Rounds with Leadership: Focusing on the Outcomes of NP Practice

In September 2008, more than two dozen national nursing organizations, including AACN, joined with the Tri-Council for Nursing to commission a study on the impact that advanced practice registered nurses have on healthcare quality and patient outcomes. The need for this research was driven in part by challenges from outside the profession questioning the efficacy of nurse practitioner (NP) education and practice. Led by Dr. Robin Newhouse, who recently concluded her service on the AACN Board of Directors, the resulting systematic review of the literature published from 1990-2008 found that NP-led care was equivalent to physician-centric care and typically resulted in shorter hospital stays, increased access to care, and lower costs.

Fast forward nearly 15 years after this groundbreaking study was released, the body of evidence highlighting the positive impact of NP practice has grown substantially. In a synopsis of more than 50 research studies, the American Association of Nurse Practitioners found that patients under the care of NPs have fewer unnecessary hospital readmissions, higher patient satisfaction scores, and fewer unnecessary emergency room visits than patients under the care of physicians only. Recent studies have shown that acute care settings with a higher percentage of NPs report fewer deaths after common surgical procedures; NPs engaging in end-of-life care had fewer hospitalizations and higher hospice use; and NPs working with pediatric and adult patients were effective at controlling chronic diseases.

Despite such compelling evidence, challenges to NP education and practice continue. More than 20 states have yet to grant full scope of practice authority to NPs, denying these expert clinicians the opportunity to exercise the full range of their clinical expertise. A recent attack in the press on NP educational preparation and clinical outcomes failed to consider the research on outcomes linked to NP care or the work underway to elevate how NPs are prepared for contemporary practice.

When AACN members endorsed the latest Essentials back in 2021, academic leaders set in motion a transition to competency-based education for NPs and other nurse providers, which will prepare graduates with a broader base of clinical knowledge and skills. For NP programs specifically, AACN co-led a task force with the National Organization of Nurse Practitioner Faculties to revise the standards used to guide NP education. AACN was one of 18 groups that endorsed the 2022 Standards for Quality Nurse Practitioner Education (6^th edition), which calls for strengthening graduate NP programs and increasing the number of required clinical hours. These important and intertwined efforts will have a sweeping impact on preparing NPs to thrive across settings while continuing to meet and exceed patient care expectations.

As nurse educators, we are committed to graduating nurses who are practice ready at every level, including specialists able to provide high quality primary, preventative, and palliative care. We continually look for ways to sustain excellence in nursing education to better serve those in need. Understanding the evidence will make us better advocates for nurse practitioners and the profession in general, while equipping us to confront misguided attempts to undermine NPs and the expanding role they play in keeping patients safe.

References and Resources:

American Association of Nurse Practitioners:

• Annotated Bibliography on the Quality of Nurse Practitioner Practice
• State Practice Environments

Aiken, L., Sloane, D.M., Brom, H.M. et al. (2021). Value of nurse practitioner inpatient hospital staffing. Medical Care, 59(10), 857-863. DOI: 10.1097/MLR.0000000000001628

Htay, M. & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care. International Journal of Nursing Studies Advances, 3(4), 100034. DOI:10.1016/j.ijnsa.2021.100034

Kosar, C.M., Thapa, B.B., Muench, U. et al. (2024). Nurse practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia. JAMA Health Forum, 5(5), e240825. DOI:10.1001/jamahealthforum.2024.0825

Newhouse, R. P., Stanik-Hutt, J., White, K. M., e al. (2011). Advanced practice nurse outcomes 1999-2008: A systematic review. Nursing Economics, 29(5), 1-22. PMID: 22372080