DOING a good job is one thing, proving it with hard data is another. That is what a group of dynamic emergency department nurse practitioners achieved and their work could have important implications for clinical practice across Australia.

The Alfred Hospital – claimed to be the busiest emergency department in the country – first introduced the role of emergency nurse practitioners in July 2004. A Victorian state funded project, it was initiated in response to increasing demands on the health care system.

Published in the April edition of the Journal of Clinical Nursing the authors evaluate the impact nurse practitioner management had on patients triaged in minor categories 3 to 5. Described as emergency nurse practitioner candidates (ENPC) this group of patients had treatment decided in consultation with a doctor.

The authors analysed a retrospective series of 572 cases managed by ED nurse practitioners and more than 2500 cases managed in the traditional ED model.

Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. This ranged from 5.5 to 28 minutes for patients to be seen as an ENPC in contrast to 11.5 to 76 minutes for patients seen in the routine way.

The length of stay within ED was also greatly reduced for the ENPC group, from 53.5 to 163.5 minutes compared with 100 to 274 minutes for patients being seen by doctors.

In a profession with a notorious “glass ceiling” which limits career development opportunities, the nurse practitioner role gives experienced, motivated nurses a pathway to achieve higher education and specialty training.

The Alfred Hospital employs six emergency nurse practitioners, but as positions are funded by individual organisations the role is often under-utilised, the authors told Consult.

“The success of the Alfred Hospital’s emergency nurse practitioner model of care has largely been due to the overwhelming support by all health disciplines, both within ED and the wider hospital community,” they said in an email interview.

According to the authors this study demonstrates that the ENPC model significantly reduced waiting times and length of stay for emergency patients. Patient and staff satisfaction with the nurse practitioner role was evaluated in the first year.

A patient satisfaction survey was used to measure 16 questions relating to patients seen by either nurse practitioners or doctors. This showed nurses were making a positive difference in relation to patient education, health promotion and follow-up information.

While patients might be happy, some could argue that there are other professional issues that need to be considered. Could it be that nurses are taking over from doctors, or alternatively do they risk being used as a less expensive alternative to a doctor with their extended role within cash-strapped systems?

“Nurse practitioners are first and foremost nurses,” say the authors, who think being exploited as a cheaper alternative to medical staff is not a valid argument.

“The ENPC model of care is viewed as one to complement and improve access to emergency care services for patients.”

A national study of the ENPC model is now in the planning phase and the results from that will further clarify the role of the nurse practitioner and effects on ED patient outcomes.

Having established their primary workload within the area of fast-tracking patients, next year the authors plan to expand this model of care to working with medical colleagues in the trauma and resuscitation areas.

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Source
Jennings N, O'Reilly G, Lee G, Cameron P, Free B, Bailey M. Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia. Journal of Clinical Nursing. 2008;17 (8) 1044-1050 doi:10.1111/j.1365-2702.2007.02038.x

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