In the face of a primary care gap, much focus has been placed on nurses, especially nurse practitioners, as the solution. The primary care gap has surfaced over the past decade from events including the Affordable Care Act, new education requirements for health care providers, and increasing clinical complexity in patient populations. This has caused a rearrangement of the US health care system, and increased roles and responsibilities for advanced practice providers, namely nurse practitioners (NPs), physician assistants, certified registered nurse anesthetists, and midwives.

Nursing professionals at the University of California, San Francisco (UCSF) are acutely aware of the new role for NPs in the evolving healthcare system. However, NPs at UC San Francisco want to take the focus away from closing the primary care gap, and refocus on the need for increasingly flexible and well-trained clinician workforces who can practice to the top of their scope.

One of the most important roles for nurse practitioners is facilitating interdisciplinary collaboration. In acute care settings NPs need to be able to provide continuous high-level care and smooth transitions between providers to reduce the potential for error. UCSF did a study by hiring an NP in a neurosurgery unit to coordinate weekend discharges for the unit’s patients. The results proved a more efficient discharge system overall and 10-15% higher bed turnover. This shows how NPs can increase efficiency in acute care settings by bridging the gap so more nurses are free to focus on bedside care while physicians focus on complex care and surgical needs of patients. This model of care expands the use of nurse practitioners to increase efficiency in cost and workflow.

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Because nurse practitioners cost less to train than physicians, while also being educated to meet most preventative and chronic care needs of primary care patient populations, they can be widely utilized for implementing a continuum of care for in- and outpatient care. This makes care more efficient when you have a person who navigates you from beginning to end, and soothes patients when they see the same face in the clinical and hospital. There is no doubt that NP roles are expanding and future opportunities are endless. The US Bureau of Labor Statistics predicts a 31 percent increase in employment for nurse practitioners, certified nurse-midwives, and certified nurse anesthetists from 2014 to 2024.

ucsfmedctrbenioffsignWith new NP roles will also come challenges. NPs are required to complete a minimum of 500 clinical hours during training, but those hours are spread across a wide variety of areas which doesn’t adequately prepare them for specialized and complicated services right out of training. Aware of these challenges, the UCSF School of Nursing is seeking out new training models for nurse practitioner programs. In 2014 they created the UCSF Surgical and Critical Care Nurse Practitioner Fellowship which allows graduates of an accredited acute care geriatric NP program to rotate through surgery and critical care services, providing direct patient care, along with opportunities to take extra course work in acute and critical care.

Through programs like UCSF’s NP fellowship, healthcare leaders and educators are hopeful that roles for advanced practice practitioners can continue to expand for all staff who will be involved in collaborative relationships with them.

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