Proposed Addition of Acute Care Nurse Practitioners in Observation Units: Identifying the Stage of Change of Staff Cohorts at Banner Desert Medical Center

Abstract

Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.