Abstract and Introduction
The purpose of this audit was to provide empirical evidence for the outcomes of care of advanced nurse practitioners (ANPs) within the emergency department (ED). In addition, the audit permitted the comparison of ANPs with other medical clinicians working in the ED setting in relation to results of radiology investigations, analgesia administration, and waiting times. Results show that ANPs have equivalent if not better radiology diagnostic skills, evidence of increased awareness of pain management practices, and a greater impact on reducing patient waiting times compared to other grades of clinician.
The population of the Republic of Ireland (ROI) has been increasing for almost 50 years after a 100-year decline. It is expected that by 2020, the population will have increased by at least 1 million people. Ireland's relatively young population, with 1 person in 10 over 65, is set to change considerably in the coming years, and it is projected that, by 2036, 1 person in 4 will be over 65. It is anticipated the Irish health service will be challenged to meet the rising needs.
Emergency departments (EDs) throughout the ROI face the prospect of curtailing their opening hours or even closing completely from a shortage of junior physicians. Reasons for shortages are multifaceted, including emigration of newly qualified physicians and the difficulty for physicians who are not from the European Union in obtaining work visas. Never has there been more need for the establishment and deployment of ANPs throughout EDs in the ROI.
The profession of nursing in the ROI is experiencing rapid change against this background of unprecedented transformation in the health service. Because of recommendations in the Report of The Commission on Nursing and Review of the Scope of Nursing and Midwifery Practice and by the work of the National Council for the Professional Development of Nursing and Midwifery (NCNM), nurses are encouraged to undertake education at higher diploma, master's, and doctoral levels. This trend is particularly evident in the area of developing clinical nurse specialist and ANP roles.
ANP roles are in the neophyte phase in the ROI in comparison to other jurisdictions, such as America and the United Kingdom. The development of advanced practice roles in the ROI is part of the strategic development of the overall health service. The first ANP post in emergency nursing was approved by the National Council in 2001, with the first ANP being accredited for that post in 2002.
Previous studies have focused on the qualitative aspect of patient satisfaction with services provided by the ANP. It is important to examine care outcomes to determine whether they have an impact on quality and cost. Little information is available on comparison of ANP outcomes of care in the ED to medical colleagues. Given the current concerns about the shortage of medical coverage in EDs, it is timely to examine measurable outcomes such as impact of ANPs on waiting times, efficacy of pain control (identified as a key performance indicator by the NCNM), and X-ray prescribing practices.