The Hospitalist and Nurse Practitioner Team

Healthcare institutions are looking for ways to cut costs and improve quality. Can this be done? Are they incompatible goals? The financial survival of hospitals is dependent on how they prevent “never events” and that quality-of-care issues that are easily foreseeable. Increasingly, hospitals are being forced by reimbursement entities like Medicare and private payors to address patient safety and satisfaction issues, reduce readmissions for certain conditions like congestive heart failure within 30 days, and, to tackle the hard issues. At the same time, there are cuts in budgets. Hospitals are scrambling to survive.

As of 2006, nearly 40% of American hospitals employed hospitalists. These individuals are physicians who are employees of the hospital. They do not have a private practice and instead, manage the hospital care for patients admitted from physicians in the community.

There is a wide range of pressures on hospitalists. They are constantly having to prove their worth. The Society for Hospital Medicine Career Satisfaction Task Force divided these pressures into the nature of the work, the nature of the work environment, career and organizational issues, personal issues, and external influences. Look at just one aspect of the role, the nature of the work:

• High acuity/complexity of illness/lack of predictability
• Life and death implications of clinical decisions
• Provider interdependency and communication
• Limited patient information
• Administrative and documentation requirements
• Medical-legal risk
• Potential hostility from patient’s family

Teaming a hospitalist and a nurse practitioner is one way to address a wide range of concerns, such as safety, quality, cost reductions, education, throughput, around-the-clock coverage, and medical staff leadership. (1)

Some of the ways that hospitalists and nurse practitioners can work together include:

• Divide up responsibilities for hospital admissions
• Provide coverage for the entire hospital patient population – issue orders, assess patients with changes in status
• Supervise residents
• Respond to rapid response requests
• Perform procedures
• Respond to cardiac arrests/codes (2)

It is clear that hospitals that perfect teamwork, that reduces barriers between professionals, will survive. They will have fewer bad outcomes and more satisfied patients.

(1)SHM Career Satisfaction Task Force
(2) Johnston, J. Jones, L. McNulty, R and Andrews, C. The NP/Physician Hospitalist Team Connection, AMSN Newsletter September/October 2011, page 1

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