Defining the scope of practice of the emergency nurse practitioner role in a metropolitan emergency department

Abstract

This study examined the emergency nurse practitioner candidate (ENPC) scope of practice in a Victorian emergency department (ED). The emergency nurse practitioner (ENP) role is relatively new in Victoria and the scope of the ENP(C) practice is yet to be defined. International research literature regarding the ENP role has focused on outcomes such as patient satisfaction, waiting times and/or ED length of stay, accuracy and adequacy of documentation, use of radiography, and patient education, health promotion and communication issues. A prospective exploratory design was used to conduct this cohort study. There were 476 ENPC-managed patients between 14 July 2004 and 31 March 2005 with an average age of 29 years. The majority (77.2%) of ENPC-managed patients were discharged from the ED. The majority of the ENPC time was devoted to clinical practice (55%) and development of clinical practice guidelines (25%). Of patients managed by the ENPC, 49.6% required medications, 51% required diagnostic imaging and 8.6% required pathology testing during their ED stay. The most common discharge referrals were made to local medical officers (73.5%) and the most common referrals made for patients requiring admission were made to the plastic surgery (37.3%) and orthopaedic (35.5%) units. Extensions to the current scope of emergency nursing practice are pivotal to effective management of specific patient groups by ENP. The ENP model of care is an important strategy for the management of increased service demands in Victoria; however, little is known about the scope of the ENPC practice and many outcomes of the ENP care are yet to be defined. Further research to better understand the relationships between ENP outcomes is required if the contribution that ENPs make to emergency care is to be accurately quantified.

Trends in Midlevel Provider Utilization in Emergency Departments from 1997 to 2006

“…Efforts to develop assessment tools and define the scope of practice of emergency MLPs have been published but not widely adopted. [31][32][33] It is important to consider that MLPs have been successfully utilized in primary care settings for decades. 34 However, in primary care, the MLP and physician supervisor work closely on a daily basis, thereby establishing the appropriate level of autonomy to be granted.…”

A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department

“…The best evidence we have suggests that NPs will see between 1 and 2 patients per hour. [29][30][31][32] The accepted target for the staff emergency physician is 3 (to 4) patients per hour. 1 One NP group was able to raise their volume from 7.85 patients per provider per 8 hour day before study, to 10.8 patients per 8 hour day by giving up breaks, no longer assisting with staff orientation or going to lecture and by implementing incentives, 33 but the desirability of this solution is questionable.…”

Impact of a nurse practitioner on patient care in a Canadian emergency department

“…Impact of an NP on ED patient care 4 (2-5) 9 (7)(8)(9)(10) access block for higher acuity stretcher patients was a greater determinant than the presence or absence of an NP.…”