Recent Research About Nursing, September 2013

Sep 4, 2013, 12:00 PM

More New Nurse Practitioners Heading to Primary Care

Two recent analyses of workforce data offer new insights into the role nurse practitioners (NPs) are likely to play in combating the coming shortage of primary care providers in the U.S.

The first analysis, commissioned by the Agency for Healthcare Research and Quality (AHRQ) and released in August, finds that slightly more than half the nation’s nurse practitioners are practicing primary care. In all, 55,625 of the nation’s 106,073 nurse practitioners are in primary care, according to data drawn from the Centers for Medicare and Medicaid Services’ National Provider Identifier database.

At the same time, an analysis of graduation trends conducted by Robert Wood Johnson Foundation Executive Nurse Fellow alumna Debra Barksdale, PhD, RN, FAAN, and colleagues, finds that graduation rates for NPs suggest more help is on the way. According to Barksdale’s reading of data from the American Association of Colleges of Nursing and the National Organization of Nurse Practitioner Faculties, 84 percent of NP graduates in 2012 were prepared in primary care. That represents an eye-catching 18.6 percent increase from 2011 to 2012.

Barksdale and colleagues contrast those numbers with the 11.6 percent of U.S. medical school graduates who matched for residencies in primary care earlier this year, calling the gap between NPs and medical students headed for primary care, “stunning.” They go on to note that, “Not all NPs prepared in primary care end up in primary care; in fact, the actual rate for NPs may be about 55 to 66 percent. Not all physicians who match with primary care residencies actually end up in primary care either. Nevertheless, reliable data documents that primary care NPs are increasing in significantly larger numbers than primary care physicians and these increasing numbers of primary care NPs will have a major, mounting role in meeting the nation’s primary care needs.”

They go on to note, however, that state scope-of-practice restrictions are a barrier to NPs practicing to the full extent of their training and education.

Read the AHRQ analysis.
Read the Barksdale analysis in Health Affairs.

Study Finds that Automated Prompts Improve Nurses' Hand Hygiene

Poor hand hygiene among health care providers is regarded as a principle cause of hospital-acquired infections, prompting a series of studies aimed at finding ways to ensure that nurses and other hospital staff wash their hands thoroughly and frequently. The latest of these studies, published in the August 2013 issue of Computers, Informatics, Nursing, reports on a test of a system that used electronic monitoring devices and automated signals intended to encourage staff to wash their hands.

With funding from the Canadian Institutes of Health Research, a team led by Alexander Levchenko, PhD, P.Eng, tested an automated system at the complex continuing care unit of the Toronto Rehabilitation Institute. The team installed 93 specially equipped gel and soap dispensers in patient rooms, at bedsides, in hallways and elsewhere on the unit, and outfitted 14 nurse participants with “wearable monitors” that interacted wirelessly with the dispensers, as well as with equipment at doorways and other locations. The equipment allowed researchers to track whether the nurses washed their hands as they entered or left particular locations. The wearable devices also had two other features: first, a "hand-hygiene status" signal—a flashing green light—that was activated when a nurse "interacted" with a gel or soap dispenser, and second, a signal—a vibration or an audible tone—triggered when a nurse passed through a particular area without using a gel or soap dispenser.

During the first of three phases of the study, dispensers were available and monitored, but the wearable devices' green light and prompting signals were disabled. In the second phase, the green lights were activated. In the third phase, both the light and the vibration/tone reminder feature were activated. In that third phase, if a nurse entered or left a patient room, the device would provide feedback to the nurse one way or the other—either a flashing green light, or a 20-second vibration/tone. If the nurse used a dispenser during that time, the reminder stopped, the green light was activated, and the "event" was classified by researchers as hand-washing "performed after prompt."

The results indicated that hand-washing behavior was nearly identical during the first two phases of the study, suggesting that the green status light had no measurable impact on hand-washing, even though nurses in the test described it as "useful." During the third phase, however, with the reminder feature activated, hand-washing rates more than doubled. The researchers conclude that, "Overall, results indicate that this technology has great potential to effectively and sustainably enhance hand-hygiene performance."

The authors call for further study of such systems across a range of health care settings.

Read an abstract of the study on PubMed.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.