2014 Tennessee Nurses Association Conference Yearbook

NURSES TRANSFORMING HEALTHCARE: A WORLD OF OPPORTUNITY
Discussion: The best-evidence practice recommends that providers who work together should adopt one assessment tool to
use in their practice. Using the same assessment tool will benefit better communication between the providers. Ten assessment
tools have been identified in the literature review. The Historical, Clinical, Risk Management-20 was identified as the most reliable
assessment tool. No assessment tool is 100% accurate all the time. Providers are encouraged to follow their instincts if it conflicts
with the assessment tool.
Conclusion: Psychiatric Nurse Practitioners can use reliable assessment tools for identifying those clients who are at risk for
being violent in the out-patient clinic.
Structural Empowerment Theory: Outcomes of Adding Nurse Practitioners to Inter-Professional
Teams
April Kapu, DNP, MSN, RN, ACNP-BC
Pam Jones, DNP, RN, NEA-C
With optimal organizational structure, NPs can decrease healthcare costs with acute transition management, decreasing length of
stay (LOS) and with adherence to clinical practice guidelines, reducing complications associated with fragmented, unstandardized
care. In addition, NPs can generate revenue as billing providers.
Our rationale was that through organizational application of Structural Empowerment Theory, we could integrate acute care NPs
into inter-professional models of care, with a subsequent increase in revenue and reduction in costs via quality improvement.
With NPs added to the intensive care units (ICU), and hospitalist teams, we tracked revenue and NP associated quality metrics.
From July 1, 2011 – June 30, 2012, we tracked NP charges and collections for 4 ICU, and 1 hospitalist NP team, utilizing the
institution’s billing system. We developed practice specific electronic progress note templates to chart daily notes and collect
quality data which was then transferred to an electronic dashboard. From January 2011-Dec. 2011, we added NPs to rapid
response teams and collected data via a secure electronic data capture tool, REDCap. For a 6-month pilot, Dec.2011 - Feb. 2012,
of adding NP hospitalists to a trauma stepdown unit, we collected LOS data utilizing admission and discharge tracking software
and compared to 2 years prior.
The gross collections met 52% (FY11) and 88% (FY12) of salary and fringe expenses for four ICUs. After addition of NPs to
the rapid response teams in 2011, the ratio of rapid response to out of ICU arrest was 18%, as opposed to 35% in 2010. The
hospitalists NPs added to a particular hospital unit for 1 year showed high staff satisfaction and a 1.0 reduction in average length
of stay to the overall trauma service.
These studies demonstrate the value of adding ACNPs to inpatient models of care.
NPs as billing providers can generate revenue, avoid costs associated with hospital complications and save costs with decreased
LOS.
Qualitative and Quantitative APRN Associated Outcomes: Implementation of an APRN Professional
Practice Evaluation Program with an Academic Medical Center
April Kapu, DNP, MSN, RN, ACNP-BC
This presentation will overview the Joint Commission standards for APRN Professional Practice Evaluation and how a consistent
framework was implemented for over 700 APRNs throughout a large medical center with varying specialties and practices.
Professional growth can be optimized with an effective performance evaluation program. The Joint Commission has identified
elements of Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE), moving from
cyclical to continuous evaluation of a practitioner’s performance to identify practice trends that impact quality, patient safety and
determine whether a practitioner is competent to maintain existing privileges or needs referral for a focused review.
In a large academic medical center, professional, practice management, procedural and clinical competencies were identified
for each APRN specialty. Qualitative and quantitative measures were created with the use of surveys and dashboards displaying
APRN associated outcomes. The OPPE included a review of clinical privileges and continued competency. OPPE reviews were
conducted twice yearly, beginning 2011 and included peer review, self-assessment and proctor evaluation. Focused Professional
Practice Evaluation (FPPE) is required when a practitioner is hired to verify competency, when applying for new privileges and
whenever questions arise regarding the practitioner’s professional performance. An FPPE program was developed to identify
competency in review, proctor assignment, comprehensive plan for improvement, timeline for evaluation and key quantifiable
measures. Both OPPE and FPPE processes were approved through the Medical Center Medical Board and finalized into hospital
policy.
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