NR 714 Discussion Reliability In Advanced Nursing Practice
DQ1 Power Analysis in Advanced Nursing Practice
Examine potential power analysis contributions that serve to
improve the advanced nursing practice environment.
DQ2 Reliability Versus Validity in Advanced Nursing Practice
Examine potential reliability and validity contributions
that serve to improve the advanced nursing practice environment.
The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes.
The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings.
A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools.
Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.
Capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.
Electronic supplementary material
The online version of this article (10.1186/s12960-017-0237-9) contains supplementary material, which is available to authorized users.
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While people of all ages receive emergency and critical care services across the world, the elderly population continues to exhaust a greater proportion of these services . The complexity and acuity of care have heightened with greater prevalence of chronic illness and multimorbidity among older adults . Correspondingly, the demand for emergency and critical care services has increased , alongside a concomitant increase in the forecasted workforce requirements for such services . The Accreditation Council for Graduate Medical Education regulations in 2006 in the United States of America (USA) recommends a high-intensity model of care involving 24-h physician coverage [3, 4]. This implementation accentuates inadequacies of the healthcare workforce to provide emergent and critical care services. In the USA, it is predicted that, compared to healthcare system’s demands, there will be a 22% shortfall of critical care physicians by 2020 and a subsequent 35% shortfall by 2030 .
With the impending rise in demand for health services, an effective utilization of the workforce is paramount to ensure high-quality yet cost-effective health service delivery . Across some countries, healthcare workers’ wages account for approximately 50% of the total healthcare expenditure . Hence, cost containment strategies will inevitably involve the workforce . Efforts are underway for measures to enhance productivity through increasing the capacity of the workforce.
One potential measure is a greater utilization of nurses in advance practice. The global annual growth of the nurse practitioner (NP) workforce has been estimated to be between three to nine times greater compared to physicians; therefore, of interest to health policymakers is the utilization of NPs and advanced practice nurses (APNs) [8, 9]. The nomenclature varies internationally. The “NP” title is used in Australia, Belgium, Canada, Sweden, the United Kingdom (UK), and the USA whereas the “APN” title is used in Switzerland, Singapore, and South Korea . Nonetheless, NPs and APNs (NP/APNs) are registered nurses “who acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice” (, p. 26) and enter the workforce with a master’s degree .
This advanced practice role was first introduced in the 1960s as a solution to the lack of primary care physicians, to meet the primary care needs of the rural and underserved populations . Primary care has first contact with patients and, subsequently, provides continuity of care within the healthcare system through the coordination of care according to patients’ needs . Studies to evaluate the quality of primary care provided by NP/APNs have been shown to be comparable to that of physicians in terms of effectiveness and safety . To fulfill primary care needs, NP/APNs in this setting are trained generalists who have a breadth of knowledge to render a wide scope of care.