& (accessed 2007 Jan 28).Google Scholar
20.Carter, AJE, Chochinov, AH. A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. CJEM 2007;9:286–95.Google Scholar
21.Beveridge, R. CAEP issues. The Canadian Triage and Acuity Scale: a new and critical element in health care reform. Canadian Association of Emergency Physicians. J Emerg Med 1998;16:507–11.Google Scholar
22.Titanich, K. Community nurse practitioners in Alberta: the story continues. In: Patterson, C, editor. Nurse practitioners: the catalyst of change. Troy (ON): Newgrange Press; 2000. p. 135–62.Google Scholar
23.Alberta Association of Registered Nurses. Nurse practitioner: a vital member of the health-care team. 2003. Available: http://www.nurses.ab.ca/publications/NPpub.html (accessed 2006 Oct 30). [Since the time of writing, this article has been printed and is no longer available online. Print copies can be requested from the Alberta Association of Registered Nurses.]Google Scholar
24.Capital Health Careers in Nursing. Available: http://www.capital health.ca/Careers/Nurses/default.htm (accessed 2006 Dec 20).Google Scholar
25.Sacchetti, A, Carraccio, C, Harris, RH. Resident management of emergency department patients: Is closer attending supervision needed? Ann Emerg Med 1992;21:749–52.Google Scholar
26.Health Professions Act, 1999. Available: http://www.qp.gov.ab.ca/Documents/acts/H07.CFM (accessed 2008 May 21).Google Scholar
27.Drummond, A. Nurse practitioners in Canadian emergency departments: an idea worthy of attention or diverting our attention. CJEM 2007;9:297–9.CrossRefGoogle ScholarPubMed