Impact of Nurse Practitioner Services in the Emergency Department Towards Clinical Effectiveness
The Impact of Nurse Practitioner Services in the Emergency Department towards Clinical Effectiveness
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Abstract
The emergency department is crucial as it offers medical interventions for various accidents and injuries. In the recent time, the emergency department has witnessed an increase in the demand for services as well as reduced patient satisfaction claims. Therefore, this change has necessitated the adoption of the necessary human resources in the form of nurse practitioners who assist in providing quality care in less time. This dissertation aims at analysing the effect of introducing the nurse practitioners in the emergency departments on the quality of care services, the time of stay and patient satisfaction. Many studies have been conducted worldwide to assess the effect of advanced nurse practitioners in improving the quality of care services. Reliable data is supporting the importance of nursing professionals in initiating change in healthcare. Therefore, the emergency departments should readily embrace the new changes if they aim at improving the quality of health care.
Keywords: emergency department, healthcare, nurse practitioners
Acknowledgment
I would like to recognise the various stakeholders who aided me throughout the process of conducting this dissertation. I would like to appreciate my family and colleagues for the support as well as the different officials from the Cardiff University who assisted me in any way.
Table of Contents
S.NO
Title
Page NO.
Title page
Abstract
2
Acknowledgement
3
Table of content
4
Chapter 1
Introduction
5
Dissertation aim
9
Chapter 2
Introduction
9
Research strategy
9
Key words
9
Literature review
9
Summary
14
Chapter 3
Quality improvement
16
Importance of Service Improvement in Healthcare System
16
Leadership in Health Care System
16
Leadership Theories
17
Leadership Styles (Transformational Leadership)
18
RAPSIES model
18
Chapter 4
Barriers to Implementation
19
Ethical Consideration
20
Recommendations
20
Conclusions
20
References
21
Appendices
22
The Impact of Nurse Practitioner Services in the Emergency Department towards Clinical Effectiveness
Chapter 1
The growing use of the advanced nursing services for the treatment of various conditions and diseases has raised the interest of the efficiency of the nursing profession in health care (West et al 2012). An important indicator of quality services in the medical sector is the type of services offered in the emergency areas. In the contemporary world, the nursing practitioners have taken up a vital role in the medical field, and they seem to be closer to the patients than the doctors are. The nurses are responsible for conducting various essential services in the hospitals such as the diagnosis of patients, minor surgeries and administering drugs. The building up of pressure on the services offered by the emergency departments necessitated the invention of creative strategies, which incorporated the emergency nurse practitioner services.
In Australia, there was an overwhelming adoption of this practice, which outpaced the practice’s evaluation models (Mullins 2010). Still little has been established on the impact of the of nurse practitioner services in the emergency department safety and quality of patient care. London hosts over three million patients in the emergency sectors every year who have limited medical institutions they can access to seek abrupt therapeutic services. The citizens in the United Kingdom have high expectations on the local emergency department’s potential to provide consistent and high-quality services (Giltinane 2013). Formerly, the emergency departments were known as the accident and emergency departments, and before then, they were called casualty.
Advanced nursing practice relies on the skills of the individual nurse (Taylor et al., 2014). The emergency departments operate without closing so that the patients can have a guarantee of accessing medical services at any time. Emergency units exist to serve people who may be involved in some fatalistic situations that would require the immediate intervention from the medical practitioners; otherwise, many people would die. Other services offered by the nursing professionals in the emergency departments include the telephone consultations. According to Gopee and Galloway (2013), this function reduces the backlog that is experienced in the emergency rooms and is suitable for the less severe health issues such as minor cuts. Telephone triage services serve in a variety of places such as general practices and the primary health care setting. Other specialist services such as the paediatrics use this method to communicate with the various clients and personnel. In the recent times, the medical departments have experienced a growth in the use of telephone triage to manage the massive demand for emergency services, especially on general health issues. Some examples of this service in different nations include the NHS Direct in England and the Norwegian primary care out-of-hours services.
In the city of Sheffield in the United Kingdom, the medics introduced a nurse profession that would head the minor injury unit in case any accident and emergency unit closed down (Sharma and Jain 2013). Previous studies on this project indicate that there were high levels of client satisfaction from the services offered by the minor injury unit although there is no evidence showing cost effectiveness (Johnson and Raterink 2009). There is an increased importance in the role of the advanced nurses in the national health services, especially in the emergency departments. Improvement of services would require the collaboration among the various stakeholders so that they can establish a culture that supports the changes, and various principles of the organisation are applied. An organised, systematic plan provides an opportunity for evaluating the reasons and causes of failure of a system (Ledlow and Coppola 2013). Thus it is possible to determine what to fix. At the micro levels, the significant conditions affecting the patients and making a difference in their lives are the location where the nurses are working. The skills of influencing changes and improving the quality of services require proper orientation to the environment and the formation of a direct line with the patients. Nurses have to understand the magnitude of the role bestowed on them to achieve change successfully. In nursing, leadership is an important factor to consider because, in most cases, nurses work in an ideal setting.
The illustration below is a depiction of the professional nursing practice
Aim
This dissertation aims at investigating the impact of incorporation of the nursing practitioners in the emergency departments and what significant difference it causes as compared to the regular nursing practice. The paper examines the role, the relationship, and aims of nurse leaders. Management and leadership are components of Interprofessional collaboration practices that affect the nurses. The article discusses both the pros and cons of the presence of these health professionals and ultimately it assesses the overall impact of the nurses as either constructive or deleterious to the health services quality. It is worth noting that, clinical effectiveness relies on the care given to the patients and their families in a bid to attain the best results. The primary thematic question is; does the introduction of nursing practitioners in the emergency departments make any impact on the quality of health services and leadership?
Chapter 2
Literature review
Introduction
Conducting a literature review generates critical information on the data and evidence that would justify the dissertation. It is important to organise and clarify the opinions of the writers so that the reader can grasp the evidence and the issue (Halm 2010). Literature review supports a research topic and guides the researchers, basing their studies on evidence.
Searching strategy
Inclusion Criteria
Inclusion Criteria
Number
Articles published after 2006
All
International papers
40
Papers in English Only
All
Qualitative Studies
2
Survey
5
Exclusion Criteria Number
Articles published before 2006
All
Cohort study
3
RCT papers (non-related topics)
2
Other papers
1
Seminar papers
1
I adopted a variety of techniques when it came to the search for literature to be used in the study. I used a variety of academic websites to get the articles that were in relation with the discussion that would follow. Notably, I used Google Scholar as the search engine in getting sources to be used in the study. Reviewed articles in form of PDF that had relevant information on the topic of study. Further, I used professional journals such as BMJ, PubMed and PubMed Central in getting articles for use in executing the discussion. The inclusion criteria was based on the issues to be discussed and the keywords. Further, articles to be used were those within a timeframe of 10 years that is from 2006 to 2016. English as my default language. My search initial yielded 56 articles, and I used exclusion criteria to limit the content to forty articles. I eliminated the case studies, cohort studies, non-related topic papers and the seminar papers. To strengthen my search strategies further, I used the various themes related to the topic to make the proper selection of articles.
Main themes:
• Length of stay in emergency department
• Patient satisfaction
• Quality of care
Keywords
Emergency medicine; Patient satisfaction; Emergency department; Interpersonal skills; Acuity; Length of stay; Technical expertise; Waiting time; nurse leader; nurse practitioner; advanced nursing practice
Chapter 2: Literature Review
Patient Satisfaction
Patients come to the hospital to seek treatment. Nurse practitioners have the mandate to ensure that after administration of treatment, the patients are satisfied with the nature of services that are offered. Notably, patients admitted to the emergency department find themselves in dire states and expect better treatment to their satisfaction. Different researchers have conducted studies that seek to explain the impact of nurses in the emergency department on the improvement of patient satisfaction. Dinh et al. (2012) recognize the significant role played by the advanced nurse practitioners when it comes to patient satisfaction through the services provided. The services provided by the advanced practitioner nurses are essential in enhancing the satisfaction levels of patients. Dinh et al. (2012) acknowledge the fact that patients are the recipients of healthcare services. Because of the same, it is critical that they are provided with the best services possible. In the study, Dinh et al. (2012) conducted a study with 236 participants including the advanced nurse practitioners and the doctors at the ED. Patients were expected to take a self-administered survey that sought to determine the satisfaction levels of the patients. The results indicated there was a high satisfaction rate among patients served by the ANPs compared to doctors. The study was valid considering the approach that was adopted. Dinh et al. (2012) illustrate that 60% of the patients who had visited the emergency department rated the survey as excellent. The patients attended to at the emergency department were suffering from a musculoskeletal injury. Findings of the study indicate that the patients were satisfied with the reduction in time taken to serve them. It could be a reflection of the fact that the presence of nurses in the emergency department is critical to improving the overall patient outcomes. However, it is essential to consider that the study could have some limitations key among them being the possibility of facing the effects of bias. The researchers adopted the use of convenience sampling that could introduce a bias that is likely to affect the outcome of the results. Further, it is critical to consider the fact that the completion of the survey may have been a problem because patients who were to see the doctors would wish for a reduced waiting time. Those who were able to see the doctor early enough could give a positive score in the survey. Overall, it is critical to consider the fact that advanced nurse practitioners have a significant role to play in increasing the patient satisfaction rate.
Soleimanpour et al. (2011) investigate patient satisfaction at the emergency department concerning factors such as physicians’ communication with the patients, nurses’ communication, and the security guard’s courtesy. The patient satisfaction rate was, however, dependent on the average amount of time they waited to be served. The satisfaction rates were recorded as security guard’s (78.3%), physician’s communication with the patients (82.5%) and nurses’ communication with patients (78%). In the study, the rate of satisfaction at the lowest level was measured at 7.7. The results are an indication of the fact that various factors determine patient satisfaction at the emergency department. However, it is evident that indeed patient satisfaction rate to a greater extent depends on the role played by the individual nurse practitioner. For example, in this study, patients identified the concept of time spent waiting to be served as a significant factor in determining the satisfaction level. The researchers enrolled a total of five hundred patients at the emergency department who took a questionnaire. However, the researchers identify other factors to be of critical significance when it comes to patient satisfaction at the emergency department. It is crucial to consider such factors in addition to the concept of the role of the nurses when it comes to improvement of patient satisfaction rate. Findings of the study are useful in helping confirm the role played by nurses when it comes to improvement of services offered to the patients. It is critical to acknowledge the fact that advanced nurse practitioners play a fundamental role when it comes to the enhancement of patient satisfaction.
Jennings et al. (2009) in her studies sought to determine the impact of the advanced nurse practitioner in the improvement of patient satisfaction. Jennings et al. (2009) conducted a survey among 202 patients where 103 were seen by the advanced nurse practitioner while the other 99 were considered by the doctors (n=103 and n=99). The questionnaire that had 16 questions indicated that a significant number of patients were satisfied with the services provided by the nurse practitioners in the emergency department. According to Jennings et al. (2009), 12 out of the 16 patients who took part in the study acknowledged that they were satisfied with the nature of services provided by the advanced nurse practitioners. The nurse practitioners were identified as being competent in areas such as health education, counselling, and management of individual cases. The decision by patients to score positively in the survey is a confirmation of the fact that indeed nurses play a significant role in the emergency department when it comes to the realization of a high rate of patient satisfaction. It is critical to appreciate the fact that nurses have a greater role to play when it comes to the enhancement of treatment of patients in the emergency department. Their input is critical toward the attainment of better treatment outcomes for patients eventually resulting in increased rates of satisfaction. However, it is crucial to consider that the studies conducted could have potential challenges that can affect the results and the final analysis. Fain et al. (2013) reiterate that use of the questionnaire may lead to multiple mistakes that can affect the eventual results of the analysis. Nevertheless, it is vital to appreciate the fact that at some level there is agreement toward the fact that patient satisfaction rate is majorly dependent on the availability of nurses at the emergency department.
In a different study approach, some researchers indicate that patient satisfaction depends on other factors to be playing a fundamental role in the improvement of patient satisfaction. For example, Ryan and Rahman (2010) state that patient satisfaction depends on the availability of health insurance. Notably, patients who had were uninsured were highly satisfied compared to those who were not. It is a reflection of the fact that most of the patients get satisfied with the nature of services provided based on their economic status.
Length of Stay in Emergency Department
The increased demand for emergency department services implies longer waiting times and delays in giving medical services. Therefore, it is important to assess the waiting time as a crucial measure of the efficiency of the emergency departments. A previous analysis conducted by Dinh et al. (2012) annualised the provision of care services by the ENT in the fast track unit (FTU).The study observed delays in the delivery of attention services among the ENP as compared to the physicians. When the ENP assessed the patient, they used seven more minutes. The study found the case to have a p-value of 0.006. The waiting time for each patient was calculated from his or her medical records of their hospital visits. In contrast to this analysis, Colligan et al. (2011) conducted an observational study that analysed the effectiveness of the ENPs and the physicians in trea
