Proposed Practice Change
Minimum healthcare providers, increase in healthcare problems, staffing shortage in the emergency department are leading to longer waiting times in the emergency department with ineffective patient care and poor outcomes. Develop a plan for practice change towards this healthcare problem by utilizing Nurse practitioners in the emergency department to deliver timely and effective care. Your plan should contribute to the safer care of adult patients with acute disorders. The plan should specify the roles and responsibilities of various collaborating healthcare providers and identify professional, legal, and/or ethical standards that would need to be considered for the proposed practice change to occur. The development of such a plan provides an opportunity to apply advanced concepts, quality care principles, and/or nursing theories toward a real-life scenario.
Please ensure that your plan clearly states:
The healthcare problem being targeted (Longer waiting time in the emergency department, poor patient care, and poor outcome)
Background information about the concerns surrounding the healthcare problem that you are targeting
How your plan of Utilizing and using Nps in the department will make health care for adult patients with an acute disorder safer and/or more cost-effective
The healthcare providers that would need to be involved in the proposed practice change to work
How those healthcare providers would need to collaborate for the proposed practice change to work
Professional, legal, and/or ethical standards that would need to be considered for the proposed practice change to occur
Be sure to incorporate advanced concepts, quality care principles, and/or nursing theories throughout your plan.
Please adhere to APA writing standards.
The Healthcare Problem Being Targeted and Background Information
The proposed practice change targets the problem of long waiting time in the emergency department, which is characterized by poor patient care and outcomes. The longer waiting period affects timely delivery of care an important element of quality care. The demand for emergency care in many countries has arisen, creating overcrowding while increasing the waiting time in the emergency department. The problem has been associated with an increase in the aging population, greater disease complexity, physical infrastructure, and manpower limitations (Shen & Lee, 2018). The prolonged waiting time in the emergency department has been associated with increased morbidity, mortality, and decreased patient satisfaction (Shen & Lee, 2018). Waiting time in the ED has been associated with bed occupancy. The major contributor to the longer waiting period in the ED is the inability to transfer patients to inpatient beds. Increased bed occupancy and lack of available inpatient beds contribute significantly to an increase in the waiting time (Paling et al., 2020). Increased demand for emergency care results in overcrowding which the quality of care through impaired decision making, incomplete examination, unwillingness to consult or conduct tests, suboptimal physiotherapy, deficient treatment, lack of a proper discharge plan, and follow-up. These factors are linked to poor outcomes such as longer duration of hospital stay, subsequent hospital admission, delays in implementation of life-saving interventions, higher risk of mortality, and lower levels of patient satisfaction (Paling et al., 2020).
Utilization of NP in the Department to Make Health Care for Adult Patients with An Acute Disorder Safer And/or More Cost-Effective
Acute care provides patients with short-term restorative stabilization. NP would act as the first point of contact for patients. Unlike NPs in primary care, NPs in the emergency department have the training to manage acute-life or limb-threatening conditions. Utilization of NP would entail granting NP autonomy to provide care and increasing their collaboration with the physicians. The utilization of NP can improve time as a quality care indicator as they can render timely care services to patients by reducing the shortage of health care professionals in the department. The addition of NP in the department provides physicians with an opportunity to focus on conditions with higher complexity and acuity, increasing access to prompt emergency care. According to Woo et al. (2017), NP develops greater familiarity with the clinical environment and with the needs of the patients improving their capacity to provide satisfy patients. NPS is rated better at providing patient education, managing pain, listening, and answering questions (Woo et al., 2017). Cost savings linked to the utilization of NP in the department stems from the decreased length of hospital stay, improved follow-up, and decreased rate of rehospitalization.
Healthcare Providers That Would Need to Be Involved in the Proposed Practice Change to Work
The proposed practice change uses a team-based approach in providing care in the emergency department. According to Shen and Lee (2018), the use of a team-based approach has been associated with improved patient satisfaction and better patient outcomes due to closer communication and coordination of care among the involved professionals. The practice change is inspired by Martha Rogers nursing theory that views nursing as an art and science and provides a view of the unitary human being hence needs for holistic care (Gonzalo, 2021). The healthcare professionals involved in the team-based approach to care would include the emergency physician, emergency nurses, nurse informatics, and a non-clinical professional such as an analyst from the facilities operations and performance management department. The emergency physician is the team leader and offers direction on the treatment that should be administered to patients, for example ordering major tests and recommending prescriptions. The emergency nurse will monitor the patient and administer patient care as directed by the physician. The nurse would be responsible for handling less complex issues for the patient while consulting the physician on more complex cases. A nurse informaticist facilitates the collection and sharing of data by improving the collection of information about the patients since arrival in the department giving the team the best chance of delivering optimal care.
How the Healthcare Providers Would Need to Collaborate for the Proposed Practice Change to Work
Collaboration involves integrating knowledge and activities requiring a partnership of shared responsibility and authority. According to Morley and Cashell (2017), collaborative practice is characterized by four major elements: coordination, cooperation, partnership, and shared decision-making. Coordination involves working together to achieve common goals, while cooperation involves contributing to the team and showing understanding and valuing the contributions of other professionals. Shared decision-making is characterized by negotiation, communication, trust, openness, and respectful power balance. Effective communication is an integral element in collaboration (Morley & Cashell, 2017). The four elements of collaborative practice cannot be achieved without open and effective communication among professionals. Implementation of the elements requires timely and effective data sharing. Effective communication can be achieved through various strategies such as organizational policies that support consultation and data sharing and health care technology to improve the quality of data shared in terms of completeness and accuracy. For example, the increase of electronic health and medical records can facilitate decision-making as the health professionals have easy access to complete and accurate information about the patient.
Professional, legal, and ethical standards for the Proposed Practice Change
All healthcare professionals are governed by professional, ethical, and legal standards. The American Medical Association adopted an ethical guideline in 2016 stating physicians as the leaders of team-based care. Physicians as team leaders are responsible for modeling leadership, articulating individual responsibilities and accountability, and mastering teamwork skills. The decision-making process in the team-based approach should be guided by ethical principles of autonomy, non-maleficence, beneficence, and justice (Haddad & Geiger, 2018). Failure to adhere to the principles may have legal and ethical implications on the individual professionals or the team. Since communication and data sharing are key in collaborative practice, the professionals must adhere to the privacy and confidentiality of patients’ information. The professionals must adhere to certain rules, such as HIPAA laws. The rights of patients under the privacy rule have to be respected. Such rights include the right to access, accounting of disclosures, requesting amendment of PHI, and the right to complain of privacy rule violation (George & Bhila, 2019). The physical, administrative, and technical safeguards must be observed. This may include proper use of passwords and physical restrictions to ensure that patient medical information is not accessible to the wrong people. Failure of the professionals to observe the rules may attract legal implications such as fines, jail terms, and withdrawal of their licenses.
Longer waiting time in the emergency department is a health care concern that affects the quality of care and patient outcomes. The proposed practice change uses team-based care where various healthcare professionals such as physicians, nurses, nurse informaticists, and others collaborate in care provision. Elements of collaboration include coordination, cooperation, partnership, shared decision-making, and effective communication. The health care professionals must adhere to legal, ethical, and professional standards such as ethical principles and HIPAA law to avoid various implications, including jail terms, penalties, and withdrawal of the license.
George, J., & Bhila, T. (2019). Security, Confidentiality, and Privacy in Health of Healthcare data. International Journal of Trend in Scientific Research and Development, 3(4), 373-377. https://www.academia.edu/download/59878777/ijtsrd23780_Security__Confidentiality_and_Privacy_in_Health_of_healthcare_data20190626-116770-ndzap5.pdf
Gonzalo, A. (2021). Martha Rogers: Science of Unitary Human Beings. Nurseslabs.
Haddad, L. M., & Geiger, R. A. (2018). Nursing Ethical Considerations. https://europepmc.org/article/nbk/nbk526054
Morley, L., & Cashell, A. (2017). Collaboration in Health Care. Journal of Medical Imaging and Radiation Sciences, 48(2), 207-216. https://www.sciencedirect.com/science/article/pii/S1939865416301175
Paling, S., Lambert, J., Clouting, J., González-Esquerré, J., & Auterson, T. (2020). Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data. Emergency Medicine Journal, 37(12), 781-786.
Shen, Y., & Lee, L. H. (2018). Improving the Wait Time to Consultation at The Emergency Department. BMJ Open Quality, 7(1), E000131.
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 1-22.