Role of Nurse Practitioners in Delivering Cost Effective and Quality Care Services

This assignment elaborates on the role of Nurse Practitioners (NPs) in delivering cost effective and quality care services to all patients, and links them to the standards of practice.

Running head: NURSING
Assessment 4
Name of the Student
Name of the University
Author Note

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Introduction
A Nurse Practitioner is also referred to as an Advanced Practice Registered Nurse,
who is entitled with additional responsibility of administering patient care, when compared to
registered nurses. In addition, NPs also have the duty of prescribing medications, examining
the patients, diagnosing their illness, and implementing necessary interventions, much like
the clinical practitioners (Peeters et al., 2014). In addition, advanced studies also help them
gain the necessary expertise to adorn additional duties that are typically left to the discretion
of physicians. Time and again it has been proved that the training that is provided to the NPs
often encompass prevention of disease, coordination of their care processes, and promotion of
optimal health outcomes (Golden, Silverman & Issenberg, 2015). In addition, the scope of
practice for a NP is decided by the jurisdiction, and all NPs have the necessary expertise of
providing acute, primary, speciality and chronic care to patients, notwithstanding of their age
or other factors. Determining the quality of health care services that are delivered to patients
is of utmost importance to all healthcare professionals owing to the fact that it provides an
overview of the functioning of the healthcare system, and also brings about a significant
improvement and enhancement in the health related quality of life. This assignment will
elaborate on the role of NPs, in relation to delivering cost effective and quality care services
to all patients, and will also link them to the standards of practice.
Description of the role
The influence of nurse practitioners on quality of care and cost in emergency
department was illustrated by Jennings et al. (2015) who specified that quality care delivery
in the emergency department has emerged as one of the most significant facility indicators in
health provision. Snowballing service burdens in the emergency department have also
brought about the implementation of several service innovation models, with emergency
nurse practitioner services being the most rapidly expanding service. Findings from the study

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indicated that some of the domains where the emergency NP tried to deliver quality care
services were namely, interpretation of X-rays, unexpected readmission of patients, missed
rates of injures, inappropriate and inaccurate patient management, unscheduled patient return
to the ED, and the percentage of patients who did not wait for the delivery of treatment
modalities. It was also stated by the researchers that NPs working in ED took significant
efforts in improving their performance indicators, which in turn created a direct impact on the
quality of care delivered to all patients. With an increase in the aging population, and the
consequential world-wide epidemic of chronic illnesses, an increase in different healthcare
demands is expected. Consequently, nurses who work in advanced practice have the
capability of adding value to their practice, and increasing patient’s admittance to healthcare
facilities by, possibly empowering the healthcare personnel.
The findings presented by Woo et al. (2017) also suggested that with the aim of
delivering quality care services, NPs displayed an intention of completing the care regimen
on their own, without seeking help from clerical or administrative staff. In addition, NPs were
also find to advocate for the implementation of a collaborative model of care that would
provide them with the opportunity of maintaining a reliable point of contact with the
interdisplinary team, thereby enhancing the health outcomes of the patients. The evidences
obtained from this research article also suggested that patients who were cared for by the NPs
demonstrated a significant decrease in their length of hospitalisation, thereby confirming the
fact that NPs took substantial efforts in delivering treatment regimen that are best fit for the
patients. One of the selected quality of care pointers in healthcare emergency setting is
associated with the time that patients spend from their arrival to the healthcare facility till
they are initially assessed by a physician. This in turn supported the fact that involvement of
NPs in management of critically diseased patients leads to significant cost savings.

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It has also been established by researchers that NPs are entitled with the duty and
responsibility of caring for a bigger percentage of Medicare beneficiaries who belong to low
socioeconomic background and suffer from disabilities. NPs have been found to play a major
role in improving care for Medicare beneficiaries who are considered vulnerable. In addition,
researchers have also elaborated on the fact that involvement of NP in providing quality care
to patients such that they are able to expand the access to healthcare facilities and enhance the
health status of vulnerable patients. In addition, it has also been proposed by researchers that
quality of primary care delivered to different patient subpopulation show differences based on
whether they are implemented by primary care physicians or NPs, In addition, it was also
found that NPs demonstrated greater advantages, in relation to whether the patients were
cared for by a NP or a PCMD. Following regulation of recipient demographic characteristics,
disease severity, and variances in the probability of being cared for NPs demonstrated
numerous advantages, in comparison to those who were cared for by the PCMDs (DesRoches
et al., 2017).
According to Masso and Thompson (2017) the role of NPs got familiarised in
Australia, following a comparatively exhaustive period that focused on exploration. It was
stated by the researchers that the decision of the healthcare system to place due emphasis on
the duty and responsibility of NP could be accredited to their decision that was based on the
positive and constructive outcomes obtained from pilot studies. The researchers elaborated on
the characteristics of a NP, in relation to the role and suggested that NPs often work in
collaboration with clinical nurse consultants in local regions, following which they move to
healthcare facilities and successfully adapt to their new position. In addition, NPs also have
the duty of working in fast track units in ED that operates within predetermined areas of a
healthcare facility, and try to deliver quality care by providing one-to-one consultation to all
patients who attend the service. Quality of care is also ensured by developing liaison and

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consultation to the hospital wards. Furthermore, quality of care delivered by the NP also
involve accurate conduction of X rays, urine culture tests, throat, vaginal and wound swabs,
electrolyte administration, blood gas administration, and providing patient education, in order
to help in crisis management.
With the aim of comparing the quality of care delivered by NPs, physician assistants
and primary care physicians, Kurtzman and Barnow (2017) used data from the previous five
years of National Ambulatory Medical Care Survey, and conducted a multivariate regression
analysis. On examining patient level outcomes, service utilisation measures, quality care
indicators, and referral pattern measures, it was found that there was lack of significant
statistical difference between the care delivered by NPs, in contrast to PCMD or PA,
Furthermore, patients who visited the NPs also demonstrated an increased likelihood of
participating in counselling sessions for smoking cessation, and showing adherence to the
recommendations made by NPs (P≤0.05). Hence, the results helped in confirming the fact
that quality care delivered by NPs is analogous to that given by general physicians.
Reflections on the establishment of a NP across hospital and palliative settings in
Australia have also been presented by O'Connor, Palfreyman and Borghmans (2018) who
further elaborated on the fact that during the initial months of their practice, NPs display an
increased awareness on the need to meet and accurately address the service demands of their
patients and often report problems in dealing with the staff constraints and workload, at the
beginning of their career. However, it was also reported by the NPs that they take
considerable efforts in striking a balance between providing ongoing and continuous support
to their patients and providing consultations, while maintaining continuity for care. The
strategies adopted by NPs for providing cost effective and quality care services were also
related to the continuous feedback that they receive from their clients, which in turn
facilitates them to implement appropriate form of organisational leadership, professional

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management, and individual mentorship. Hence, the findings of the study illustrated the
importance of developing incessant liaison with the multidisciplinary team members, and the
need of developing confidence amid the patients.
Kapu, Kleinpell and Pilon (2014) also elaborated on the fact that there are a range of
national initiatives, which specifically target safe, quality, and cost-effective interventions,
thereby developing an optimal environment that allows NPs to display their capabilities and
offerings. Findings from their research suggested that NPs also adorn the role of billing
providers and add revenue through gross collections. Taking into consideration the fact that
expenses of NPs are generally less, when compared to the expense of usual physician, the
revenue when matched against expenditures was found to be mostly greater for the NP teams.
Furthermore, the research was also accurate in demonstrating that the length of stay of
patients in hospitals, for all NP teams were significantly lesser, when compared to other
healthcare professionals, to to data obtained from previous years when the patients were not
cared for by the NPs. Upon conducting a comprehensive and thorough evaluation of the
hospital charges, in relation to NP team, there was a saving of roughly $28 million in hospital
charges, which characterised cost evasion to the organisation, predominantly when the
patients were underinsured or uninsured.
Similar findings were also presented by Martin-Misener et al. (2015) who provided
evidence for the fact that quality care delivered by NPs were able to reduce the cost per
consultation (mean difference: −€6.41; 95% CI −€9.28 to −€3.55; p<0.0001) (2006 euros).
This could be accredited to the fact that under most circumstances, the NPs were considered
equivalent to general physicians by the patients. Furthermore, with an increase in the
complementary roles that NPs have to fulfil, appropriate use of resources and additional costs
are anticipated in a healthcare organisation, taking into consideration the fact that NP have
the primary objective of delivering quality care in a manner that improves patient outcomes.

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However, it was also found that when NPs focused more on educating the patients about their
illness and increased use of resource for preventive care, an increase was observed in the
number of patient visits, contact time, and associated costs. It has also been illustrated by
Allen et al. (2014) that while the NPs provide quality care to patients, with the aim of
addressing their cardiovascular disparities, an increase in medication administration and
laboratory testing is quite apparent, thereby significantly contributing to a rise in the inclusive
cost of the selected intervention, in comparison to the cost incurred while providing usual
care to the patients. Furthermore, it was also found that NPs have the role of closely
monitoring and keeping a surveillance on patients, based on medical guidelines, which in turn
increased the number of diagnostic tests that are to be conducted for patients. In addition, the
researchers were also correct in stating that NPs use evidence based algorithm for treatment,
in the form of a cost-effective strategy for implementing national guidelines that helps in
managing patient health outcomes.
Standards of practice
The role of NPs in providing quality care is in accordance to the statement 1.1 that
requires them to validate wide-ranging familiarity of health assessment, and demonstrates all-
inclusive ability in clinical analysis encompassing mental, ethnic, social, physical, and
cultural dimensions. Furthermore, they also act in alignment with standard 1.1 since it
requires NPs to critically examine the influence of social determinants on the population, and
interpret the assessment findings of patients (NMBA, 2014). Timely use of diagnostic
interventions form an essential aspect of standard 1.2, and are imperative for quality care
delivery. The standard focuses on the fact that NPs are accountable for result interpretation
and patient follow-up and must also make correct decisions, based on research evidences
(Barnes, 2015). Hence, implementation of evidence based interventions also helps in ensuring
cost effectiveness of the care processes.

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Standard 2.1 focuses on translating and integrating evidence in the care process. In
other words, while subjecting the patients to different laboratory tests that are essential to
determine the presence of health abnormalities, NPs must show adherence to standard 2.1
that will help them ethically explore the different therapeutic options that are available
(NMBA, 2014). Patient education forms a crucial aspect of providing cost-effective and
quality care to all clients. Hence, it is imperative for NPs to respect the rights of their patients,
and acknowledge their autonomy, while delivering care services. According to Buerhaus et
al. (2015) they are also expected to foster collaboration and partnership with the patients, in
order to correctly address their therapeutic goal and treatment outcomes.
The aforementioned two roles are in alignment with standard 2.2 and 2.3,
respectively. Furthermore, standard 4.1 also expects NPs to evaluate, monitor, and document
different interventions and treatment, and implement best available evidences. This will help
in reducing hospital stay, lowering costs, and enhancing health outcomes. Quality care is also
governed by providing counselling and support to the patents about their condition and self-
management, and coordinating the services with other community resources (standard 3.2)
(NMBA, 2014).
Impact of the role
Time and again it has been confirmed that the role of a NP involves working directly
with all patients, while diagnosing their health ailments. NPs have the authority to perform
extensive physical examination, interpret different laboratory tests, provide counselling
services to the patients, and write prescriptions for treating the presenting complaints. In
other words, it is imperative for a NP to provide a directed vision for the organisation, and
secure the resources that are considered necessary for ensuring quality improvement of the
organisation (Barnes, 2015). Research evidences have elaborated on the fact that NPs have
the expertise of providing increased level of medically focused care in different healthcare

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contexts. In recent years, NPs have been identified as an integral part of medical teams, and
the number of healthcare facilities that utilise their clinical expertise and abilities is
increasing (Poghosyan, Boyd & Knutson, 2014).
Their experience as nursing professionals provides them with the unique opportunity
of delivering quality care services to their patients. It must be taken into consideration that
nurse practitioners make up a large segment of health and social care sector and work in
different settings, thereby providing care to a range of population. In other words, on giving
nurse practitioners the permission for practicing to their complete range of their training and
education, a necessary workforce can be built, which in turn will be able to meet the health
care needs of a snowballing number of patients, particularly those who are medically
underserved (Hain & Fleck, 2014). In the words of Costa et al. (2014) the NPs also play an
significant role in helping to offset the scarcity of primary care physicians in remote and rural
regions, and also provide healthcare service of equal quality, thus increasing health outcomes.
In addition, they also play an important role in expanding the convenient retail clinics.
Conclusion
To conclude, NPs are autonomous and licensed clinicians who place an emphasis on
effective management of the health conditions manifested in patients, thereby preventing the
onset and progression of disease. There is abundant evidence for the fact that NPs are entitled
with the responsibility of providing high quality care services, thereby lowering the number
of hospital readmission, enhancing health outcomes, and implementing cost-effective
interventions. Thus, the findings from the literature discussed above also suggests that in
order to deliver quality care, they are responsible for diagnosing the patients, developing
individualised treatment plans, collaborating with different healthcare professionals, and
engaging in patient education.

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