Assessment of Neonatal Nurse Practitioner Workload in a Level IV Neonatal Intensive Care Unit
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Date
2015-05
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The Ohio State University
Abstract
The neonatal nurse practitioner (NNP) is a direct care provider in the neonatal intensive care unit (NICU), with responsibilities for patient care management and supervision of physician fellows and residents, and monitoring the care activities performed by the nurse with the patient and family. In recent years, regulations have been set in place to limit the number of patients for whom a resident should provide care. This has resulted in more neonates left to the care of the NNP, and fellows who have less clinical experience than was true in the past. There are no standards or processes for determining the assignments of the NNP, and assignments seldom account for the acuity of the patients. The purpose of this DNP Final Project was to describe the assignment patterns of the NNPs in a 59-bed level IV NICU in a freestanding academic children’s hospital located in the Midwest region of the United States. Twenty-five NNPs responded to an electronic survey at the end of each worked shift during the project period. The following objective measures were utilized to describe the workload during a worked shift: (a) number of NNPs assigned to the shift, (b) caseload, (c) patient acuity, (d) experience and competence of the NNP, (e) perception of safety, and (f) level of satisfaction of the NNP in relation to assignment factors.
The project was designed to describe NNP activity in one level IV NICU using an electronic survey completed by each NNP at the conclusion of the worked shift. The survey captured (a) caseload, (b) patient acuity, (c) additional duties and responsibilities, and (d) the perception of the NNP regarding safety and satisfaction. Participants were provided an opportunity to enter a narrative comment to explain the rating. At the initiation of the project, the participants completed an individual demographic survey identifying years of experience in the NICU and level of NNP competence using Benner’s levels of skill acquisition. Descriptive statistics and correlations were used to analyze the resulting data.
Participants reported satisfaction with performance with a mean rating of 2.2 (N=45, standard deviation (S.D.) =0.7) in week 1, and 1.67 (N=4, S.D.=0.8) in week 2. Participants reported satisfaction with patient outcome with a mean rating of 2.09 (N=45, S.D.=0.8) in week 1, and 1.65 (N=43, S.D.=0.8) in week 2. There was a weak correlation between satisfaction with performance and, patient acuity score (r=0.24, p≤0.001 in weeks 1 and 2), and patient caseload number (r=0.02, p≤0.001 in week 1, and r= -0.13, p≤0.001 in week 2); and between satisfaction with patient outcome and, patient acuity, (r=0.19, p≤0.001 in week 1, and r=0.25, p≤0.001 in week 2), and patient caseload number (r= -0.23, p≤0.001 in week 1, and r= -0.17, p≤0.001 in week 2). Though the participation of the NNPs was strong, there were limited data to yield a significant relationship of the measures to satisfaction and patient acuity.
The data reported are those from the first two weeks of an ongoing project, and considered only one of the many possible questions. The implication of this project for NNP practice was to monitor a baseline of activity describing and measuring the workforce, workload, caseload and satisfaction. Change measures should be based on the continual evaluation of objective measures to sustain a culture of safety, optimum outcome and NNP satisfaction.
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Keywords
neonatal nurse practitioner, neonatal intensive care unit, workload, acuity, neonate, satisfaction, caseload