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Over the past two decades, the emergency nurse practitioner (ENP) role has significantly enhanced emergency care in the United States. With the increasing complexity of emergency care, ENPs have expanded into nontraditional settings, necessitating regulatory updates to maintain patient safety. The Consensus Model for Advanced Practice Registered Nurse Regulation has influenced ENP practice, yet consistent regulatory recognition is still needed due to the marked evolution in ENP practice. Despite collaborative efforts to prepare the ENP workforce and ensure competency through standardized education, certification, and licensure, recent unethical publications and skewed statistics have threatened the specialty's progress. Addressing these challenges is crucial for advancing the ENP role and ensuring high-quality emergency care delivery. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed the use and perceptions of physician associates/assistants (PAs) and NPs at liver transplant centers and sought to determine their financial effect. Methods: Leaders of liver transplant programs performing 25 or more transplants in 2020 were contacted to complete an 11-question survey about the role and effect of PAs and NPs in liver transplant. A single-center retrospective analysis compared length of stay (LOS) and readmission rates for primary liver transplants and simultaneous liver-kidney transplants before and after a dedicated PA team was established. Chi-square and t-test analyses were performed. Results: The survey achieved a 77% response rate, and 98% of institutions reported using PAs and NPs. The single-center study found the mean LOS post-transplant was significantly shorter in the post-PA cohort (P = .0005). No significant difference was found in 30-day readmission rates. Conclusions: PAs and NPs are used broadly across the postliver transplant care continuum. Using LOS as a surrogate financial marker suggests that a dedicated PA and NP team may contribute to cost savings. [ABSTRACT FROM AUTHOR]

Information on the employment of patient-care clinicians is needed for policy planning and human resource management. The 2021 Bureau of Labor Statistics (BLS) employment data were probed for occupational settings of 698,700 physicians and surgeons, 246,690 NPs, and 139,100 physician associates/assistants (PAs). These three healthcare professionals accounted for about 1.1 million medical and surgical clinicians serving a US population of 331.5 million. Clinician demographics differ--in 2021, the median age of physicians was 45 years; NPs, 43 years; and PAs, 39 years. The largest employment location is "office of a physician" (physician, 53%; NP, 47%; PA, 51%), followed by hospitals (physician, 25%; NP, 25%; PA, 23%), and outpatient centers (physician, 4%; NP, 9%; PA, 10%). The 10-year job outlook predicts physician growth at 3%, NPs at 46%, and PAs at 28%. NP and PA employment is growing more than that of physicians because of constrained physician postgraduate education funding. Other factors influencing employment changes include medical practice mergers, the rising value of team-based care, the cost of new medical schools, and task shifting. [ABSTRACT FROM AUTHOR]

Purpose: Postgraduate clinical training (PCT) has been available to PAs since the 1970s and to NPs since at least 2007. Some programs now enroll PAs and NPs. Although this new training model appears to be expanding, little data about integrated PA/NP programs are available. Methods: This study examined the PA/NP PCT landscape in the United States. Programs were identified from membership rosters of the Association of Postgraduate Physician Assistant Programs and the Association of Post Graduate APRN Programs. Data (program name, sponsoring institution, location, specialty, accreditation status) were identified from programs' websites. Results: We identified 106 programs at 42 sponsoring institutions. Various specialties, most commonly in emergency medicine, critical care, and surgery, were represented. Few were accredited. Conclusions: PA/NP PCT is now common, with about half of the programs accepting PAs and NPs. These programs represent a unique form of interprofessional education involving full integration of two professions in the same program and are worthy of further investigation. [ABSTRACT FROM AUTHOR]

NPs are likely to encounter patients using cannabis with therapeutic intent, with or without legal authorization. During the clinical history and assessment process, NPs need to engage in frank discussion about cannabis therapeutics, including the risks and benefits, evidence for use, dosing considerations, potential drug interactions, and harm reduction. [ABSTRACT FROM AUTHOR]

Health workforce policy in the United States from the mid-1970s has been strongly influenced by perceptions of the adequacy of the physician supply and its relationship to physician assistants/associates (PAs) and NPs. During the 1980s, a series of inaccurate reports by the federal government mistakenly warned of an impending physician surplus and shaped policy decisions for decades. In spite of perceptions of a physician surplus, the PA profession expanded rapidly in the 1990s. Projections of the adequacy of the physician supply changed to a shortage in the first decade of this century and the PA component of the healthcare workforce continued to expand. During the past decade, the Association of American Medical Colleges has employed microsimulation modeling expertise to project the extent of physician shortages, an effort that initially failed to incorporate the contributions of PAs and NPs in the workforce. Although current projection models include the contributions of PAs and NPs, the substitution ratios used are notably low. Specifically, PA and NP productivity effort was set roughly at one-quarter to one-half that of the physician. PAs and NPs make up a substantial contingent within the US healthcare workforce and should be included fully in future workforce projection estimates. This article provides policy recommendations for the advancement of PA contributions to the delivery of medical care. [ABSTRACT FROM AUTHOR]

Objective: Organizational leaders must continually assess the productivity, turnover, and vacancies of physician assistants (PAs) and NPs. Optimizing the feasibility, effect, strategic placement, and monitoring increases patient access, improves wait times and affordability, and increases revenue. This quality improvement project sought to develop a systematic, data-driven approach to optimize productivity and placement of NPs and PAs in outpatient primary care sites. Methods: Results from this project are reported using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) framework. Postformation of a quality improvement team, a gap analysis, and action plans were developed and implemented. Results: Priority areas requiring action included the development of an integrated position justification algorithm and tracking form addressing NP and PA placement, establishing consistent patient contact hours, setting workload expectations, and consistently communicating these via an organization-specific situation, background, assessment, and recommendation communication tool. Conclusions: Healthcare leaders should leverage the talents of NPs and PAs meeting organizational benchmarks and goals as well as the needs of patients. NP and PA leaders should focus on benchmarking performance and analyzing barriers to optimization. These efforts are most beneficial when multidisciplinary in nature. [ABSTRACT FROM AUTHOR]

Background: The demand for health care in the United States is increasing because of an aging population and an increase in the number of individuals insured. This has led to requests to revamp the primary care infrastructure fundamentally. Local Problem: The optimal use of nurse practitioners (NPs) and physician assistants (PAs) is still a subject of debate, but recently, it was reported that for many medical conditions, NP and PA-managed care outcomes are consistent with physician-managed care outcomes. Methods: Radiologists' productivity was measured according to relative value units (RVUs)/shift and professional billing changes. Patient care metrics measured were prescribed protocol to patient appointment lead time and number of same-day prescribed imaging protocol changes. Interventions: The focus was on radiologists' productivity and patient care for three months before and three months after integrating NP and PA into our abdominal radiology consult service. Results: We observed significant increases in the mean RVUs/shift (15.2 6 0.9 vs. 6.2 6 1.8; p = .02), studies read per shift (10.160.5 vs. 4.461.5; p = .003), revenue per shift hour ($756.20655.40 vs. $335.40632.60; p = .007), and protocol prescription to patient appointment lead time (39.3 6 6.7 days vs. 16.3 6 2.9 days; p = .005) and saw significant decreases in the mean prescribed CT (19.3 60.6 vs. 3.36 0.6; p = .001) and MRI (11.7 60.6 vs. 8.30 6 0.12; p = .011) same day protocol changes in NP and PA integrated workflow. Conclusions: These findings suggest that NP and PA can be effectively integrated into the abdominal radiology consult service, increasing radiologists' productivity and enhancing clinical care. [ABSTRACT FROM AUTHOR]

Increasingly, physician assistants (PAs), advanced practice nurses, and physicians are fi nancially involved with healthcare product manufacturers. Although the relationships themselves might not be illegal, when the transaction infl uences the healthcare provider's medical decision-making, patients can be harmed and the healthcare provider and manufacturer can face accusations of violating federal and state law. In 2019, the federal government recouped $2.6 billion from healthcare fraud and abuse by healthcare stakeholders. PAs' and NPs' behaviors violating the Anti- Kickback Statute (AKS) and False Claims Act (FCA) were partially responsible for the reported amount. To increase the transparency of the fi nancial relationships between healthcare providers and healthcare manufacturers, the federal Centers for Medicare and Medicaid Services, under statutory obligation, created the Open Payments program, which will begin reporting PAs' and advanced practice nurses' fi nancial relationships with manufacturers in 2022. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of interest Author Kim is a paid consultant at Verve Therapeutics and SeQure Dx, unrelated to this research. Author Kim’s interests were reviewed and are managed by Mass General Brigham in accordance with their conflict-of-interest policies. Author Shiau, Author Young, Author Baker, and Dr Bae have no conflicts of interest to declare.

The National Association of Neonatal Nurse Practitioners (NANNP) conducted its second workforce survey of certified neonatal nurse practitioners in the fall of 2016. National Association of Neonatal Nurse Practitioners partnered with the National Certification Corporation and the American Association of Nurse Practitioners to conduct this electronic survey, containing 69 questions and focusing on practice sites and total compensation packages (including benefits) and workforce deficits.Findings indicate a rising neonatal nurse practitioners (NNPs) position vacancy rate across the country. Regional salary data indicated that the southeast had lower compensation rates for NNPs, with regions 4 and 11 (South) having the lowest rates. A promising trend indicated that new graduate NNPs with a doctorate are earning more. The study findings indicate that tailoring benefit packages to the age and years of experience for the individual NNP may aid in recruiting and retaining NNPs in practice. For experienced NNPs, altered shift lengths (shorter), higher employer matching rates in retirement plans, and less employee cost sharing for health insurance benefits are more appealing strategies.It is critical for NNPs to continually evaluate the profession's workforce data. There are more than 205,000 nurse practitioners practicing in the United States, with neonatal NPs making up approximately 3% of the larger whole. Increased participation in future surveys will assist in creating sustainable solutions to the workforce crisis facing the profession. [ABSTRACT FROM AUTHOR]

Healthcare workforce projections have important policy implications. Provider shortages can shortchange patients, and overproduction of providers imposes costs on society. The most publicized physician supply and demand projections, commissioned annually by the Association of American Medical Colleges, regularly predict dire physician shortages. These projections are based on unrealistically low estimates of the amount of physician work that can be replaced by physician assistants (PAs) and NPs. For example, the projections factor in the contribution of one primary care PA or NP as one-fourth that of a physician. If workforce projections used evidence-based productivity estimates, the predicted physician shortfalls would be much smaller and perhaps even disappear. [ABSTRACT FROM AUTHOR]

The nursing discipline in the United States (US) has a history of creating various doctorates.One such degree, the Doctor of Nursing Practice (DNP), serves as an alternative to the traditional Doctor of Philosophy (PhD) degree for Nurse Practitioners (NPs) exploring career options. The availability of the DNP has sparked a debate within the profession: close attention to the issues iswarranted for any school considering the development of a DNP program. However, some of theseissues are not applicable, or apply differently to other contexts including Canada, where the highestlevel of education for an NP is a PhD. This article will review the history of doctoral education inboth countries, compare the practice-focused and research-focused doctorates, discuss the issuesof debate, and explore implications for NP practice. To fully inform the decision of the NP, we recommend further research to explore the need for a practice doctorate. [ABSTRACT FROM AUTHOR]

Multifactorial changes within healthcare systems across the United States and beyond have forced hospitals to reevaluate the ways in which resources are used. With recent restrictions on resident work hours, the nurse practitioner has emerged as a front-line player in healthcare. This change, however, has brought with it more advanced therapies, treatments, and interventions which the nurse practitioner now practices more independently. As a result, the role of the trauma nurse practitioner emerged over the past few years to assist in meeting the complex demands of trauma programs. To date, little information on the demographic data and the background of these professionals has been published, nor has there been much discussion related to the orientation process for this innovative role. [ABSTRACT FROM AUTHOR]

Background: Physician Assistants (PAs) and Nurse Practitioners (NPs) are widely utilized in United States (US) Emergency Departments(EDs). We sought to characterize ED PA and NP utilization and practice characteristics in US EDs 2010-2017., Methods: A retrospective, secondary analysis of the Center for Disease Control's National Hospital Ambulatory Medical Care Survey was performed. National estimates of ED visits involving PAs/NPs alone (PA/NP), PAs/NPs with physician involvement (PA/NP+), or physician only (PHYS) were analyzed for patient demographics and hospital characteristics., Results: Between 2010 and 2017, 1 billion US ED visits occurred. 8.4% (±4.2%) of visits were seen by a PA/NP, and 11.8% (±4.5%) by a PA/NP+; 76.3% (±7.2%) by PHYS. There was an increase in utilization by PA/NP observed in 2016. PA/NP acuity was highest for semi-urgent/nonurgent (53.2%, ±8.6%). PA/NP see the minority of ambulance arrivals [5.4% (±1.2%)] and admit less patients overall [1.6% (±0.7%)]. Less laboratory [53.6% (±10.0%) vs. 67.0% (±6.2%)] and radiographic [38.0% (±7.0%) vs. 51.6% (±4.6%)] studies were performed during PA/NP only vs. PHYS visits. PA/NP visits were most common for patients 25-44 years old (yo) (31.1%, ±5.5%) and 0-15 yo (23.9%, ±4.7%). Most PA/NP visits result in a length of stay (LOS) between 1 and 1.9 h (33.4%, ±5.7%) compared to most PHYS visits resulting in a LOS greater than 3 h (40.3%, ±3%)., Conclusions: From 2010 to 2015, PA/NP utilization remained stable until an increase in 2016. There was a decrease in 2017. Various PA/NP patient characteristics are significant compared to PHYS. PHYS continue to see most ED patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)