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Introducing a nurse practitioner into an urban Canadian emergency department

Published online by Cambridge University Press:  21 May 2015

Ivan P. Steiner ,
Sandra Blitz ,
Darren N. Nichols ,
Dwight D. Harley ,
Leneela Sharma  and
Andrew P. Stagg
Ivan P. Steiner*
Affiliation:
Department of Family Medicine, University of Alberta, Edmonton, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Sandra Blitz
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Darren N. Nichols
Affiliation:
Department of Family Medicine, University of Alberta, Edmonton, Alta. Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
Dwight D. Harley
Affiliation:
Division of Studies in Medical Education, University of Alberta, Edmonton, Alta.
Leneela Sharma
Affiliation:
Division of Studies in Medical Education, University of Alberta, Edmonton, Alta.
Andrew P. Stagg
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
*
205 College Plaza, 8215-112 St., Edmonton AB T6G 2C8; ivan.steiner@ualberta.ca

Abstract

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Objective:

Our objective was to compare the emergency care provided by a nurse practitioner (NP) with that provided by emergency physicians (EPs), to identify emergency department (ED) patients appropriate for autonomous NP practice and to acquire data to facilitate the development of the clinical scope of practice recommendations for ED practice for NPs.

Methods:

Using a comprehensive 3-part process, we selected and hired the best NP from 12 applicants. The NP was oriented to the operations of our free-standing community ED and incorporated in the care team, working in real time with EP preceptors during a 6-month, prospective clinical assessment comparing NP care with EP care. ED preceptors reviewed every case in real time with the NP and completed an explicit evaluation form to determine whether NP assessment, investigation, treatment and disposition were “all equivalent to emergency physician care” (AEEPC) or whether they differed. The proportion of AEEPC interactions was determined for 23 patient presentation categories. Our a priori assumption was that a patient presentation category might be suitable for autonomous NP practice if 50% of NP encounters in that category were rated as AEEPC. Descriptive data were presented for patient case mix, teaching domains and time criteria.

Results:

Eighty-three NP shifts and 711 patient encounters were evaluated by 21 EP preceptors. The NP saw a median of 8 patients per shift. In 43% of encounters, NP care was AEEPC. Highest AEEPC rates were found in the patient follow-up categories general follow-up (55.4%), diagnostic imaging (91.7%) and microbiology laboratory results (87.6%). NP scores over 50% were also seen for lacerations (63.6%) and isolated sore throats (53%). With teaching, NP performance improved over time.

Conclusion:

With the exception of follow up–related complaints, simple lacerations and isolated sore throats, NP care differed substantially from EP care. Although NPs with extensive emergency experience and training might ultimately be able to function as autonomous ED care providers, Canadian EDs currently developing job descriptions for emergency NPs should focus on a model of collaborative practice with EPs.

Keywords

nurse practitioneremergency carequality assuranceemergency departmentemergency physician
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 4 , July 2008 , pp. 355 - 363
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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