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The Value of Surgical Advanced Practice Providers in the Acute Care Setting: A Nursing Perspective
Leigh-Ann Berk, NP, Rachel Baines, NP, Shirley Koczan NP, Yuriy Kotsur NP, Amanda Kut NP, Julie Rocke NP, Sarah
Southard NP, Darlene Sweet MSN RN, Jennifer Tomich DNP
Beth Israel Deaconess Medical Center, Department of Surgery
The Team
Introduction/Problem
There is a lack of institutional data at Beth Israel Deaconess Medical Center (BIDMC)
describing the impact and perspective of Advanced Practice Provider (APP) practice in
acute care surgery. A literature search, including a BIDMC cardiology service, was
performed and outlined several measures positively impacted by APP practice including
a decreased length of stay, reduced readmission rate by 50 percent and consistent
point of contact for patients and nurses (David, Britting & Dalton, 2015; Jarrett &
Emmett, 2009), . We are unaware of any existing institutional qualitative or quantitative
data for an inpatient surgical service with APPs to date.
Aim/Goal
The global aim of this project is to evaluate the value of APP practice and its ability to
enhance overall patient care in the acute hospital setting by identifying and highlighting
the positive attributes APPs contribute to healthcare. An additional intent of our project
is to identify areas for practice improvement.
The specific aim of this project is to assess the perspective of surgical registered
nurses who frequently collaborate with APPs regarding their ability to impact and
enhance patient care while upholding the core values of BIDMC; these values include
integrity, respect, caring with compassion, excellence, stewardship, and community.
Goal: The goal of this project is to demonstrate the current nursing perspective of APP
value and their ability to uphold core BIDMC values.
David, D., Britting, L., & Dalton, J. (2015). Cardiac acute care nurse practitioner and 30-day readmission. Journal of
Cardiovascular Nursing, 30(3), 248-255.
Jarrett, L. A., & Emmett, M. (2009). Utilizing trauma nurse practitioners to decrease length of stay. Journal of Trauma
Nursing, 16(2), 68-72.
Leigh-Ann Berk, NP
Rachel Baines, NP
Shirley Koczan, NP
Yuriy Kotsur, NP
Amanda Kut, NP
Julie Rocke, NP
Sarah Southard, NP
Darlene Sweet, MSN, RN
Jennifer Tomich, DNP
The Interventions
Conducted an extensive literature review regarding the impact of APPs on various
aspects of care in the acute hospital setting.
Designed and conducted an anonymous survey consisting of 15 questions using
“Survey Monkey” services and distributed it to nurses on four surgical units via
email.
Communicated with nurse managers prior to distribution of survey to improve
participation. Nurses were encouraged by APPs to participate in the study via email
and during huddles.
Collaborated with The Director of Quality Programs, John Tumulo, to review the
study design, ensure the design targeted the intended purpose, and abstract the
results.
Abstracted and reviewed the results of the qualitative survey bar graphs.
Extracted potential process improvement initiatives from nursing comments.
Held interdisciplinary team meetings to discuss the results.
Debriefed Nursing Directors of each unit surveyed with a summary of results.
For more information, contact:
Leigh-Ann Berk, NP lberk@bidmc.harvard.edu
�The Value of Surgical Advanced Practice Providers in the Acute Care Setting: A Nursing Perspective
Leigh-Ann Berk, NP, Rachel Baines, NP, Shirley Koczan NP, Yuriy Kotsur NP, Amanda Kut NP, Julie Rocke NP, Sarah
Southard NP, Darlene Sweet MSN RN, Jennifer Tomich DNP
Beth Israel Deaconess Medical Center, Department of Surgery
Nursing Comments
Progress to Date
‘ Very much agree with this, APPs always take nursing input seriously and always address any concerns whereas
residents and interns don’t always.’ Rosenberg 7
Response Data
Total # Survey Recipients
Overall Response Rate
179
Response Distribution by Floor
Strongly Agree to
Agree:
‘There have been multiple times potentially dangerous situations have been avoided due to involvement of the NP as well
as interventions early on to prevent delay of discharge. Overall, much smoother hospital course with the close follow up
they provide.’ Float Pool
Total : 65
Rosenberg 7: 22
Rosenberg 6: 13
Stoneman 5: 15
Float Pool: 12
Other: 2
89%
‘APPs take time to explain and educate pts, are very knowledgeable on subjects as they have a great deal of experience
in their field.’ Rosenberg 7
Lessons Learned
Data below reflects the sum response to each value. Two questions per value were included in
each category.
100
Strongly Agree
Agree
Neutral
Disagree
92
90
80
79
78
70
70
Next Steps
54
50
41
38
35
31 31
23
16
20
0
38
30
10
In conclusion, collaboration between nurses and APPs on surgical units is an essential component of
improved patient care, knowledge, dignity and satisfaction. Nurses felt that APPs valued their input
and respected them as team members. Having an APP on the service was viewed as very beneficial
due to their positive impact on the plan of care and patient outcomes. Overall, the communication
between nurses and APPs was viewed as effective and efficient allowing nurses to address the
needs of the patients in a timely manner. However, response to pages on one of the services was
identified as an area for practice improvement. Finally, nurses agreed that having an APP on service
resulted in reduced length of stay and facilitated the discharge process.
67
60
40
‘Patients seem to value their presence on the floor because they are able to spend more time at patients' bedside and
make them feel more comfortable.’ Stoneman 5
9
9
2 0
Integrity
4
Respect
0
6
0 0
Caring with
Compassion
6
0 0
Excellence
4
1
0 0
Stewardship
Community
Partner with the Department of Surgery APP Council to improve inter-divisional collaboration.
Conduct a process improvement initiative to improve pager response time.
Increase clinical education for nursing staff to improve patients outcome (e.g. in-services).
Discuss the benefits of additional APPs on surgical services.
Compare inter-hospital departmental data with APP and without APP for: length of stay, accidents,
trigger activation, etc.
Present survey results to the Advanced Provider Practice Council
Resurvey nursing staff in six months to re-evaluate response time
For more information, contact:
Leigh-Ann Berk, NP lberk@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Leigh-Ann Berk (<a href="mailto:lberk@bidmc.harvard.edu">lberk@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
Nursing
Project Team
Leigh-Ann Berk
Rachel Baines
Shirley Koczan
Yuriy Kotsur
Amanda Kut
Julie Rocke
Sarah Southard
Darlene Sweet
Jennifer Tomich
John Tumulo
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Value of Surgical Advanced Practice Providers in the Acute Care Setting: A Nursing Perspective
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency