Response to Bragg M letter: ‘Alternate models of care and the role of the emergency nurse practitioner’

Abstract

Response to Bragg M letter: 'Alternate models of care and the role of the emergency nurse practitioner'We thank Dr Bragg for his comments regarding our editorial 'Emergency Nurse Practitioners: an underestimated addition to the emergency care team'. We agree that alternate models of care should be considered, trialled and evaluated against transparent criteria.The context of our editorial suggested that emergency nurse practitioners (ENP) are 'one potential solution to an overstretched health care system, crippled by access block', but not a solution to access block itself. 1 We appreciate that access block is multifactorial and to suggest that ENP are the solution is indeed incorrect. However, ENP do facilitate patient flow, and impact on ED overcrowding by independently assessing, treating, discharging and referring low-acuity emergency patients.The ENP role is evolving nationally and therefore there is limited published research available. Australian-based nurse practitioners (NP) are working hard to gather the required data to write future papers. A recent international systematic review (n = 33) looked at NP impact on cost, quality of care, patient satisfaction and waiting times in the ED. 2 This literature review suggested that NP do reduce waiting times for the ED, provide high patient satisfaction and a quality of care equal to that of junior doctors.The cost of employing endorsed ENP is higher than that of junior medical officers; however, the benefits returned on other levels are considerable. The ENP model provides senior nursing leadership, role modelling and a steady staff base, and thus consistency in departmental and hospital processes. These benefits are hard to quantify in monetary terms. However, a stable workforce with minimal recruitment problems, which follows departmental guidelines, is highly desirable!We are under no illusions that the ENP role cannot progress without the collaboration and support from emergency physicians. The ENP from the outset engaged a team of multidisciplinary stakeholders to assist in role development, and ongoing strategies to improve, evaluate and monitor ENP-led care. At the Alfred Hospital Emergency and Trauma Centre (Melbourne, Victoria) we work within a dual model of both independent and collaborative practice. Our 25 clinical practice guidelines clearly articulate our scope of 'independent' practice, and working beyond the guidelines necessitates physician input. Like all care providers within the ED, ENP work with delegated authority as part of a team.With patient presentations on a steady increase, a service gap was identified, with Australasian Triage Scale category 4 and 5 patients waiting long periods of time for assessment and treatment. The ENP model has successfully filled this gap and at the same time satisfied a career progression for motivated senior nurses. However, the greatest benefit has been to patients who as a consequence are assessed and treated or referred within acceptable time frames.The NP models require ongoing critical analysis to ens...