OBJECTIVE: Nurse practitioner-led MET calls have been shown to improve clinical outcomes versus ICU registrar-led MET calls. However, the cost implications of a nurse practitioner-led MET call system is not known. We conducted cost analysis from the healthcare service perspective to compare the costs of nurse practitioner- and ICU registrar-led MET calls.
METHODS: A retrospective study of MET calls between 1 June 2016 and 9 March 2018 including patients with first MET call during their hospital admission. The cost analysis compared MET calls attended by nurse practitioners against those attended by ICU registrars.
METHODS: Inpatient costs for nurse practitioner- and ICU registrar-led MET calls.
RESULTS: 1,343 MET calls were included in the full dataset with a mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls of AU$19,836 (95 % CI: AU$15,778 - AU$23,895) versus AU$16,404 (95 % CI: AU$14,988 - AU$17,820) respectively and a difference of AU$3,432 (95 % CI: -AU$38 - AU$6,903, p = 0.053). In the propensity-score matched analysis, the mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls was AU$19,009 (95 % CI: AU$15,439 - AU$22,578) and AU$13,937 (95 % CI: AU$12,038 - AU$15,835) respectively, with a difference of AU$5,072 (95 % CI: AU$1,061 - AU$9,082, p = 0.013). A 24-hour nurse practitioners-led MET call service would break even at 101 MET calls leading to ICU admissions per year.
CONCLUSIONS: Nurse practitioners-led MET calls saved significant costs compared to ICU registrar-led MET calls. Assuming that the difference in costs is due to shorter ICU length of stay, a health service that receives more than 101 MET calls leading to ICU admissions per year can save costs with a 24-hour nurse practitioner-led MET call service.
CONCLUSIONS: This study helps in identifying the healthcare services where nurse practitioners -led MET systems could be implemented to be cost saving from health service perspective.

Background and Purpose: This study adapted the Nurse Practitioner Primary Care Organizational Climate Questionnaire to measure the organizational climate of nurse practitioners in acute care settings and validated the Nurse Practitioner Acute Care Organizational Climate Questionnaire (NP-ACOCQ). Methods: We used a three-phase instrument adaptation design. In phase 1, experts assessed face and content validity. In phase 2, pilot testing enabled item analysis and preliminary reliability testing. In phase 3, field testing supported exploratory factor analysis. Results: The NP-ACOCQ had a three-factor structure representing subscales. The subscales had Cronbach\'s alphas of 0.87, 0.90, and 0.94. The subscales, Institutional Visibility, Interprofessional Relationships, and Organizational Autonomy each had between 5 and 13 items. Conclusions: The NP-ACOCQ is a valid and reliable measure to assess organizational factors determining the acute care nurse practitioner work environment.

The advanced practice nurse (APN) has been introduced in France, following the 2016 health law and implementing decrees published in 2018. In this context, the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has already issued guidelines regarding the allocation of APNs\' new clinical competences and their collaboration with physicians. It is now providing new recommendations on the transversal activities that can be fulfilled by APNs, such as research, leadership, training and teaching. Additionally, the guidelines outline how APNs can cooperate with other professionals in departments of haematology and cellular therapy, including nurses, coordinators and health managers.

The quality of medical care provided to older residents in nursing homes may depend upon available staffing models; this study examined the relationship between physician and nurse practitioner (NP) presence, care involvement, and resident outcomes. The secondary analysis of data collected in the Translating Research in Elder Care (TREC) study during 2019-20 included items on daily presence of physicians and NPs on units, physician involvement in care planning, and ability to contact physician or NP when necessary linked to routinely collected Resident Assessment Instrument-Minimum Data Set version 2.0 data. Eight logistic regression models tested the association between measures of staffing involvement and each outcome (antipsychotic use without indication (APM), physical restraint use, hospital transfers, and polypharmacy). The sample consisted of 10,888 residents across 320 care units in 90 facilities. Of the units, 277 (86%) reported a physician or NP visited daily, 160 (72.1%) reported that the physician was involved in care planning, and 318 (99%) units reported that the physician or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no statistically significant associations between presence/involvement of medical professionals and resident outcomes (for example, physician or NP presence on the unit and hospitalization transfers [AOR=1.17, 95% CI: 0.46-3.10] or polypharmacy [AOR=1.37, 95% CI: 0.64-2.93]). We found non-significant associations between medical staff presence and involvement and selected resident outcomes, suggesting either the presence of many unaccounted for confounding inter-related resident-care provider variables or underlying insensitivity of the available data.

In the past decade, the rise of state legislation that allows for advanced practice provider (APP) independence has grown steadily across the country. Most recently, Montana has enacted House Bill 313, which allows for physician assistant independent practice in primary care services. This is a concerning trend because there is a multitude of studies that demonstrate worsened patient outcomes and increased healthcare expenditures for care delivered by nonphysicians. There are also many unintended consequences that are likely to occur due to this inappropriate expansion of scope of practice for APPs. In this commentary, we outline the ramifications that are likely to occur in states such as Montana that enact legislation that expands the scope of practice for nonphysicians.

Introduction There have been exponential growth and increased interest in postgraduate residency/fellowship formalized training among nurse practitioners (NPs) and physician assistants/associates (PAs). Although not a requirement for state licensure and entry-level practice, postgraduate NP and PA residency/fellowship programs offer a structured pathway for new graduates and experienced PAs and NPs looking to transition into a new medical or surgical specialty/subspecialty. In this article, we examine the perceptions of employed NPs and PAs toward postgraduate training including the concept of developing a program at our institution.  Methodology This was a cross-sectional single-large academic medical center (AMC) study, where an anonymous electronic survey was initially developed by the director of advanced practice providers (APPs). The survey was piloted by members of the Advanced Practice Council (APC) comprising NPs, PAs, and certified registered nurse anesthetists (CRNAs), and their collective feedback was used to finalize the survey prior to distribution. Descriptive statistics were used to describe and summarize the data. In addition, we assessed the association between respondents\' characteristics and perceptions regarding NP and PA residency/fellowship programs using chi-squared tests of independence. Results The majority of the respondents (69.1%; 65/94) believed that starting an advanced practice residency/fellowship program at our AMC has many benefits such as increasing specialty-specific knowledge and training (79.8%; 75/94), improving medical decision-making (73.4%; 69/94), promoting professional development and clinical education (73.4%; 69/94), and improving procedural competency (60.6%; 57/94). Moreover, over half of the respondents (53.2%; 50/94) indicated that there is value in an APP residency/fellowship program obtaining optional accreditation. Additionally, over half of the respondents (56.4%; 53/94) indicated that they would be interested in participating as a clinical preceptor if an APP residency/fellowship program was developed at our AMC. Lastly, about one-third of the respondents felt strongly that APP residency/fellowship training programs should offer post-professional doctoral degree options such as Doctor of Nursing Practice (DNP), Doctor of Medical Science (DMSc), and Doctor of Health Science (DHSc). Conclusion Although most respondents have never completed a formalized postgraduate training program and were less familiar with the published literature regarding these programs, our findings suggest that the attitudes of employed NPs and PAs are generally positive toward the concept of postgraduate specialty-specific training.

Advanced practice providers (APPs) have become essential to trauma teams in the United States during the last few decades. The optimal utilization of APPs is not yet known and is likely highly variable secondary to many factors. We discuss three aspects of the multidisciplinary approach to caring for trauma patients. First, a review of the literature demonstrates that APPs in trauma improve quality of care, patient throughput, and decrease cost. We then report on models of APP utilization by comparing five trauma centers across the country, concluding that utilization remains highly variable due to several system and provider factors. The final portion of this review highlights current billing and coding practices in integrated teams considering recent changes to Centers for Medicare and Medicaid rules in 2024.

OBJECTIVE: Clinical trials (CTs) play a crucial role in advancing medical knowledge and patient care but are increasingly complex and resource-intensive. This scoping review aims to explore the current approaches for evaluating workload (WL) in oncology CTs and identify tools for measuring clinical research nurses\' WL.
METHODS: The search was conducted through MEDLINE, Scopus, CINAHL, and COCHRANE databases and carried out through the framework developed by Arksey and O\'Malley and revised by the Joanna Briggs Institute. Data extraction and synthesis were performed to analyze instruments used for WL assessment and their dimensions.
RESULTS: Of the 1,005 records identified, 12 meet the inclusion criteria. The complexity and WL associated with CTs can be attributed to five main domains: (1) protocol, (2) single case, (3) data management, (4) regulatory, and (5) worker-related. These instruments varied in their approaches, scoring systems, and domains assessed. Notably, the protocol-related domain was prevalent across most instruments, highlighting its importance in WL evaluation. Furthermore, findings revealed a wide range of WL scores across different studies, emphasizing the complexity and variability in WL management within CTs.
CONCLUSIONS: This scoping review underscores the importance of evaluating WL in CTs and provides insights into existing tools and approaches. Nurses, as integral members of clinical research teams, bear significant responsibilities in trial management, necessitating a balanced approach to WL allocation. Future research should focus on validating and standardizing assessment tools to optimize resource allocation and enhance research efficiency in CT centers.
CONCLUSIONS: Understanding WL dynamics in CTs is essential for nurses involved in research delivery. By utilizing validated WL assessment tools, nurses can advocate for appropriate staffing levels and promote efficient trial management, ultimately improving patient outcomes and research quality in CT settings.

OBJECTIVE: 1. To explore the perceptions of physicians, registered nurses (RN) and allied health professionals (AHP) towards the role of ward-based advanced practice nurse (APN). 2. To examine healthcare professionals\' perception of APN role expansion in inpatient care.
METHODS: Cross-sectional study.
METHODS: A 43-item survey comprising of five domains was conducted on healthcare professionals\' perceptions towards ward-based APNs in five medical wards of a tertiary hospital from November 2022 to February 2023. The participants were recruited using convenience sampling via email and cross-platform messaging service.
RESULTS: A total of 181 completed respondents including 26 physicians, 102 nurses and 45 AHPs. Statistical analysis was performed with IBM SPSS Version 28.0. APNs were perceived to be spending a great extent of time across all five domains, namely, \'direct comprehensive care\', \'support of systems\', \'research\', \'education\' and \'publication and professional leadership\'. Significant differences were noted in perceptions based on prior experience with APNs and between different healthcare professions. The majority recognized APNs\' positive impact on patient safety, efficiency and patient-centeredness.
CONCLUSIONS: This study offers valuable insights into ward-based APNs\' practice patterns, roles and impact, revealing a positive shift in their acceptance and expanding roles within inpatient general wards. It also highlights the valuable roles and impact of ward-based APNs in direct patient care, system support, research, education and leadership, despite ongoing challenges in role clarity, particularly in treatment planning and ward rounds.
UNASSIGNED: APNs are highly regarded as competent and a consistent personnel in the wards. However, there are divided views on clinical activities that APNs undertake.
UNASSIGNED: What problem did the study address? ○ Role ambiguity for ward-based APNs. ○ Healthcare professionals\' readiness and acceptance of APNs. What were the main findings? ○ APNs are perceived to have a strong involvement in direct patient care, support of system, research, education and leadership. ○ APNs are recognized for their significant impact on patient safety, efficiency and patient-centredness, but there were varied perceptions on the extent of time they spend in different practice domains. ○ The critical roles of APNs participating in daily ward rounds and initiating discharge plans were highlighted, emphasizing their importance in timeliness and continuity of care. Where and on whom will the research have an impact? ○ It will affect healthcare professionals including physicians, nurses, allied health professionals and healthcare administrators by providing insights into the roles and contributions of ward-based APNs. ○ The findings will guide policymakers and nurse leaders in making informed decisions about the implementation and development of APN roles, ultimately improving patient care and outcomes.
UNASSIGNED: No Patient or Public Contribution.

BACKGROUND: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.
METHODS: We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis.
RESULTS: Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients\' health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it- \"a grey area.\" Establishing and maintaining a longitudinal relationship that responded holistically to patients\' needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients\' needs. Participants indicated NPs tried to address all of a patient\'s concerns at each visit.
CONCLUSIONS: Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size.