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The role of nurse practitioners in pediatric urology is growing. With the increasing work force shortage in pediatric urology and urology in general-it has to.
San Francisco-The role of nurse practitioners in pediatric urology is growing. With the increasing work force shortage in pediatric urology-and urology in general-it has to. So, can nurse practitioners really decrease the surgeon workload? Are they cost effective, and can they improve the quality and continuity of care?
Angelique Champeau, RN, MSN, CPNP, tried to answer those questions-and challenged her colleagues to do research to find more answers-in her keynote address at the first World Congress of Pediatric Urology in San Francisco. Champeau is the senior nurse practitioner in the department of pediatric urology at the University of California, San Francisco's Children's Hospital.
Her questions aren't easy to answer just yet. Most of the research done on the value of advanced practice nursing has been in primary, not specialty, care. Indications from that literature seem to confirm that advanced practice nurses can supplement and even replace some physician-provided care cost effectively and without any decrease in the quality of care. But because there's so little research in the specialties on this, Champeau began her own, based on a survey of pediatric urology nurses.
Research points to versatility of nurses
Literature on the topic in the 1990s concluded that nurses can take on much of the job of health promotion and routine management of chronic conditions. In fact, some argue that nurses might be able to take on as much as 70% of the work done by physicians. Literature reviews and meta-analyses in the 1990s suggested that nursing-led care results in similar outcomes with increased patient satisfaction and compliance, longer consultations, and higher rates of investigation.
A 2005 Cochrane review aimed at assessing the effects of nurses working as doctor substitutes in primary care concluded that studies showed no appreciable differences between doctors and nurses in terms of patient outcomes, process of care (such as adherence to guidelines), resource utilization, and cost outcomes (Cochrane Database System Rev, April 18, 2005). The impact on physician workload and direct cost of care was variable, however.
"I think that's the focus we want to make," Champeau said. "It's not who is cheaper than whom, it's what model is going to be the most cost efficient."
Because so little is known about the nurse practitioner's potential to shoulder the workload in pediatric urology, Champeau conducted a survey of pediatric urology nurse specialists.
The 67 who replied (a 50% response rate) demonstrated that these nurses were in a good position to take on an important share of the workload. On average, they had 24 years in nursing and 10 years in urology. Well educated, 72% of them had masters' degrees and 6% had PhDs or were working toward them. Thirty-three percent were publishing independently and 39% collaboratively, while 85% attended conferences, 71% did writing and updating of protocols or procedures, and more than 50% spoke or presented at conferences, lectured, or conducted seminars and classes. Furthermore, 70% taught students, including physicians (48%).