COMMENTARY

How Are NPs Viewed in Hospital Roles? Very, Very Well

Tom G. Bartol, NP

Disclosures

December 09, 2014

An Evaluation of the Implementation of Advanced Nurse Practitioner (ANP) Roles in an Acute Hospital Setting

McDonnell A, Goodwin E, Kennedy F, Hawley K, Gerrish K, Smith C
J Adv Nurs. 2014 Oct 22. [Epub ahead of print]

The Impact of Hospital-Based Nurse Practitioners

This qualitative study from England examines the impact of implementing advanced nurse practitioner (APN) roles on patients, staff members, and organizational outcomes in an acute care hospital. The study used a collective case study approach comprising interviews with strategic stakeholders, followed by three individual mixed-method case studies in the three areas where APNs had been introduced: medicine, surgery, and orthopedics. A purposive sample of 13 strategic stakeholders with insight into the role implementation were selected from management, education, medicine, and nursing, as well as senior operational managers and consultant medical staff members.

Interviews were conducted with the APNs at the start and again at the end of the study. Interviews with patients and staff members were conducted to explore perceptions and impact of APNs on experience and care. A researcher also shadowed the APNs working in each area on two to five occasions for about 4 hours per visit. These observations were made to gain greater insight into the APN role in practice. Three researchers recorded, transcribed, and analyzed all interviews and coded them for themes.

The evidence pointed to a positive impact of APNs on patients' experience of care. A holistic approach by the APN and an ability to understand the patient perspective were highly valued. Continuity of care was also seen as enhanced by APNs, providing a reassuring, individualized, and confidence-building approach for patients. APNs were seen as capable, knowledgeable, and skilled, and they had a positive impact on the patient experience through improved communications.

A clear consensus among staff was that APNs also had a positive impact on patient safety outcomes. They were seen as proactive, recognizing problems and promptly managing patient changes. Ward nurses found them approachable if they had patient concerns. Senior staff members commented on the organizational skills of APNs and the accuracy, completeness, and legibility of their documentation.

Junior doctors (doctors in training or residents, as we might know them in the United States) valued the clinical expertise and in-depth knowledge of APNs. There was no evidence that APNs detracted from their learning or diluted the experiences available to the junior doctors. They commented on APNs' decision-making and clear rationale for decisions. Enhanced communications and bridging the gap between doctors, nurses, and other professionals were other positive observations.

The introduction of APNs had a positive effect at the organizational level, with patients receiving more timely care, as well as increased throughput and shorter length of stay. This study found that APNs, who took on roles often performed by junior doctors in an acute hospital setting, had a positive impact on patient experience, patient outcomes, and patient safety while enhancing organizational priorities and targets.

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