Memphis Medical News
April 2013
By Suzanne Boyd
Nurse practitioners are not new to the hospital setting, but their roles have expanded in recent years.
Hospitals have turned to NPs to fill the void from the nationally mandated reduction in hours that medical residents can work and the lack of physician specialists, as well as in response to organizational changes that enhance patient care and improve quality and efficiency. At The Med in Memphis, advanced practice nurses have been playing an expanded role for 10 years and seeing the benefits of it.
Nurse practitioners are advanced practice nurses, providing high-quality healthcare services. Among other things, NPs diagnose and treat a range of health problems and are employed in a variety of roles, including clinical care, health promotion, disease prevention and education. The scope of the NP practice is determined by state law, and the responsibilities vary by place of employment. Nurse practitioners facilitate the care process by managing patient care in collaboration with physicians.
The Med recently celebrated the 10-year anniversary of its Trauma Step-Down Unit, which includes 11 UT Medical Group trauma nurse practitioners. The NPs care for trauma patients, from admission to discharge and even afterward for follow-up outpatient care. The NPs first began working with the trauma surgeons in The Med’s Critical Care Assessment, which is its trauma emergency department, in 1999. When The Med opened the Step-Down Unit in January 2003 as a bridge between the Critical Care Assessment and the two trauma floors, the NPs expanded their roles to include Step-Down as well. In 2010, UTMG also opened an outpatient clinic so the trauma NPs could provide follow-up care for patients after discharge. In 2011, the NPs further extended their duties to include caring for patients on the two trauma floors in the hospital.
“Beginning in 1999, there were three nurses working with the director of the Trauma Center who were pulled into working trauma in Critical Care Assessment at The Med,” said Jane Ann Sullivan, lead NP for the group, who has been in nursing for 33 years, and an advanced nurse practitioner for 14 years. “The group saw there were other things we could do, such as staff the Step-Down Intensive Care Unit. We opened the unit serving as the front-line providers with the attending physicians. We now have 11 nurse practitioners, all of which have additional certifications in emergency and trauma care. Some of them are also dual certified as acute care NPs and family nurse NPs.”
Dual certification is becoming a popular option for nurse practitioners in that it allows them to treat a broader scope of patients, thereby allowing them more options in terms of where they can practice. The advantage of having dual certification, Sullivan says, is that as an acute care NP you are trained to work in the hospital as well as in specialty clinics.
“There are no dual programs – you have to do one or the other. I usually see family nurse practitioners, who are trained to work in the community, go back and get their acute care certification because they are interested in it,” she said. “There is more of a push for dual certification from an academic standpoint rather than a licensing one. In Tennessee, as long as you have specialty training in your area and are supervised by a physician with a specialty in that area, you can work in a hospital.”
In Tennessee, a nurse practitioner is required to have an attending physician work with them. The Med’s protocols require it as well. When the state changed regulations that reduced the number of hours a resident or intern could be in the hospital, it meant a cutback in staffing for the unit and the ER.
“When the interns got their time cut back, it was only natural that we could step in to provide care since we were already working in those areas,” Sullivan said. “Nurse practitioners covered the two trauma floors, which could have from 20 to 40 patients in them at a time.”
When staffing in the clinic began to run short, nurse practitioners were again a natural fit, and they began working with the attendants and residents in the clinic.
“It wasn’t long before the nurse practitioners realized we could have our own clinic and see more patients as long as we had an attending to call if there was a problem,” Sullivan said. “Although we did not see as many patients as the physicians and residents, we do see the patients that are appropriate for our clinic. We soon discovered we could see them faster, then get back to hospital to cover Critical Care Assessment and the Unit.”
The nurse practitioners run their clinic two mornings a week.
“Because the nurse practitioners already know the trauma patients from treating them while they were in the hospital, it is beneficial for them to see those patients in the clinic,” said Martin Croce, MD, medical director of The Med Trauma Center. “The group is very efficient and moves patients through the clinic quickly, which is appealing to all parties. We have seen high marks for the clinic in terms of patient satisfaction.”
Sullivan has also seen a multitude of benefits from the expanded role nurse practitioners are playing at The Med.
“Our group brings continuity of care to the patients in that we have seen them as an inpatient. We know the protocols the patient needs to have and have seen the patient on a consistent basis on the floor,” she said. “By not having to have someone sign off on each patient, we can move them through the clinic more efficiently. Plus, the patients and their families like that they are seeing a familiar face.”
Because trauma is a field driven more by mistakes, such as alcohol, violence and drugs, the patient population does not always have a payor source.
“As a university-supported level one trauma center, finding tangible benefits of using nurse practitioners in an expanded role may be harder to see,” Sullivan said. “We are more consistent in what we do and we are impacting length of stay, which cuts cost. We also serve as great educational resources for the nursing staff, since our practice is a blend of the medical and nursing models of care.”
In the current environment of healthcare reform, facilities have to adapt to the changing healthcare workforce and find new ways to deliver care. Maximizing the use of nurse practitioners can be to their advantage.
“Healthcare reform may lead to fewer choices for physicians in terms of their practice specialty, which may mean more nurse practitioners will end up in the hospital setting,” Sullivan said. “Working trauma is labor intensive and mentally challenging, especially when we cover the unit and the floor 24/7, but we are there because we believe we can do what needs to be done. Our physicians are so supportive of the great group of nurse practitioners we have. They are a dedicated group. We still have nine of the original group still with us.”
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