Evaluation of a nurse practitioner-led transitional care program.

BACKGROUND: Transitional care management (TCM) is a growing field in the delivery of post hospital discharge care. Current data suggest that implemented nurse practitioner (NP)-led transitional care models can be useful in reducing 30-day readmission rates. However, there is lack of data regarding the costs involved to implement and sustain a transitional care model. LOCAL PROBLEM: The Transitional Care Encounter Program (TCEP) implemented by an NP at a private practice affiliated with a 250-bed acute care facility required program evaluation. This article addresses the TCEP's cost and sustainability, reimbursement, and nonmonetary value added to the practice. METHODS: The Centers for Disease Control and Prevention (1999) "Framework for Program Evaluation in Public Health" was used for formal program evaluation. The TCEP's billing and revenue data compared with the TCEP's cost determined the financial impact. Qualitative data were also collected. INTERVENTIONS: Patients discharged from the hospital to home had a TCEP visit within 7 days of discharge. The patient's hospital records were extensively reviewed. Medication reconciliation, education about current medications, diagnosis, and treatment plan were incorporated. RESULTS: Total reimbursement was $53,330.32. Providers expressed they could allocate more time to primary care patients and averaged 2-3 more patients by having a dedicated transitional care provider. Providers expressed patients were "empowered" after the TCEP visit. CONCLUSIONS: The TCEP was a source of revenue and improved provider satisfaction. Exploration of the TCM's impact on 30-day readmission rates and patient satisfaction are recommended to further support the model.

The consensus model for regulation of APRNs: implications for nurse practitioners.

PURPOSE: To examine the Consensus Model for APRN Regulation as a proposed solution to simplify and unify regulation of advanced nursing practice with respect to licensure, certification, accreditation, and educational standards. DATA SOURCES: Policy statements and reports issued by national organizations of nursing professionals and discussion within the scholarly literature provided an overview of regulatory differences among the 50 U.S. states, their impacts on advanced practice registered nurse (APRN) practice, and discussion of the Consensus Model as a potential solution. CONCLUSIONS: Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today's complex healthcare system and, ultimately, reduced access to safe, quality care for patients. IMPLICATIONS FOR PRACTICE: The Consensus Model for APRN Regulation promises to unify APRN education, practice, and licensure, promoting greater mobility among nursing professionals. Elimination of inconsistencies in APRN licensure, education, certification, and accreditation requirements will promote greater value and mobility for the APRN within the healthcare system.

States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners.

The use of nurse practitioners (NPs) is one way to address the shortage of physician primary care providers. NP training programs and the number of practicing NPs have increased in the past two decades. However, regulations limiting their scope of practice vary greatly by state. We assessed the impact of state regulations on the increase in care provided by NPs in the United States, using a 5 percent national sample of Medicare beneficiaries. We found that between 1998 and 2010 the number of Medicare patients receiving care from NPs increased fifteenfold. By 2010 states with the least restrictive regulations of NP practice had a 2.5-fold greater likelihood of patients' receiving their primary care from NPs than did the most restrictive states. Relaxing state restrictions on NP practice should increase the use of NPs as primary care providers, which in turn would reduce the current national shortage of primary care providers.

The consensus model for regulation of APRNs: Implications for nurse practitioners.

Purpose: To examine the Consensus Model for APRN Regulation as a proposed solution to simplify and unify regulation of advanced nursing practice with respect to licensure, certification, accreditation, and educational standards. Data sources: Policy statements and reports issued by national organizations of nursing professionals and discussion within the scholarly literature provided an overview of regulatory differences among the 50 U.S. states, their impacts on advanced practice registered nurse (APRN) practice, and discussion of the Consensus Model as a potential solution. Conclusions: Major organizations of nursing professionals have endorsed the Consensus Model, indicating the importance of this significant step toward standards and consistent quality in APRN education and practice. Diverse regulatory criteria, such as variable accreditation standards, disparate certification and licensing requirements, inconsistent population foci, and scopes of practice, represent barriers to optimized APRN function within today's complex healthcare system and, ultimately, reduced access to safe, quality care for patients. Implications for practice: The Consensus Model for APRN Regulation promises to unify APRN education, practice, and licensure, promoting greater mobility among nursing professionals. Elimination of inconsistencies in APRN licensure, education, certification, and accreditation requirements will promote greater value and mobility for the APRN within the healthcare system.

The successful use of problem-based learning in an online nurse practitioner course.

The development of technology and online education has opened the door to creative use of new and existing teaching methodologies. The authors describe how they used problem-based learning in an online course as a method for teaching clinical decision making to nurse practitioner students. The close match between problem-based learning and the characteristics of adult learners and successful distance learners is outlined as support for use of this methodology. In addition, the authors describe the challenges, rewards, and lessons learned in this innovative approach to online education.