Nurse Practitioner and Wait Times in Emergency Departments Capstone Project

Excerpt from Capstone Project :

Hiring a Nurse Practitioner reduces wait times (overcrowding) in the Emergency Department

estimation of the ED (Emergency department) compromise with care afforded to patients because of overcrowding from the perspective of the provider of services.

/I researched literature and bonafide / authenticated texts that chose to: Study causation, impacts and resolution tactics aimed at ED crowding; Collected and analyzed data using established methods; specifically target the ED scenario and the day-to-day crowding at the ED in care centers and hospitals. There is in each case a lot of reporting done on the circumstances ( like shortages of beds and staff) and that have led to the crowding that can be seen to increase with each passing day at ED centers, the overall impact that has had on the quality of care given to the patients as a result, and the solutions that have either been worked out or are being discussed ( like additional staffing, increase in furniture for boarding, administrative measures and increase in primary care facilities) to alleviate the problem that is taking a grim shape very fast.

Conclusions: The most easily perceived notion associated with crowding is that of inadequate service and care provided to the patients. There is no unanimity amongst doctors, physicians, nurses and the patients themselves over the exact cause of compromised care, in what way care was compromised and what was the identity of the real sufferer.


Crowding pervades almost all the ED's (emergency Departments) across the nation as of date. The causation is multidimensional. The main factors that cause crowding include, but are not limited to: rapidly diminishing capacity of the hospitals clubbed with the fact that there are a number of hospitals that are themselves closing down or, are at least closing down their ED's; The patients that report to ED's are increasing; a perceptible shortage of trained nurses and skilled staff; health care services in general and administrative procedures that need to be followed by the service providers has become very involved and cumbersome and a very practical logistical problem of the inability of the hospitals to smoothly transfer the ED patients to the 'in-patients' section leading to stagnation of movement of patients and adding to the crowding.

This crowding of epidemical scales has adversely affected health care services to the patients in ED. It has also led to unacceptable delays in providing care to the patients. The waiting-period for the patients has increased considerably enough to cause concern. Staffing problems and boarding inadequacy are the two glaring causes that have to be assessed and addressed as a result of which crowding manifests. Many solutions to the problem have been suggested to alleviate the situation of the patients. Urgent care that needs to be given at times of emergencies superseding normal situations is found wanting in its resources most of the times.

On the face of it, it is a simple case of demand -supply gap. Incessantly increasing patients that want to or need to access ED and a shortage of adequately trained staff for the purposes couple with other logistical factors like boarding inadequacies and space constraints as also inability of the service providers to ease out the treated patients to less critical or 'general' departments are at the root of this malady that affects the nation. There are processes and steps that can be taken to improve the situation, though. Curtailment of stay duration of patients admitted to ED, once the progress is assured is one of the steps that need to be taken. Steps have to be taken for: screening those in absolute need of the ED treatment and immediate release of those who have been treated and need not be boarded in the ED. There are many more roles that are expected of the ED in addition to its being the care provider of those suffering trauma or in need of urgent attention in complex cases. A plausible way out suggested is to train and employ Nurse Practitioners who would be equipped to decide the merits of a case and help screening process, taking the weight of the resident physician who are already burdened with lot more.

Rationale and significance for advanced practice nursing (nurse practitioners)

The origin of Nurse Practitioners in the U.S. can be traced back to the delicate and careful handling required for the infants and toddlers- broadly termed as pediatrics (Silver and Ford, 1967). The scope evolved to provide specialist care in the fields that include family care, old-age caring and of late to extraordinary care to patients of acute illnesses. NP's now provide medical care to: infants and babies, incapacitated patients, those who are seriously afflicted and those that need long-term care. The nursing and basic medical services are provided by the NP's to individuals, families and at times to groups as well ((American Academy of Nurse Practitioner (AANP, 2003).the services provided by the NP's have a much larger vista than providing the said services of nursing and medical attention in that they also provide for educating the society to take preventive measures as well as promoting healthy living lifestyles and general wellness habits and practices (AANP, 2002). ACNP (Acute Care Nursing Practitioners) basically developed and took shape to care for those acutely afflicted and in need of crucial medical attention, which had been inadvertently ignored. These activities accorded a specialist status to the ACNP fraternity. They are hence trained to obtain skills that supersede the NP's of everyday care. The special endowments that the ACNP's possess have seen their increased use and need of their services in the ED. In the following discussion, the emergence of the importance of the ACNP's in the ED domain is traced and its growth is studied (Cole and Kleinpell, 2006).

The medical insight and skills possessed by the ACNP's enable them to anticipate and suggest proper nursing and medical services needed for the patients competently. The nursing and medical acumen possessed by the advanced nurses is based on solid logic and practical experiences and hence useful to all categories and stages of patients; primary, secondary as well as tertiary. These nurses are well equipped to train people and communities, peers and leaders, mentor communities, take up leadership roles and also venture to participate in administration as well as provide scholarly inputs. ACNP's can not only act as aides to doctors and physicians and carry forward the medical services given by the doctors, they can also act independently as primary health care providers on their own.

The skills possessed by the ANP's enable them to provide health care services in all cases at least as a primary service and their scope is not bound by community, society age or sex. They are trained enough to be depended upon to provide services in a wide range of medical afflictions including chronic patients, long-term illnesses, baby care, emergency care and the myriad medical treatments that may be needed. They do not discriminate between the acuteness, urgency or primary health care; in short they are well-rounded and appropriately groomed 'generalists' whose service can be relied upon primarily. They can also be called upon to train people in social health initiatives. The study of ANP's role in providing medical care has revealed a very positive picture of these professionals from the perspective of the patients as well as the medical fraternity. The general dispensations as well as the specialized acumen that these skilled, knowledgeable ANP's possess can be relied upon in cases of emergency care with utmost confidence. There are of course instances when their services need the support of physicians and doctors and use of more advanced diagnostic tools and apparatus to get to the root of the medical problems for detailed diagnoses. It has been observed that ANP's seek to learn more than conventionally taught by keeping in touch with interacting inquisitively with the medical fraternity trained for and possessing deeper insights and having a wider knowledge base (Royal college of nursing, n.d).

A major contribution that the aforementioned ANP's can make significantly to alleviate the deteriorating ED services is by screening the incoming patients for ED admission. Those who do not need ED services can be directed to other sections according to their evaluated needs (Cole and Kleinpell, 2006). The proper segregation and classification of patients needing urgent and Ed attention need to be screened out to reduce the stress on the heavily burdened ED. This practice is being increasingly adopted by more hospitals of late (McGee and Kaplan, 2007). As such, increased use of the services of ANP's are being availed of, by the health care facilities across the nation.

Literature search strategy and methods used to search the literature

The literature review was accomplished using a process of iteration. The data extraction and quality assessment tools were developed based on the established methods that have given substantiated results consistently.

Search Strategy

With consultation, the online web-based searching platforms; OVID Medline and its In-Process and Other Citations were used for searching for studies put…

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