Are there enough nurse practitioners or clinical nurse specialists to provide adequate hospitalist care or support, whatever the model?

To maximize savings many hospitals attempt to under-staff nurse practitioners requiring doubling of shifts. When negotiating nurse practitioner hospitalists provisions, use financial and quality data to reinforce the overall net profits obtained from using nurse practitioners in this role. Over and over again, the data reflect decreased hospital stays and improved care which pays for the use of nurse practitioners within this role.

Some hospitals maintain their own quality data and research, which is used to improve quality within care settings, while others keep data in response to mandated reporting requirements developed through legislation.

Check with your legislative unit and/or with the state hospital association to ascertain whether the state requires the retention of hospital quality data and if so, whether that data may benefit you.

If the hospital is required to report the data to the state, we recommend requesting the data periodically prior to the initiation of the collective bargaining process directly from the state agency. Also, some hospitals and health institutions are voluntarily reporting on quality and evidenced based practice through participation in government studies or data collection programs (NDNQI). Request this information prior to the collective bargaining period. You can cross-reference that data requested against information provided by the hospital in response to information requests.

References

1. Kleinpell, RM, Perez, DF, McLaughlin, R. Educational options for acute care nurse practitioner practice, J Am Acad Nurse Pract. 2005 Nov; 17 (11): 460-71.
2. Chris Schrieber, Boon or Bust? Nurse Practitioners as part of the on-site hospitalist team, NurseWeek, March 25, 2000 as found at Nurseweek.
3. Deborah Gesensway, Why hospitalists may be destined to become the first responders for inpatient stroke, Today's Hospitalist 2007 as found at Today's Hospitalist
4. See Howie, Jill, Erickson, Mitchel, Acute Care Nurse Practitioners: Creating a Model of Care for an Inpatient General Medical Service, AJCC 11(5):448 (2002). This article also includes citations and summaries of studies conducted related to the use of nurse practitioners in impatient settings from 1998 to 2002 as found at AJCC
5. Physician/NP teams can reduce the costs while maintaining care quality.(MEDSURG MINUTE) (nurse practitioners) (brief article), as found at MedSurg Nursing, August 1, 2007 Acute Care/Hospitalization, Collaboration of hospitalists/attending physicians and nurse practitioners can reduce hospital stays and increase profit found at: AHRQ Acute Care/Hospitalization, Multidisciplinary physician/nurse practitioner teams can reduce the costs of hospital care while maintaining care quality as found at : AHRQ
6. See also "An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model," by Susan L. Ettner, Ph.D., Jenny Kotlerman, M.S., Abdelmonem Afifi, Ph.D., and others in the January 2006 as found at Medical Decision Making 26, pp. 9-17
7. "The effect of a multidisciplinary hospitalist/physician and advanced practice nurse ollaboration on hospital costs," by Dr. Cowan, Martin Shapiro, Ph.D., M.D., Ron D. Hays, Ph.D., and others, in the February 2006 as discussed at: Journal of Nursing Administration 36(2), pp. 79-85, with abstract
8. Berthold, Jessica, Eliminating disparities in stroke outcomes, ACP Hospitalist, 2008 as found at ACP Online
9. Logan, Paul, The acute care nurse practitioner as hospitalist, as found at Nurse Practitioner, 1999
10. Howie and Erickson, ibid.
11. Larking, Howard, The Case For Nurse Practitioners as reported at Hospitals and Health Networks