Ruth M. Kleinpell, PhD, RN-CS, FAAN, FAANP - Springer Publishing

Chapter 1 Measuring Outcomes in Advanced Practice Nursing 49
research on APNs has further explored the effects of APN care on carerelated,
patient-related, and performance-related outcomes.
Yet, often the overall impact of APN care has been difficult to assess.
Many studies group APNs and other midlevel care providers together;
other studies, by virtue of their study design, preclude attributing direct
causation of an outcome to APN care. The outcome studies on APN
care that exist are not enough to describe the true outcomes that result
from APN care. A concept analysis of outcomes for APNs highlighted
the importance of the measurement of clinically relevant outcomes that
reflect the work of the APN (Neis et al., 1999).
The use of nurse-sensitive indicators to develop appropriate measures
and outcomes for APNs has also been suggested (Wong, 1998), yet,
determining which are most appropriate can be challenging. Identifying
domains of APN practice may help in categorizing role functions that
are unique to APN practice and that can be examined in terms of their
effect on patient outcomes. Beal (2000) examined the practice of nurse
practitioners working in a neonatal intensive care unit and identified
nine domains of NP practice, including (a) diagnostic/patient monitoring,
(b) management of patient health/illness, (c) administering/monitoring
therapeutic interventions and regimens, (d) monitoring/ensuring
quality of health care practices, (e) organization and work role, (f)
helping role, (g) teaching/coaching role, (h) management of rapidly
changing situations, and (i) consulting role. The case management role
of APNs has also been highlighted (Foss & Koerner, 1997). Evaluating
what a particular APN role encompasses in terms of role functions,
enables outcomes that are affected by APN care to be more readily
identified.
Recent studies have focused solely on comparing APN care to other
health care providers. Although it is important to establish that APN
care does not differ (or is better) than that of other health care providers,
research on the unique contributions and outcomes of APN care is
needed. Several synthesis reviews on the impact of APNs on patient
outcomes have confirmed that additional studies are needed to demonstrate
APN importance to cost and quality outcomes in a variety of
populations (Boyle, 1995; Sechrist & Berlin, 1998; Urden, 1999). As
the APN role is expanding to a variety of unique practice settings,
including inpatient hospital settings, subacute care, urgent care, home
care, long-term care, and traditional primary care settings, the impact
of the APN in these settings needs to be established.