Advanced Practice Nurse Outcomes 1990–2008

A Systematic Review

Robin P. Newhouse, PhD, RN, NEA-BC; Julie Stanik-Hutt, PhD, ACNP, CCNS, FAAN; Kathleen M. White, PhD, RN, NEA-BC, FAAN; Meg Johantgen, PhD, RN; Eric B. Bass, MD, MPH; George Zangaro, PhD, RN; Renee F. Wilson, MS; Lily Fountain, MS, CNM, RN; Donald M. Steinwachs, PhD; Lou Heindel, DNP, CRNA; Jonathan P. Weiner, PhD

Disclosures

Nurs Econ. 2011;29(5):230-250. 

In This Article

Clinical Nurse Specialist Outcomes

Outcomes from 11 studies (four RCTs and seven observational) were aggregated for four outcomes: satisfaction, hospital length of stay, hospital costs, and complications. The number and type of studies for each outcome are described.

Satisfaction. Three studies (two RCTs) reported satisfaction. Studies were conducted with samples in inpatient oncology or community settings. When comparing CNS and non-CNS groups, a high level of evidence supports equivalent group satisfaction scores, indicating the CNS does not have a direct effect on patient satisfaction.

Length of stay. Seven studies (two RCTs) reported patient LOS. Studies were conducted with inpatient samples of patients post-coronary bypass surgery, in end-of-life care, undergoing radical prostatectomy, and post total knee replacement. When comparing CNS and non-CNS groups, there is a high level of evidence to support equivalent or lower LOS for patients cared for in the CNS group.

Cost. Four studies (two RCTs) reported cost outcomes. Studies were conducted with samples of CNS postpartum care, a population of patients at risk to die, and guideline implementation for patients with radical prostatectomy. When comparing CNS and non-CNS groups, there is a high level of evidence to support that the CNS group has lower cost of care.

Complications. Three studies (one RCT) reported patient complications. Studies were conducted with samples of patients discharged with a diagnosis of stroke and transient ischemic attack, a surgical intensive care unit, postoperative cardiac surgery, and a pregnancy wellness program. When comparing CNS and non- CNS groups, there is a moderate level of evidence to support that the CNS decreases complication rates.

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