• J Hosp Med · Oct 2014

    Nurse practitioner and physician assistant scope of practice in 118 acute care hospitals.

    • Anand Kartha, Joseph D Restuccia, James F Burgess, Justin Benzer, Justin Glasgow, Jason Hockenberry, David C Mohr, and Peter J Kaboli.
    • Center for Healthcare Organization and Implementation Research (CHOIR) at the VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
    • J Hosp Med. 2014 Oct 1; 9 (10): 615-20.

    BackgroundAdvanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs) are cost-effective substitutes for physicians, with similar outcomes in primary care and surgery. However, little is understood about APP roles in inpatient medicine.ObjectiveDescribe APPs role in inpatient medicine.DesignObservational cross-sectional cohort study.SettingOne hundred twenty-four Veterans Health Administration (VHA) hospitals.ParticipantsChiefs of medicine (COMs) and nurse managers.MeasurementsSurveys included inpatient medicine scope of practice for APPs and perceived healthcare quality. We conducted bivariate unadjusted and multivariable adjusted analyses.ResultsOne hundred eighteen COMs (95.2%) and 198 nurse managers (75.0%) completed surveys. Of 118 medicine services, 56 (47.5%) employed APPs; 27 (48.2%) used NPs only, 15 (26.8%) PAs only, and 14 (25.0%) used both. Full-time equivalents for NPs was 0.5 to 7 (mean = 2.22) and PAs was 1 to 9 (mean = 2.23). Daily caseload was similar at 4 to 10 patients (mean = 6.5 patients). There were few significant differences between tasks. The presence of APPs was not associated with patient or nurse manager satisfaction. Presence of NPs was associated with greater overall inpatient and discharge coordination ratings by COMs and nurse managers, respectively; the presence of PAs was associated with lower overall inpatient coordination ratings by nurse managers.ConclusionsNPs and PAs work on half of VHA inpatient medicine services with broad, yet similar, scopes of practice. There were few differences between their roles and perceptions of care. Given their very different background, regulation, and reimbursement, this has implications for inpatient medicine services that plan to hire NPs or PAs.© 2014 Society of Hospital Medicine.

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