nurse practitioner in emergency: the bethesda hospital experience patti fries facility manager

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Nurse Practitioner in Emergency: The Bethesda Hospital Experience Patti Fries Facility Manager Bethesda Hospital/Bethesda Place 204-346-5150. Bethesda Hospital 64 Acute care beds, including medicine, surgery, obstetrics Surgical Program with some Ortho - PowerPoint PPT Presentation

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  • Nurse Practitioner in Emergency:The Bethesda Hospital Experience

    Patti Fries Facility ManagerBethesda Hospital/Bethesda Place204-346-5150

  • Bethesda Hospital64 Acute care beds, including medicine, surgery, obstetricsSurgical Program with some Ortho20 Rehabilitation beds with Rehab Therapy Services Cancer Care

  • Emergency DepartmentSee ~25 000 patients per year2 beds in resuscitation room3 private rooms2 stretchers with privacy curtains2 hallway stretchers

  • Staffing2-3 RNs / shift1 physician 24 hours per day, with second physician 1400-2200 h dailyOne NP Monday Friday 0800-1600 hOne CRN Monday Friday 0900-1545 h

  • How Did This Come To Be?Need identified by current NP who was working in ER as a casual nurse while a student in the NP program.Together with Facility Manager, a proposal was written and presented to Manitoba Health.Pilot project for 0.8 EFT started July 17, 2006, became a full-time permanent position July 17, 2008.

  • Why Did We Need An NP?Recognized need for alternate practitioner to provide care for less urgent patient populationImprove patient flow in a busy ERDecrease workload on existing practitioner thereby improving overall wait times.

  • ER Visits125% increase since 1987/8635% increase since 1996/199723,500 or 64 pts./day from 2004/05 with slight decrease (alternate space)2/3 of regions population increase; 29% increase since 1998Acuity (Level 1-3) 97% increase 2000 2004 with 200% increase from 2003 - 2005

  • Integration of the RoleInformal integration and education by NP while current staff nurse attending school and during practicumPhysician coach/mentor who completed chart auditsManitoba Health deliverables360 evaluation by peersCollaborative Practice Agreement Presentation by WRHA NP to all staff

  • Successes & Challenges

  • What Made It A Success? Existing staff memberSupportive team physicians, allied health, managementNPs key role in initiating support for proposalAdvanced critical skill base with pediatric specialtyTeam playerCommitment to best practice and high standard of care

  • What Were The Challenges?Lack of understanding of role, on both sidesTreating NP as NP and not a staff nursePaving way for new position Slight transition with assessments and writing ordersUnable to write Rx independently for some items (i.e. air cast)

    Some insurance companies, organizations not accepting NP signatures (i.e. MPIC)Some specialists not wanting to discuss referral from NP (i.e. orthopedic surgery referral)

  • Supporting the NPFlexibility of both NP and managementER Team supportDedicated office space with computerProtected administration/education/research timeEducation supportInclusion on teams where input sought Nursing PracticeER/EMSNP Implementation (new)Pandemic PlanningPrimary Care Planning