Authors: Laurie A. McGee, MN, ARNP, and Louise Kaplan,
PhD, ARNP, Centralia, and Vancouver, Wash
Laurie A. McGee is Family Nurse Practitioner, Washington
Orthopaedic Center, Centralia, Wash.
Louise Kaplan is Assistant Professor, Washington State University,
For correspondence, write: Louise Kaplan, PhD, ARNP, 14204 NE
Salmon Creek Ave, Washington State University, Vancouver, WA
98686; E-mail: firstname.lastname@example.org.
J Emerg Nurs 2007;33:441-6.
Copyright n 2007 by the Emergency Nurses Association.
Earn Up to 8 CE Hours. See page 518.
Introduction: Emergency department overcrowding is a serious
problem nationwide. Of an estimated 14 million visits to hos-
pital emergency departments, only 12.9% are considered emer-
gent. Many emergency departments, however, employ only
physicians despite the fact that nurse practitioners have a
proven record of providing high quality, cost-effective care in
the emergency department. The purpose of the study was to
determine factors that influence the decision to use nurse prac-
titioners in the emergency department.
Methods: Interviews were conducted with ED managers in hos-
pitals that both employ and do not employ nurse practitioners
in the emergency department.
Results: In this study, the primary reason that nurse practi-
tioners were not employed by emergency departments was
that physician groups with whom the hospitals contract refuse
to use nurse practitioners. Emergency department managers of
facilities with nurse practitioners reported high levels of satis-
faction with the nurse practitioners performance. The 2 ED man-
agers without nurse practitioners in their facility were highly
supportive of having nurse practitioners in the emergency de-
partment and have advocated for hiring nurse practitioners.
Discussion: Education needs to occur with emergency depart-
ments regarding the value of the nurse practitioner’s role to
the facility. Research is needed to investigate why emergency
department physician groups resist hiring nurse practitioners.
Increased staffing with nurse practitioners in the emergency de-
partment can serve to reduce overcrowding, reduce waiting times,
and increase patient satisfaction.
Factors Influencing the
Decision to Use Nurse Practitioners in the
R E S E A R C H
JOURNAL OF EMERGENCY NURSING
groups resist hiring nurse practitioners. Increased staffing
with nurse practitioners in the emergency department can
serve to reduce overcrowding, reduce waiting times, and in-
crease patient satisfaction.
Efforts need to focus on increasing community-based
capacity for primary care rather than providing primary care
in the emergency department that leads to ED overcrowding
and excess costs. Hospitals need to consider the addition of
an urgent care staffed by nurse practitioners where patients
with non-emergent problems could be seen. This primary
and non-urgent care could be delivered in areas of the hos-
pital that are not used continuously such as clinic areas.
Hospitals must look at alternatives to ED care for non-
emergent visits. Until a systems level change occurs, emer-
gency departments and patients will be best served when
nurse practitioners are employed more widely in emergency
departments. Nurse practitioners will improve the quality
of care, lower cost, and improve patient satisfaction by de-
creasing ED overcrowding.
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