Does Having a Unit-Based Nurse Practitioner Increase Nurses Level of Satisfaction with Patient Care Delivery? Patricia Meyer, DNP, CRNP, NE-BC

Does Having a Unit-Based Nurse Practitioner Increase Nurses Level of Satisfaction with Patient Care Delivery? Patricia Meyer, DNP, CRNP, NE-BC

INTRODUCTION Why Nursing Satisfaction Is Important Improved patient outcomes ( Spence,Lashinger, Almost & Tuer-Hodes, 2003) Reduction in nursing turnover rates (Jones, 2005) Reduced costs to hospital or healthcare system, as much as $ 2,079,000 a year (Drenkarnd, 2010) 2

INTRODUCTION Why Nurse Practitioners are Needed and Utilized in the Acute Care Setting Decreased medical staff due to work hour restrictions, residents restricted to 80 hours in a work week (Lundber, Wali, Thomas, & Cope, 2006) Physician shortage in primary care and other specialties Decreased enrollment in medicals schools have resulted in decreased staff in hospital residency programs (Cooper, 2007) 3

INTRODUCTION Why Nurse Practitioners are Needed and Utilized in the Acute Care Setting Increased patient acuity Physician time restraints Assistance with nursing staff education Assistance with throughput Access to advanced clinical skills Quality improvement initiatives Research contributions (Rosenthal & Guerrasio, 2010) 4

INTRODUCTION The Nurse Practitioner Role in the Acute Care Setting Clinical related skills Advanced physical assessment Care intervention Planning of care Ordering tests and medications (Sidani et al., 2006) 5

INTRODUCTION The Nurse Practitioner Role in the Acute Care Setting Collaboration with consulting clinical staff Education and mentoring of nursing staff Participation in research Participation in quality initiatives Patient and family education, counseling 6 (Rosenfield, McEvoy, & Glassman, 2003)

INTRODUCTION The Nurse Practitioner Role in the Acute Care Setting Members of the interdisciplinary team/ helps to facilitate communication (Howie-Esquivel & Fontaine, 2006) A visible source of clinical leadership (Carryer, Gardner, Dunn, & Gardner, 2006) Will rapidly intervene for patient care issues Readily available for consultation with the nursing staff (Shimabukuro, 2011) 7

SIGNIFICANCE OF PROBLEM Nursing profession is currently recovering from a national nursing shortage There will be a need for 23% more nurses by the year 2016 (Dohm & Shniper, 2007) Hospitals are focusing on ways to increase nursing satisfaction (Gokenbach & Denkard, 2011) Hospitals are developing strategic plans to prevent nursing turnover and improve nursing retention (Montalvo, 2007) 8

PURPOSE/SPECIFIC AIMS Primary Aim Evaluate if unit-based nurse practitioners contribute to increased nursing staff satisfaction levels RESEARCH QUESTION Does working with unit-based nurse practitioners (NPs) on six medical floors in a community-teaching hospital, increase nursing staff satisfaction when their patients are followed the unit-based NP versus patients that are followed by (Traditional Coverage) hospitalist, teaching service, family health service or general attending services? 9

REVIEW OF LITERATURE Attributes Associated with Increased Nursing Work Place Satisfaction Quality of nursing leadership Organizational structure Management style Personnel policies and programs Professional models of care (Lundmark, 2008) 10

REVIEW OF LITERATURE Attributes Associated with Increased Nursing Work Place Satisfaction Quality improvement Available resources for consultation Autonomy Relationships between the hospital and the community Opportunities for nurses to teach (Lundmark, 2008) 11

REVIEW OF LITERATURE Attributes Associated with Increased Nursing Work Place Satisfaction Quality of care A positive image of nursing Interdisciplinary relationships Opportunities for professional development (Lundmark, 2008) 12

REVIEW OF LITERATURE How the Unit-Based Nurse Practitioner can Influence Nursing Staff Satisfaction NPs are a visible source of clinical leadership on the nursing units They are a resource that is available for consultation NPs can assist with mentoring and education of nursing staff ( VanSoren & Miceviski, 2001). They can assist with clarification of issues regarding patient safety NPs participate on interdisciplinary teams (Klienpell, Wesley, & Gabenkort, 2008) 13

REVIEW OF LITERATURE How the Unit-Based Nurse Practitioner can Influence Nursing Staff Satisfaction Unit-based NPs can respond rapidly to: Clinical Issues Patient issues Family issues They are helpful to the nursing staff for these issues 14 secondary to their clinical knowledge, accessibility, and approachability ( Hoffman, Happ, Scharfenberg, DiVirgilio-Thomas, & Tosota, 2004)

PROJECT DESIGN AND METHODS Comparison study Setting: A community, teaching hospital with magnet designation in Pittsburgh, PA Institutional Review Board (IRB)-Approvals were obtained 15

PROJECT DESIGN AND METHODS Sample Convenience sample Recruited by email Email sent to medical floors that had unit-based NP coverage Email explained the study Subjects consented electronically When subjects consented they were instructed to a hyperlink which lead them to an electronic survey 16

PROJECT DESIGN AND METHODS Inclusion Criteria Must be a registered or licensed practical nurse Must be in current role at least six months Must work on a unit with a unit-based NP Must be at least 18 years of age 17

PROJECT DESIGN AND METHODS Exclusion Criteria Not a registered or licensed practical nurse Has not been in current role at least six months Does not work on a unit with a unit-based NP Not at least 18 years of age 18

ETHICAL CONSIDERATIONS Risk and benefits Results confidential/anonymous Participation voluntary Results password protected Electronic consent was obtained 19

TIMELINE January 2014 Week One Group recruitment email / consent / survey sent to nursing staff on units with unit-based NP coverage January 2014 Week Two Follow up group recruitment email / consent / survey sent to nursing staff on units with unit-based NP coverage January 2014 Week Three Follow up group recruitment email / consent / survey sent to nursing staff on units with unit-based NP coverage January 2014 Week Four Follow up group recruitment email / consent / survey sent to nursing staff on units with unit-based NP coverage 20

DATA COLLECTION / INSTRUMENTS 168 emails/consent/surveys sent out Sixty-six nurses met inclusion and completed survey Response rate 39% Revised Advanced Practice Registered Nurse (APRN) Collaboration Scale (Cobb & Kutash, 2011) Likert Format Rates results from 1 (strongly disagree)- 5 (strongly agree) Ten of the same questions for both the NP model and traditional coverage model Results analyzed using Statistical Package for the Social Sciences (SPSS) 21

DATA COLLECTION / INSTRUMENTS Same Questions Asked about Nurse Practitioner Coverage and Traditional Coverage Coverage Same Questions Asked about Nurse Practitioner Coverage and Traditional 1. Coordinates with nursing staff regarding discharge planning 2. Coordinates with nursing staff regarding treatment plan 3. Provides patient/family education about treatment plan 4. Is readily available to nurse for assistance and consultation 5. Creates an optimal environment for obtaining orders, asking questions, and responding to problems 6. Is responsive to patient needs 7. Mentors growth of staff knowledge 8. Assists and makes recommendations for patient discharge planning 9. Role adds to overall quality of patient care 10. Encourages evidenced based practice (EBP) 22

DATA ANALYSIS / RESULTS Calculation of mean scores Reliability analysis Paired t-test A series of paired t-tests 23

RESULTS Comparison of Total Means The Paired t-test reveals a significantly (p < 0.01) higher level of overall satisfaction with the NP model than with the traditional coverage model 24

RESULTS 25 Comparison of total means A series of paired t-tests shows that nurses responded more favorably to the NP model than the traditional coverage model on each of the ten questions, p < 0.01. Four items emerge more than one scale point greater for the NP model: availability, optimal environment, responsiveness to patient needs, and mentoring.

DISCUSSION NP model was rated higher in satisfaction than traditional coverage model = p <0.01 Four items stood out with exceptionally higher levels of satisfaction = p <0.01 Availability Creating an optimal environment Responsiveness to patient needs Mentoring 26

LIMITATIONS Only one hospital was utilized for the study Did not correlate to see if nursing care was improved for patients 27

IMPLICATIONS FOR FURTHER RESEARCH Comparison of hospital utilized in study to a hospital with similar demographics Comparison of a teaching hospital as utilized versus a nonteaching hospital Comparison of a magnet status hospital as utilized versus a non-magnet status hospital Evaluation if the unit-base NP model may impact patient satisfaction 28

CONCLUSIONS Research supports workplace environment can influence nursing satisfaction There has been little research on how unit-based nurse practitioners may contribute to nursing satisfaction Unit-based nurse practitioners have many of the attributes that are associated increased nursing staff satisfaction There was significantly higher overall satisfaction with the NP model versus the traditional coverage model Nurse responded more favorably to the NP model on all of the survey questions 29

ACKNOWLEDGEMENTS We Would Like To Thank The sixty six nurses who participated in this study The Chief Nursing Officer at the hospital utilized for research. Karen Weimer, MSN, CRNP Susan Van Cleve, DNP, CPNP, PMHS Thomas Cline, PhD, MBA. 30

31 QUESTIONS

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