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Nurse will aid ICU staff with continuum of care
Among physicians, hospitalists are being touted as the latest player on the care management team. However, similar opportunities may be awaiting critical care nurses.
Hospitalists are physicians who specialize in hospital-based inpatient care and practice across a spectrum of hospital inpatient departments such as emergency, critical care, and geriatrics. Usually, they do not maintain an office-based practice but practice full time in a hospital.
As nursing roles expand into more complex areas of inpatient care and more highly educated RNs step up to the plate, some experts say similar opportunities will soon open up for many nurse practitioners and other advanced practice nurses.
Nurse managers are being advised to keep their eyes open as hospitals may soon begin designating qualified advanced practice nurses to hospitalist positions, according to Anne Foster-Schuller, RN, MSN, a manager with The Camden Group, a health care consulting firm in El Segundo, CA.
The presence of a nurse-hospitalist would affect ICUs in the following ways:
• Because the role of nurse-hospitalist would cut across several inpatient departments, they are likely to offer ICU/CCU managers a direct link to other acute and sub-acute care units outside the ICU; therefore offering a smoother transition for daily patient management and transfers, according to Foster-Schuller.
• They also would reinforce the care management team’s responsibility in the absence of attending physicians and represent the nursing viewpoint in the development of treatment plans and therapies.
• The job classification would involve broader patient management responsibilities than most bedside or senior nurses presently hold. For one, the duties would span a cross-section of acute-care units, including the ICU, trauma, and emergency departments (EDs) simultaneously.
• Furthermore, the individual would participate in key clinical decision-making with physicians, including developing treatment plans and post acute-care case management, Foster-Schuller says.
"The nurse-hospitalist would work with a defined group of patients and oversee all aspects of their care from admission to discharge," says hospitalist Jeffrey Hay, MD, medical director of inpatient services at HealthCare Partners Medical Group, a Los Angeles-based managed care organization (MCO). The group has 300 primary care physicians and 30 hospitalists who work at 13 local hospitals.
However, nurse-hospitalists are far from an accepted idea. Neither the American Association of Critical Care Nurses in Aliso Viejo, CA, nor the American Nurses Association in Washington, DC, recognizes the professional designation or offers a certification for the position.
Nevertheless, pressure to achieve better clinical outcomes and lower costs has expanded the role of qualified nurses. In recent years, hospitals increased the role played by experienced nurses and technicians. Many have credentialed quasi-physician extender positions such as clinical nurse specialists and nurse practitioners to improve patient management. (For more on nurse practitioners, see article, p. 19.) However, these credentialed nurses largely have been limited to working within specific departments in specified ways.
In contrast, nurse-hospitalists would be certified to function across a broader set of clinical disciplines, notably in pulmonology, critical care, emergency, and internal medicine, Hay says.
The focus is on the patient’s continuum of care throughout the hospital stay, Foster-Schuller says. In practice, "the individual organization would really be the one that defines the nurse-hospitalist’s responsibilities."
In general, the nurse-hospitalist would function in the following ways:
• Provide screening and evaluation on patients with an anticipated admission when they arrive in the ED.
• Assume overall patient-care responsibility for patients from admission to discharge and thereafter.
• Directly manage patients’ daily condition during their ICU stay.
• Interact with unit nurses and coordinate care across inpatient departments, especially during patient discharge and transfer.
• Coordinate treatment plans between patients and their primary care physicians.
• Accept responsibility for patients admitted through the ED who do not have a primary care provider.
A 1995 study conducted by Hay at Huntington Memorial Hospital in Pasadena, CA, reveals the use of hospitalists in inpatient care reduced the number of physician consults by 40% over a 12-month period. It also cut the number of specialist visits to the ICU by 5% over three years, which, according to Hay, was significant.
Hospitalists also accounted for a 20% reduction in cost per inpatient case among managed care patients and 35% for Medicare cases.
[Editor’s note: For more on the emerging role of hospitalists, contact: Anne Foster-Schuller, manager, The Camden Group, 100 N. Sepulveda Ave., Suite 600, El Segundo, CA 90245. Telephone: (310) 320-3990. E-mail: firstname.lastname@example.org]