McDonnell Ann, Goodwin Emma, Kennedy Fiona, Hawley Kay, Gerrish Kate, Smith Christine
Sheffield Hallam University, UK.
J Adv Nurs. 2015 Apr;71(4):789-99. doi: 10.1111/jan.12558. Epub 2014 Oct 22.
To evaluate the impact of implementing Advanced Nurse Practitioner roles on patients, staff members and organizational outcomes in an acute hospital.
The worldwide development of advanced practice roles in nursing has been influenced by increasing demands and costs of health care. A key issue in the UK has been the reduction in hours junior doctors can work. While there is evidence these roles can have a positive impact in a variety of clinical specialties, little is known about the impact advanced nurses substituting for junior doctors can have on patients, staff members and organizational outcomes in general hospital care settings.
Collective case study.
A collective case study in a district general hospital in England was undertaken in 2011-2012. Interviews with strategic stakeholders (n = 13) were followed by three individual case studies. Each case study represented the clinical area in which the roles had been introduced: medicine, surgery and orthopaedics and included interviews (n = 32) and non-participant observation of practice.
The ANPs had a positive impact on patient experience, outcomes and safety. They improved staff knowledge, skills and competence and enhanced quality of working life, distribution of workload and team-working. ANPs contributed to the achievement of organizational priorities and targets and development of policy.
ANPs undertaking duties traditionally performed by junior doctors in acute hospital settings can have a positive impact on a range of indicators relating to patients, staff members and organizational outcomes which are highly relevant to nursing.
评估在一家急症医院实施高级护理执业者角色对患者、工作人员和组织成果的影响。
全球护理领域高级执业角色的发展受到医疗保健需求增加和成本上升的影响。英国的一个关键问题是初级医生工作时长的减少。虽然有证据表明这些角色在各种临床专科中能产生积极影响，但对于高级护士替代初级医生在综合医院护理环境中对患者、工作人员和组织成果的影响却知之甚少。
集体案例研究。
2011 - 2012年在英格兰一家地区综合医院进行了集体案例研究。在对战略利益相关者进行访谈（n = 13）之后，开展了三个单独的案例研究。每个案例研究代表引入这些角色的临床领域：内科、外科和骨科，包括访谈（n = 32）以及对实践的非参与性观察。
高级护理执业者对患者体验、结果和安全产生了积极影响。他们提高了工作人员的知识、技能和能力，提升了工作生活质量、工作量分配和团队协作。高级护理执业者有助于实现组织的优先事项和目标以及政策的制定。
在急症医院环境中承担传统上由初级医生执行的职责的高级护理执业者，可对一系列与患者、工作人员和组织成果相关的指标产生积极影响，而这些指标与护理高度相关。
