Rising Trends of the Nurse Practitioner

We sat down with Sound Physicians’ Tracy Cardin, Vice President, Advanced Practice Providers, to ask her about Issues that are helping shape Nurse Practitioner contributions and roles.

How are you seeing the Nurse Practioner role evolving?

At Sound Physicians, Nurse Practitioners (NPs) are instrumental in driving advanced care planning and coding. They’re adept at driving end-of-life conversations and identifying the correct patient population. Nationally, in the post-acute space, a large portion of care is driven by NPs. For instance, when you look at Sound’s recent skilled nursing facility pilot, we utilized NPs as remote rounders to identify high-risk patients, review medical records, and virtually round with Registered Nurses (RNs) to help prevent readmission for facilities.

What trends are impacting the rising contributions of NPs?

The four major trends I see precipitating wider use of NPs are:

• Team care. A growing awareness around the benefits of diverse, team-based care. Data reflects that diverse teams perform better in a variety of arenas. We’ve seen this at Sound Physicians.
• Fewer physicians and more NPs. The well documented, anticipated physician shortage of approximately 120,000 by 2032 and a growing NP workforce of 26 percent, according to the U.S. Department of Labor. It only makes sense that NPs will be an integral part of care delivery moving forward.
• Cost pressures. Hospital margins are lean, and only getting leaner in the setting of decreased reimbursements. Hospitals and hospital systems are looking for cost-effective care delivery models and NPs are a major part of the solution.
• Safety and efficacy in care. The well-documented safety and efficacy of NPs are driving care in a variety of areas including hospital medicine, critical care, and emergency medicine.

How are physicians’ perceptions of NPs evolving?

The Journal of Nurse Practitioners reported on survey data from hospitalists who were asked about factors influencing their perceptions of NPs and Physician Assistants (PAs). Based on the results, the great news is that physician perceptions were strongly positive; they recognize and value the contributions of APPs. Notable highlights included:

• Hospitalists feel NPs and PAs positively impact clinical care and efficiency.
• NPs and PAs contribute to creating a collaborative learning environment.
• Hospitalists prefer working with NPs and PAs with postgraduate training.
• Hospitalists report that working with NPs and PAs improves their job satisfaction.

What new training or approach to education will best support NPs contributions to hospital medicine?

Having structured, specific training and onboarding processes tailored to the clinical acumen of clinicians is a key factor for success. This means providing educational materials that follow the clinical progression and the Society of Hospital Medicine’s core competencies.

At Sound, we developed a standardized transition to practice program for our APPs who are new graduates or new to hospital medicine. Though APPs receive foundational knowledge in graduate programs, true clinical competence is acquired with “on-the-job” exposure. We have three main components to our structured program: gradual clinical progression, didactic materials utilizing the Society of Hospital Medicine/AAPA NP/PA Bootcamp in Hospital Medicine, and evaluation of professional behaviors and knowledge once APPs complete the program. This program, now deployed at our 300 hospital medicine sites, supports the success of our APPs.

Do you have advice for hospital leaders who want to better integrate NPs into their programs?

To maximize the use of NPs, consider looking at traditional care delivery models in new ways. Instead of one physician and one NP providing patient care, consider a care model delivered by multiple NPs where the physician acts as consultant and mentor; only deploying when higher-level medical decisions are needed. This is an innovative model utilized at tertiary care centers. I’ve also seen preliminary success with NPs deployed in BPCI (Bundled Payments for Care Improvements) to improve advanced care planning conversations and transitional care for patients.

NPs are delivering a significant amount of care to the most fragile patients in safe, effective ways. To all NPs, I want to express gratitude and appreciation. Likewise, I encourage colleagues and hospital leaders to take time this week and throughout the year to recognize NPs who tirelessly work supporting their teams, patients, and patients’ families.

Sources:

1. https://www.npdb.hrsa.gov/resources/2012annualReport/2012NPDBAnnualReport.pdf  National Practitioner Databank.
2. “Based on our Loss Run data, we have 246 open claims currently – 7 of those claims involve an NP or PA”.- Victoria G. Stairs, Esq. | Associate General Counsel, Risk Management | Sound Physicians
3. Kapu AN, Kleinpell R, Pilon B. Quality and financial impact of adding nurse practitioners to inpatient care teams. J Nurs Adm. 2014;44(2):87-96. Accessed Mar 17, 2018. doi: 0.1097/NNA.0000000000000031.
4. Singh S, Fletcher K, Schapira M, et al. (2011) A comparison of outcomes of general medical inpatient care provided by a hospitalist-physician assistant model vs a traditional resident based model. J Hosp Med 6:122–30
5. https://www.npjournal.org/article/S1555-4155(18)30605-6/fulltext.  Physician Perceptions of Advanced Practice Providers and Hospitalist teams.
6. Capstack T, et al., (2016) Journal of Clinical Outcomes Management 23(10):455-461. A Comparison of Conventional and Expanded Physician Assistant Hospitalist Staffing Models at a Community Hospital.
7. 2014 State of Hospital Medicine Report. Based on 2013 data.