1. Rosenfeld, Peri PhD

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Since the advent of the nurse practitioner (NP) in the 1960s, there's been substantial evidence of NPs' effectiveness, particularly in primary care settings. Until recently, the NP has been typically associated with ambulatory and community-based practices.


But NPs have also become attractive to acute care facilities. Managed care has put increasing pressure on hospitals to provide cost-effective, high-quality care, and intense pressure to reduce house staff has forced teaching hospitals to seek practitioners who can perform services heretofore performed by residents and interns. In addition, increasing acuity among the inpatient population-partially the result of the increasing average age of hospitalized patients-combined with the need to reduce lengths of stay, suggests a need to reconsider the delivery of care in acute care settings. The NP is helping hospitals meet these clinical and financial challenges.


Acute care nurse practitioners (ACNPs) are found in most specialty areas, including neonatal intensive care, acute care of the elderly, cardiothoracic intensive care, medical rehabilitation, and internal medicine. Different models of care, such as unit-based and service-based NP practices, are emerging as ACNPs gain entry into highly specialized clinical areas.



Table. Distribution ... - Click to enlarge in new windowTable. Distribution of Major Components of Health Care Expenditures Among Medicare Beneficiaries Age 65 and Older, 1996

Both acute care and primary care NPs spend the bulk of their time in direct patient care that includes examination and assessment of patients and development of treatment plans. But a recent study showed that, on average, ACNPs spend more hours performing those tasks than do their primary care counterparts. In addition, ACNPs spend significantly more time in consultation with physicians and RNs, while primary care NPs are more involved in writing prescriptions and ordering laboratory tests.


These distinct practice patterns reflect the characteristics of the settings and the acuity of the patient populations served in those facilities. In acute care, NPs care for a larger number of older adults than do primary care NPs. The complex needs of those patients may necessitate more frequent NP consultation with physicians than do those of younger patients.


Source: Rosenfeld P and McEvoy ME, 2000 (unpublished). For a copy of the study, contact the authors at hartford., or (212) 998-5355.




[black down pointing small triangle]Average length of stay in hospitals for patients aged 65 and older was 6.3 days, and for patients under age 65 it was 4.6 days, in 2000.


[black down pointing small triangle]In 1999, 86.8% of newly licensed nurses were employed in hospitals, as compared with 58% in 1996.


[black down pointing small triangle]Of those RNs who were employed in nursing in 2000, 59.1% (1.3 million) worked in hospitals.[black down pointing small triangle]The injury rate among hospital workers in 1999 was the fourth highest among all service industries.


Sources:; Hertz, JE, et al.Linking the NCLEX-RN national licensure examination to practice: 1999 practice analysis of newly licensed registered nurses in the U.S.Chicago: National Council of State Boards of Nursing, 2000; Bureau of Health Professionals. Division of Nursing.The registered nurse population. National Sample Survey of Registered Nurses - March 2000: Preliminary findings.Rockville (MD): Department of Health and Human Services; 2001 Feb.,; Bureau of Labor Statistics. Department of Labor.Safety and health statistics. Table 1: incidence rates of nonfatal occupational injuries and illnesses by selected industries and case types, 1999.