The impact of nurse/physician collaboration on patient length of stay

Aim  This study examines the relationship between nurse/physician collaboration and patient length of stay (LOS).
Background  The quality of nurse/physician relationships has been shown to have an impact on patient outcomes. As the acuity level of patients admitted to hospitals continue to rise, the need for collaboratively determined care is essential for avoiding errors and promoting quality.
Methods  Data were collected on four units located in two Midwest hospitals. Nurses ( n  = 135) were asked to complete a survey seeking perceptions of nurse/physician collaboration. The survey data were then linked with patient ( n  = 310) data, including LOS, diagnostic-related groups (DRG) category and other patient-specific characteristics.
Results  Perceptions of nurse/physician collaboration were positively linked with actual LOS ( P  < 0.001) and inversely related to deviation from expected LOS (i.e. patient stay longer than expected) ( P  < 0.01). Patients receiving care from nurses who perceived greater collaboration were elderly and had higher levels of acuity. Longer LOS for these patients may be a result of their higher acuity level.
Conclusions and implications for Nursing Management  This study found that collaboratively determined care may result in longer LOS, but could prevent complications that may otherwise go untreated. Nurse administrators must implement strategies that foster the development of nurse/physician collaboration.     

Improving retention through nurse/physician communication

Patient safety has a strong link with communication between nurses and physicians, according to research. In fact, patient safety is more closely linked with communication than it is with clinical competence!¹ Also, poor communication between nurses and physicians has been shown to be very stressful for nurses.^{2 and 3}     

Nursing2008 nurse/physician relationships survey report

Are physicians and nurses pulling together more now than when we reported our last survey in 1991? Compare your experiences with those of readers responding to this nationwide survey.     

Securing "good" nurse/physician relationships

Responses to a study of 279 staff nurses from 14 Magnet hospitals enabled researchers to develop a five-category nurse/physician relationship scale.     

Family physician/nurse practitioner: stories of collaboration

AIMS: This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice. BACKGROUND: Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners. METHODS: Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000. RESULTS: Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve. CONCLUSIONS: The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice.     

Characteristics of patient visits to nurse practitioners and physician assistants in hospital outpatient departments

Many authors have described differences between nurse practitioners and physician assistants. Most studies have compared physician with nonphysician providers' practice. Few studies have compared nurse practitioners and physician assistants, and none has used a national data base. This exploratory, atheoretical research examined which of the following characteristics predicted patients being seen by nurse practitioners and physician assistants: patient and hospital demographics, diagnosis, diagnostic/screening services, therapeutic services, and disposition of the visit. The data set used for analysis was the 1992 National Hospital Ambulatory Medical Care Survey. Based on a multistage probability design yielding national estimates for patient visits in hospital outpatient settings, the National Hospital Ambulatory Medical Care Survey showed that there were 2,847 weighted patient visits to either nurse practitioners or physician assistants (4.6 million patient visits using national estimates). Results of multivariate logistic regression suggest that nurse practitioners were the most likely nonphysician provider for outpatients receiving more health promotion and counseling (therapeutic) services and for those needing women's and children's services. Outpatients in rural areas predicted visits to physician assistants. As more nonphysician providers enter the work force, the results of this research may assist with understanding the utilization of nurse practitioners and physician assistants in primary care.     

Medical patient/nurse dependency in Israel

Patients' needs for nursing care have been studied in internal medicine departments in Israel. The needs in regard to ambulation, bathing, feeding, toilet and certain treatments were analysed for three standards of hospitals: university, central and peripheral. Considerable differences were found between the rates for these groups of hospitals as well as among individual hospitals and even among parallel departments in the same hospital. On average for all surveyed departments, 54·4% of the hospitalization days were of selfcare patients, 32·0% of intermediate patients and 13·6% of bedfast, highly dependent patients.
A comparison with similar studies in New Zealand and Switzerland showed that patients in medical departments in Israel are less dependent on nursing care than in the other countries.
Findings of this study stress that allocation of nursing manpower proportionally to the number of beds does not meet objective needs and is inequitable. Real needs of the patients should serve as a basis for allocation of personnel. Part of the nursing personnel should be 'floating', with a possibility of directing them daily to different departments according to priorities.     

A nurse residency program for competency development using human patient simulation.

A new graduate registered nurse residency program integrating human patient simulation was developed at an academic medical center. The program focused on orientation through skill-based learning, critical thinking, human factors engineering, and patient safety using simulated experiences for a wide variety of high-risk, low-frequency, as well as high-frequency, commonly occurring clinical events and situations. Structured evaluations demonstrated that simulation serves as a highly effective strategy for developing competency, confidence, and readiness for entry-into-practice. It strengthened assessment and clinical skills, and enhanced nurse residents' ability to apply critical thinking to simulated patient scenarios. The time and cost of orientation decreased while recent graduate nurse satisfaction with orientation was high.