Date of Award

1-1-2017

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Margaret Grey

Abstract

Background: Determining the conditions that promote high performing advanced nursing practice is important because hospitals are increasingly dependent on the use of nurse practitioners (NPs) to deliver front-line care to acute and critically ill patients.

Objective: To describe the outcomes of a front-line care model that uses certified pediatric acute care NPs, limits work hours and night time and weekend patient-to-provider ratio, on the outcomes of patients cared for in an academic Pediatric Intensive Care Unit (PICU).

Methods: A retrospective quasi-experimental design was used to describe the outcomes of an NP Team model compared to a physician-only, Traditional Medical Team model that existed simultaneously in the same PICU.

Results: Patients cared for by the NP Team had lower mean acuity, experienced equivalent mortality, shorter length of stay (LOS), and with the exception of Catheter Related Urinary Tract Infections (CAUTI), slightly lower device associated hospital acquire infection rates compared to those cared for by a Traditional Medical Team.

Conclusions: In an academic PICU, a front-line care delivery model that used certified pediatric acute care NPs who were intermittently supplemented by pediatric hospitalist pediatricians and residents, and that limits work hours and night time and weekend patient-to-provider ratio, resulted in outcomes that are at least equivalent to those of traditional medical teams.

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