Health Policy Research Center, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Open Notes, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Nurs Outlook. 2020 Sep-Oct;68(5):591-600. doi: 10.1016/j.outlook.2020.04.010. Epub 2020 May 21.
The delivery of emergency, trauma, critical, and intensive care services requires coordination among all members of the care team. Perceived teamwork and role clarity may vary among physicians (MDs) and nurse practitioners (NPs).
To examine differences in perceived roles and responsibilities of NPs and MDs practicing in emergency, trauma, critical, and intensive care.
Secondary Analysis of the National Survey of Emergency, Intensive, and Critical Care Nurse Practitioners and Physicians, a cross-sectional national survey of clinicians. Mail survey of randomly selected stratified cross-sectional samples of MDs and NPs drawn from national lists of clinicians in eligible specialties working in emergency, trauma, intensive, and critical care units in the United States. 814 clinicians (351 NPs and 463 MDs) were recruited from national by postal mail survey. Our initial sample included n = 2,063 clinicians, n = 1,031 NPs and n = 1,032 MDs in eligible specialties. Of these, 63.5% of NPs and 70.1% of MDs completed and returned the survey excluding those who were ineligible due to lack of current practice in a relevant specialty.
NPs in ICU/CCU are more likely to be female and report working fewer hours than do MDs and provide direct care to more patients. 55% of NPs and 82% of MDs agree that their individual role in their unit is clear (p < .001); 34% of MDs and 42% of NPs agree that their unit is an example of excellent team work among professionals (p = 0.021); 41% of MD and 37% of NP clinicians (p = 0.061) agree that their teams are "prepared to provide outstanding care in a crisis or disaster." Perceived role clarity was significantly associated with increased perceptions of excellent teamwork and disaster preparedness.
At the time of this survey, and majority of NPs and MDs working in emergency, critical and intensive care did not agree that their teams were prepared for a crisis or disaster. Leaders of health organizations should encourage teamwork and professional role clarity to assist units to perform effectively in emergency and disaster preparedness.
紧急、创伤、重症和强化护理服务的提供需要护理团队的所有成员之间的协调。医生（MDs）和护士从业者（NPs）对团队合作和角色清晰度的感知可能有所不同。
检查在紧急、创伤、重症和强化护理环境中执业的 NPs 和 MDs 对其角色和职责的感知差异。
对国家紧急、强化和重症监护护士从业者和医师调查的二次分析，这是一项对临床医生的横断面全国性调查。通过邮件向来自美国紧急、创伤、强化和重症监护病房的合格专业的 MD 和 NP 临床医生的全国名单中随机抽取的分层横断面样本进行调查。814 名临床医生（351 名 NP 和 463 名 MD）通过邮政邮件调查被招募。我们的初始样本包括 n = 2063 名临床医生，n = 1031 名 NP 和 n = 1032 名 MD 在合格的专业中。其中，70.1%的 NP 和 63.5%的 MD 完成并返回了调查，排除了因缺乏相关专业的当前实践而不合格的人。
在 ICU/CCU 工作的 NPs 更有可能是女性，并且报告的工作时间比 MD 少，为更多的患者提供直接护理。55%的 NP 和 82%的 MD 同意他们在单位中的个人角色是明确的（p <.001）；34%的 MD 和 42%的 NP 同意他们的单位是专业人员之间出色团队合作的典范（p = 0.021）；41%的 MD 和 37%的 NP 临床医生（p = 0.061）同意他们的团队“有能力在危机或灾难中提供出色的护理”。角色清晰度的感知与对出色团队合作和灾难准备的感知呈正相关。
在进行这项调查时，大多数在急诊、重症和强化护理环境中工作的 NPs 和 MD 并不认为他们的团队已经为危机或灾难做好了准备。卫生组织的领导人应鼓励团队合作和专业角色清晰度，以帮助单位在紧急和灾难准备方面有效运作。
