ABSTRACT
Curriculum development for preparation of acute care nurse practitioners requires a comprehensive process. To develop a program for their preparation at a large university, the faculty examined needs of the target patient population and care delivery system; scope of acute care nurse practitioner practice; current guidelines for the education of primary care nurse practitioners; evolving guidelines for the didactic and clinical education of acute care nurse practitioners; educational requirements of governing or licensing and certifying bodies; and placement of this new role within the existing healthcare team structure. A curriculum was then developed using a collaborative, multidisciplinary approach.
Subject(s)
Acute Disease/nursing , Curriculum , Nurse Practitioners/education , Certification , Comorbidity , Humans , PreceptorshipABSTRACT
This article provides specifics on the development of a clinical track for faculty appointments at the University of Pittsburgh. The criteria to be used for appointment and promotion on the clinical track are discussed along with the practice requirements of 60 hours per term of participation in and responsibility for direct care of patients. The purposes of faculty practice are set forth along with the formation and functioning of a Faculty Practice Council which handles decisions related to faculty practice. Results of the first year after implementation of a clinical track showed that 64 per cent (18) of the faculty had met all of their faculty practice obligations; of the remaining 36 percent (10) who had not, a variety of circumstances were cited. The Income to the School of Nursing for faculty practice, although modest, has helped to highlight that practice is valued and an integral part of the faculty role.
Subject(s)
Nursing Faculty Practice/organization & administration , Schools, Nursing/organization & administration , Nursing Faculty Practice/economics , Organizational Culture , Professional Staff Committees , Program Development , Staff Development/methodsABSTRACT
As public concern for quality control of medical care at the beginning of this century forced regulations on medical licensing of physicians, the forces of change in health care are again substantial, this time driven by concerns for cost and access. Our experience at the University of Pittsburgh Medical Center leads us to believe that well-trained physician extenders will play a valuable role in improving efficiency and effectiveness in the care of critically ill patients. We have developed a method for training and supervision. Graded practice supervision, with physician-led professional review, is considered a reasonable goal. We propose that the appropriate degree of supervision in any given area can be determined by: a) careful development of training programs; b) careful assessment of the individual's practice with the target patient population; and c) application of a review process that is sensitive in that population. Issues surrounding the independent practice and reimbursement of acute care nurse practitioners (ACNPs) are not resolved. These issues should be addressed by joint position statements that are based on objective documentation of the safe, effective performance of ACNPs, and on the incorporation of routine performance measurements with continued medical or joint evaluation of the quality review system. Guidelines regarding the evolving roles of ACNPs should be established by professional associations and state or national boards of both nursing and medical practice. Critical care physician and nursing leaders should lead such initiatives.
Subject(s)
Efficiency, Organizational , Intensive Care Units , Nurse Practitioners/statistics & numerical data , Practice Guidelines as Topic , Clinical Protocols , Hospitals, University , Humans , Inservice Training/organization & administration , Interprofessional Relations , Medical Staff, Hospital/psychology , Models, Educational , Models, Nursing , Nurse Practitioners/education , Nurse Practitioners/psychology , Nursing Evaluation Research , Nursing, Supervisory , Pennsylvania , Professional Autonomy , Quality Assurance, Health Care , Reimbursement Mechanisms/economics , WorkforceABSTRACT
Clinical decision-making is the process nurses use to gather information, evaluate it and make a judgment that results in the provision of patient care. This research sought to increase our understanding of clinical decision making by nurse practitioners. The sample consisted of 27 nurse practitioners; 6 OB/GYN nurse practitioners, 11 experienced family nurse practitioners and 10 inexperienced family nurse practitioners. All subjects cared for the same patient who was presented via computer and interactive video. Findings indicated that nurse practitioners use a process of clinical decision-making in which diagnostic hypotheses drive data acquisition. The OB/GYN nurse practitioners were more likely to develop lists of diagnostic hypotheses which reflected the patient's chief complaint, while both experienced and inexperienced family nurse practitioners were more likely to acquire subjective and objective data that did not appear to be hypothesis driven.
