EAST Advanced Practitioner Survey

1. EAST Advanced PractitionerSurvey Martin D. Zielinski Advanced Practitioners Committee January 20, 2010

2. Why are APs in Demand? • Increased need for advanced practitioners (AP) • 80 hour work week for residents • Resident goal clear • AP goals less clear and variable • Pay • Life-work balance • Education • Administration

3. Goals • Develop “best practice” model • Satisfaction • Retention • Appropriate patient care • Meet AP needs

4. Nurse Practitioners and Physician Assistants considered equivalent for purposes of this report

5. 242 total responses 70% Surgeons 19% Advanced Practitioner 10% Trauma Coordinator Job Description

6. ACS Level

7. The “Typical” ACS Advanced Practitioner: • Works on the Trauma floor service (95.4%) • Cares for 6 – 10 (42%) patients per shift • Takes no call (71.4%) • Has similar responsibilities to a junior resident (57.3%)

8. Advanced Practitioner Area of Practice

9. Staffing Use on Acute Care Surgical Services

10. AP Staffing Level

11. Advanced Practitioner Common Floor Responsibilities

12. Procedure Performance

13. OR Presence

14. Other Responsibilities

15. Areas EAST May Impact • Strategic Plan • Plan AP billing seminar • ATLS for APs (they’re in the trauma bay!) • Full EAST membership • Recommend AP geared conferences

16. Areas EAST May Impact • Garner further knowledge • Refine survey • AP specific society • Practice Management Guideline • National Standards • Retention • Other manuscripts • Enthusiasm

17. 5-7 minutes • Brief intro and brief summary • Where they’re used (scope in Jan 2010) – floor, ICU (everywhere!) • What they do – procedures, charting, etc… • Decide these at EAST meeting: • ?PMG for APs • Retention for a future discussion • ? Subcommittee's • Mission statement goals • Discuss to expand AP to allow EAST membership • ?ACS AP accredidation • 2-3 good projects (high impact)

18. Background • Increased need for advanced practitioners (AP) • 80 hour work week for residents • Resident goal clear • AP goals less clear and variable • Pay • Life-work balance • Education • Administration

19. Background • Develop a model • Satisfaction • Retention • Appropriate Patient Care • NPs and PAs considered equivalent for purposes of this report

20. Survey Audience

21. 242 total responses 70% Surgeons 19% Advanced Practitioner 10% Trauma Coordinator Job Description

22. ACS Level

23. Trauma Volume

24. Advanced Practitioner and Resident Staffing and Interaction

25. Staffing Use on Acute Care Surgical Services

26. Trauma Staffing per ACS Level

27. Trauma Staffing per Trauma Volume

28. Surgeon vs AP View of Responsibility Level

29. AP Staffing Level

30. Resident and AP Interaction • When residents are present: • Similar number of APs per shift (3.2 vs. 2.6) • Same patient load responsibility (6-10) • Similar rate of bedside procedures • Less OR responsibility (48% vs. 18%) • Less number of APs per night call (0.7 vs. 0.3)

31. Advanced Practitioner Scope of Practice

32. The “Typical” Advanced Practitioner: • Works on the Trauma floor service (95.4%) • Cares for 6 – 10 (42%) patients per shift • Takes no call (71.4%) • Has similar responsibilities to a junior resident (57.3%)

33. Advanced Practitioner Area of Practice

34. Advanced Practitioner Partners Per Shift

35. Advanced Practitioner Partners per Shift Viewpoint

36. Advanced Practitioner Call • If APs do take call, 84.4% are in house • If residents are present, there is less AP call (24% vs. 45%)

37. Advanced Practitioner Common Floor Responsibilities

38. Procedure Performance

39. Procedure Performance Perception

40. OR Presence

41. Billing 37% of surgeons believe APs perform procedure notes while 92% of APs state they do

42. Other Responsibilities

43. Retention

44. Retention • 33% > 5 years • 63% leave at 2 – 4 years • Retention is a problem!

45. Retention - Incentives

46. Retention • Institutional incentives offered • AP desires? • Work-Life balance • Time off • Call • Education

47. APs Want To Be Educated! • 75% attend in-house conferences geared towards surgical residents • 19% attend in-house AP geared sessions • Only 62% undergo orientation • Average orientation 4-5 weeks • 71% attend paid conferences

48. Summary • Trauma services seem to be more robust and experienced • Can use trauma as a model to push the other services forward in practice • Must be careful as there seems to be poor retention at the year 2-4 level

49. Summary • Institutional practice • Clearly insufficient retention

50. Future Directions • Can we develop a model for each ACS level? • Each center is different • Resident availability • Volume • ACS level (i.e. acuity)