The top 100 cited Nurse Practitioner publications: a bibliometric analysis.

BACKGROUND: Development of the Nurse practitioner role and the specialisation of practice is an increasing focus in healthcare. To date, a bibliometric evaluation of scholarly work referring to Nurse Practitioners, has not been located in the published literature. OBJECTIVE: With the aim of identifying the top 100 cited articles in the Nurse Practitioner domain, the Scopus™ database was searched for Nurse Practitioner studies during 2007-2021. Using bibliometric analysis we identified prolific authors; annual trend; citation rates; countries of origin; and study design. RESULTS: There were 1768 papers identified across 360 peer reviewed journals in 33 countries. CONCLUSIONS: Finding from this analysis provides evidence of an evolving research area of inquiry which contributes to knowledge of the Nurse Practitioner role and scope of practice.

Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities.

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours 'on-call' care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Nurse practitioner work patterns: A cross-sectional study.

AIM: The aim was to determine how nurse practitioner (NP) roles are translated into clinical practice across Victoria, Australia. This paper reports details about NP work patterns and scopes of practice across multiple clinical settings and geographic locations. DESIGN: A quantitative survey design was used. A data abstraction tool, based on previous work, was adapted for this study. METHODS: All NPs in one state of Australia were eligible to participate in the study and invited to complete an online survey about their NP practice. A previously developed data collection tool, capturing practice patterns of NPs, was adapted for online use in REDCAP. The data were exported, and descriptive statistics were analysed using SPSS. RESULTS: Participants were mostly female, with males accounting for 25%. Findings indicate several NPs working in outpatient settings, community settings and forensic care. Patterns of practice-prescribing and ordering diagnostics-are associated with clinical context and model of care of the NP work.

To stitch or not to stitch: A case review: Auricular lacerations involving cartilage management in the emergency department.

Patients with Parkinsonism are at risk of frequent falls by virtue of their unstable gait. Auricular lacerations involving the cartilage are usually managed by Plastics Surgeons. Patient Mr Jones (an alias for this case review) had sustained a significant full thickness auricular laceration that was complicated by a past medical history with Parkinson's disease. This case review summarises a nurse practitioner's (NP) clinical decision-making processes and the experience in the management and treatment of auricular cartilage lacerations in the emergency department.

How do we capture the emergency nurse practitioners' contribution to value in health service delivery?

The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.

Profiling wound management in the emergency department: A descriptive analysis.

BACKGROUND: The service profile of wound, skin and ulcer presentations to emergency departments is an area that lacks an existing published commentary. Knowledge of these presentations would inform the allocation of resources, staff training, and, in turn, patient outcomes. The aim of this study was to describe the discharge and referral status of adult patients presenting to one Australian emergency department with a wound, skin or ulcer condition. METHODS: A retrospective descriptive review was conducted of all emergency presentations including discharge and referral statuses for skin, wound and ulcer related conditions from 1st January 2014 until 31st December 2014. RESULTS: A total of 4231 wound, skin and ulcer conditions were managed, accounting for 7% of the total emergency presentations. Wound conditions were the most prevalent (n=3658; 86%). Males were more likely to present for all three conditions. For all conditions, discharge to home was the most common destination. Following discharge to home, over half all patients were referred to the local medical officer. CONCLUSIONS: Nursing workforce models, education and training needs to reflect the skill set required to respond to wound, skin and ulcer conditions to ensure that high quality skin and wound care continues outside of the emergency department.

Review article: Diagnostic accuracy of risk stratification tools for patients with chest pain in the rural emergency department: A systematic review.

Risk stratification tools for patients presenting to rural EDs with undifferentiated chest pain enable early definitive treatment in high-risk patients. This systematic review compares the most commonly used risk stratification tools used to predict the risk of major adverse cardiac event (MACE) for patients presenting to rural EDs with chest pain. A comprehensive search of MEDLINE and Embase for studies published between January 2011 and January 2015 was undertaken. Study quality was assessed using QUADAS-2 criteria and the PRISMA guidelines.Eleven studies using eight risk stratification tools met the inclusion criteria. The percentage of MACE in the patients stratified as suitable for discharge, and the percentage of patients whose scores would have recommended admission that did not experience a MACE event were used as comparisons. Using the findings of a survey of emergency physicians that found a 1% MACE rate acceptable in discharged patients, the EDACS-ADP was considered the best performer. EDACS-ADP had one of the lowest rates of MACE in those discharged (3/1148, 0.3%) and discharged one of the highest percentage of patients (44.5%). Only the GRACE tool discharged more patients (69% - all patients with scores <100) but had a MACE rate of 0.3% in discharged patients. The HFA/CSANZ guidelines achieved zero cases of MACE but discharged only 1.3% of patients.EDACS-ADP can potentially increase diagnostic efficiency of patients presenting at ED with chest pain. Further assessment of tool in a rural context is recommended.

Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department.

INTRODUCTION: Emergency department presentations after mammalian bites may be associated with injection of bacteria into broken skin and may require prophylactic antibiotics to prevent subsequent infection. We aim to describe the epidemiology of patients presenting with a mammalian bite injury and antibiotic choice to an Australian adult tertiary centre. METHODS: A retrospective cohort study was performed capturing all presentations after mammalian bite wounds between 01 Jan 2014 and 31 Dec 2014. An explicit chart review was conducted to determine management of each case. Cases were subgrouped into high- and low-risk groups as defined by the Australian Therapeutic Guidelines for animal bites. RESULTS: There were 160 cases of mammalian bite wounds included, with 143 (89.4%) patients grouped as high-risk and 17 (10.6%) patients identified as low-risk. High-risk features were delayed presentation > 8 hours (57 patients, 35.6%), bites to the head, hand or face (113 patients, 70.6%), and puncture wounds unable to be adequately debrided (74 patients, 46.3%). There was a significant association with delayed presentation of more than eight hours and clinically established infection [OR 36.2; 95% CI: 12.6-103.6; P < 0.001]. Prescriptions for antibiotics that adhered to current guidelines occurred in 99 (61.9%) cases. CONCLUSIONS: This study highlights variability in antibiotic prescription practice among clinicians and the need for ongoing education on antibiotic stewardship. Intervention strategies, including ongoing education, are indicated to improve adherence to antibiotic guidelines.

Time to analgesia and pain score documentation best practice standards for the Emergency Department - A literature review.

BACKGROUND: Emergency Department pain management is an often overlooked aspect of acute care and is of paramount importance. Patients are often forced to wait extended periods of time without pain assessment or being offered analgesia for their painful condition. This has been associated with poor psychological and physiological consequences both for the health system and the patient. This is suggestive of a lack of clarity around best practice standards for time to analgesia and pain score documentation in the ED. METHODS: A literature review was undertaken to investigate best practice in relation to acute pain management. Key outcomes were pain score documentation and time to analgesia. After a search of the electronic databases, a total of 992 abstracts were screened and 38 potentially relevant full articles were reviewed. There were 23 articles excluded for a variety of reasons including poor methodology, indirect specialty and inappropriate focus or age of study. A total of 15 studies were appropriate for inclusion in the review. RESULTS: Of the 15 studies, only eight included pain score as an outcome and 13 used time to analgesia as a measure. Four studies specifically investigated nurse initiated analgesia programs in relation to improving acute pain management. A higher incidence of pain assessment, reassessment and pain score documentation was generally correlated with decreased time to analgesia. CONCLUSIONS: Whilst there is an abundance of evidence available on the current practice and challenges of quality acute pain management in the ED, there is a lack of well-controlled studies on best practice standards for health care services to benchmark their practice and improve. Mandating pain score reporting, pain assessment and reassessment within specific timeframes and analgesia administration within 30 min of arrival is highly recommended. The implementation of nurse led analgesia protocols should be encouraged to increase incidence of documented pain assessment and reduce time to analgesia.

Evaluating emergency nurse practitioner service effectiveness on achieving timely analgesia: a pragmatic randomized controlled trial.

OBJECTIVES: The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. METHODS: Patients presenting with pain were randomly assigned to receive either standard ED medical care or NP care. Primary investigators were blinded to treatment allocation for data analyses. The primary outcome measure was the proportion of patients receiving analgesia within 30 minutes from being seen by care group. Secondary outcome measures were time to analgesia from presentation and documentation of and changes in pain scores. RESULTS: There were 260 patients randomized; 128 received standard care (medical practitioner led), and 130 received NP care. Two patients needed to be excluded due to incomplete consent forms. The proportion of patients who received analgesia within 30 minutes from being seen was 49.2% (n = 64) in the NP group and 29.7% (n = 38) in the standard group, a difference of 19.5% (95% confidence interval [CI] = 7.9% to 31.2%; p = 0.001). Of 165 patients who received analgesia, 64 (84.2%) received analgesia within 30 minutes in the NP group compared to 38 (42.7%) in the standard care group, a difference in proportions of 41.5% (95% CI = 28.3% to 54.7%; p < 0.001). The mean (±SD) time from being seen to analgesia was 25.4 (±39.2) minutes for NP care and 43.0 (±35.5) minutes for standard care, a difference of 17.6 minutes (95% CI = 6.1 to 29.1 minutes; p = 0.003). There was a difference in the median change in pain score of 0.5 between care groups, but this was not statistically significant (p = 0.13). CONCLUSIONS: Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.

The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review.

AIMS: To provide the best available evidence to determine the impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department for adult patients. BACKGROUND: The delivery of quality care in the emergency department is emerging as one of the most important service indicators in health delivery. Increasing service pressures in the emergency department have resulted in the adoption of service innovation models: the most common and rapidly expanding of these is emergency nurse practitioner services. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this service model in terms of outcomes related to safety and quality of patient care. Previous research is now outdated and not commensurate with the changing domain of delivering emergency care with nurse practitioner services. DATA SOURCES: A comprehensive search of four electronic databases from 2006 to 2013 was conducted to identify research evaluating nurse practitioner service impact in the emergency department. English language articles were sought using MEDLINE, CINAHL, Embase and Cochrane and included two previous systematic reviews completed five and seven years ago. REVIEW METHODS: A three step approach was used. Following a comprehensive search, two reviewers assessed all identified studies against the inclusion criteria. From the original 1013 studies, 14 papers were retained for critical appraisal on methodological quality by two independent reviewers and data were extracted using standardised tools. RESULTS: Narrative synthesis was conducted to summarise and report the findings as insufficient data was available for meta-analysis of results. This systematic review has shown that emergency nurse practitioner service has a positive impact on quality of care, patient satisfaction and waiting times. There was insufficient evidence to draw conclusions regarding outcomes of a cost benefit analysis. CONCLUSION: Synthesis of the available research attempts to provide an evidence base for emergency nurse practitioner service to guide healthcare leaders, policy makers and clinicians in reform of emergency service provision. The findings suggest that further high quality research is required for comparative measures of clinical and service effectiveness of emergency nurse practitioner service. In the context of increased health service demand and the need to provide timely and effective care to patients, such measures will assist in evidence based health service planning.

Time to analgesia for care delivered by nurse practitioners in the emergency department ­ a retrospective chart audit.

OBJECTIVES: To evaluate quality of care delivered to patients presenting to the emergency department (ED) with pain and managed by emergency nurse practitioners by: 1 Evaluating time to analgesia from initial presentation 2 Evaluating time from being seen to next analgesia 3 Measuring pain score documentation BACKGROUND: The delivery of quality care in the emergency department (ED) is emerging as one of the most important service indicators being measured by health services. Emergency nurse practitioner services are designed to improve timely, quality care for patients. One of the goals of quality emergency care is the timely and effective delivery of analgesia for patients. Timely analgesia is an important indicator of ED service performance. METHODS: A retrospective explicit chart review of 128 consecutive patients with pain and managed by emergency nurse practitioners was conducted. Data collected included demographics, presenting complaint, pain scores, and time to first dose of analgesia. Patients were identified from the ED patient information system (Cerner log) and data were extracted from electronic medical records. RESULTS: Pain scores were documented in 67 (52.3%; 95% CI: 43.3-61.2) patients. The median time to analgesia from presentation was 60.5 (IQR 30-87) minutes, with 34 (26.6%; 95% CI: 19.1-35.1) patients receiving analgesia within 30 minutes of presentation to hospital. There were 22 (17.2%; 95% CI: 11.1-24.9) patients who received analgesia prior to assessment by a nurse practitioner. Among patients who received analgesia after assessment by a nurse practitioner, the median time to analgesia after assessment was 25 (IQR 12-50) minutes, with 65 (61.3%; 95% CI: 51.4-70.6) patients receiving analgesia within 30 minutes of assessment. CONCLUSIONS: The majority of patients assessed by nurse practitioners received analgesia within 30 minutes after assessment. However, opportunities for substantial improvement in such times along with documentation of pain scores were identified and will be targeted in future research.

A protocol for a pragmatic randomized controlled trial evaluating outcomes of emergency nurse practitioner service.

AIM: To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. BACKGROUND: Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. DESIGN: Pragmatic randomized controlled trial at one site with 260 participants. METHODS: This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. DISCUSSION: Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752.

Evaluating patient presentations for care delivered by emergency nurse practitioners: a retrospective analysis of 12 months.

BACKGROUND: The delivery of quality patients care in the emergency department (ED) is emerging as one of the most important service indicators to be measured in health services today. The emergency nurse practitioner role was implemented as a service innovation in one Melbourne, ED, Australia, in July 2004. The primary aim of the role was intended to enhance healthcare services, improve the efficiency and timely delivery of high quality care to patients. AIM: To conduct a retrospective study of patient presentations at the ED to obtain a profile of the characteristics of patients managed by emergency nurse practitioners. Specifically the objectives of the study were to: (1) examine the demographics of the patient population and (2) evaluate data on emergency department service indicators for this patient cohort. METHOD: A descriptive exploratory design was used. All patients presenting to the ED from January 01, 2011 to December 31, 2011 and managed by emergency nurse practitioners were included in the review. Data collection included baseline demographics, waiting times to be seen, length of stay, ED discharge diagnoses and referral patterns. Data were extracted and imported directly from the ED patient information system (Cerner log), for the specified time frame. RESULTS: A total of 5212 patients were reviewed in the study period. The median age of patients was 35 years and 61% of patients were male. The most common discharge diagnosis was open wounds to hand/wrist. Waiting times to be seen by the emergency nurse practitioner were 14 min and length of stay for patients with a discharge disposition of home were 122 min. CONCLUSIONS: This study has provided information on patient baseline characteristics and performance on important service indicators for this patient sample that will inform further research to evaluate specific outcomes of the emergency nurse practitioner service.

A survey of patient satisfaction in a metropolitan Emergency Department: comparing nurse practitioners and emergency physicians.

The Emergency Nurse Practitioner role was introduced to an Emergency Department, Melbourne in 2004 as an alternative health-care model to provide accessible and efficient patient care. The aim of the study was to explore patient satisfaction using a questionnaire from their emergency department experience comparing Emergency Nurse Practitioners and emergency department doctors. Patients who received care from either Emergency Nurse Practitioners or emergency department doctors were given a self-administered questionnaire to complete. Descriptive statistics and non-parametric tests were used for data analysis. A total of 202 patients completed the survey with 103 seen by the Emergency Nurse Practitioners and 99 seen by emergency department doctors. Significant differences were reported in 12 of the 16 questions comparing patient satisfaction with either Emergency Nurse Practitioners or emergency department doctors with greater patient satisfaction demonstrated with the Emergency Nurse Practitioners. The Emergency Nurse Practitioner model demonstrates consistent levels of patient satisfaction with patients reporting more favourable satisfaction with the Emergency Nurse Practitioners compared with emergency department doctors.

Evaluating outcomes of the emergency nurse practitioner role in a major urban emergency department, Melbourne, Australia.

AIMS AND OBJECTIVES: The aim of this study was to evaluate the impact of the introduction of Emergency Nurse Practitioner Candidates (ENPC) on waiting times and length of stay of patients presenting to a major urban Emergency Department (ED) in Melbourne, Australia. BACKGROUND: As part of a Victorian state funded initiative to improve patient outcomes, the role of the Emergency Nurse Practitioner has been developed. The integration and implementation of this role, is not only new to the Alfred Emergency and Trauma Centre but to EDs in Melbourne, Australia, with aims of providing holistic and comprehensive care for patients. DESIGN: A retrospective case series of all patients with common ED diagnostic subgroups were included. The ENPC group (n = 572) included all patients managed by the ENPC and the Traditional Model (TM) group (n = 2584) included all patients managed by the traditional medical ED model of care. Outcome measures included waiting times and length of stay. RESULTS: Statistically significant differences were evident between the two groups in waiting times and length of stay in the ED. The overall median waiting time for emergency patients to be seen by the ENPC was less than for the TM group [median (IQR): ENPC 12 (5.5-28) minutes; TM 31 (11.5-76) minutes (Wilcoxon p < 0.001)]. Length of stay in the ED was also significantly reduced in the ENPC group [median (IQR): ENPC 94 (53.5-163.5) minutes; TM 170 (100-274) minutes (Wilcoxon p < 0.001)]. The comparison of overall waiting times for ENPC shifts vs. non-ENPC shifts revealed significant differences [median (IQR): ENPC rostered 24 (9-52) minutes; ENPC not rostered 33 (13-80.5) minutes (Wilcoxon p < 0.001)]. CONCLUSIONS: This study has demonstrated that ENPCs implementation in Melbourne, Australia were associated with significantly reduced waiting times and length of stay for emergency patients. Emergency Nurse Practitioners should be considered as a potential long term strategy to manage increased service demands on EDs. Relevance to clinical practice. This study is the first in Australia with a significant sample size to vigorously compare ENPC waiting times and length of stay outcomes with the TM model of care in the ED. The study suggests that ENPCs can have a favourable impact on patient outcomes with regard to waiting times and length of stay.

An exploration of staff knowledge on the nurse practitioner's role in the emergency department.

BACKGROUND: The role of the Nurse Practitioner (NP) was introduced to the Emergency Department (ED) at a metropolitan hospital in Melbourne, Australia in July 2004. AIMS: The aims of the study were to explore staff knowledge of the NP role. METHODS: A survey was used to elicit the information from the ED staff. The survey used was a five point Likert scale from "strongly agree" to "strongly disagree". Descriptive statistics and non-parametric tests were used for data analysis. FINDINGS: A total of 76 medical and nursing staff completed the survey. The role of the NP was favourably reported by staff with 90% agreeing to statements about the role. Knowledge gaps were found in one third of respondents in relation to the scope of practice and clinical practice guidelines and over 40% (n=31) did not understand the procedural requirements for NP endorsement. What is unclear is whether the lack of staff knowledge affected patient care or implementation of the NP role. CONCLUSION: This study demonstrated a good level of staff knowledge with the NPs in the ED. Further staff education is needed regarding some aspects of the NP role.