Background
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Describe tasks performed by PAs and NPs in hospitals,
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Categorize patient and non-patient-related tasks,
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Describe how the supervision and collaboration was organized and what the contributed value of the PA and NP was, and
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Assess the reliability of hospital administrative systems to capture the activity of PAs and NPs.
Theoretical framework
1 | Substitution (transfer of tasks) is aimed at a structural transfer of tasks. This means tasks are carried out autonomously, the tasks are part of standard scheduling, and the NP or PA is considered to be fully responsible for the “transferred” task. |
2 | Delegation is the incidental transfer of tasks. It involves entrusting certain tasks to the NP or PA. In this respect, the temporary nature as well as the direct involvement of the physician (MD) is crucial, i.e., the task is not routinely planned and there is the possibility of direct supervision and intervention by the MD. The task is performed on behalf of the MD. |
3 | Additional tasks are an extension of the tasks of existing professionals. In this case, a distinction is made between “patient-related” and “non-patient-related” to point out the difference between, for example, psycho-social care and administrative/logistic tasks. |
Methods
Study design
Setting
Data collection and data analysis
Step 1
Step 2
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Type of task transfer,
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Number of tasks and activities,
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Duration of the execution of the task and needed supervision.
Step 3
Step 4
Results
NP (N = 32) | PA (N = 21) | |||
---|---|---|---|---|
Hours | % | Hours | % | |
Task substitution | 309 | 22 | 465 | 31 |
Task delegation | 52 | 4 | 34 | 2 |
Additional tasks | 254 | 18 | 128 | 9 |
Other tasks | 766 | 55 | 875 | 58 |
Total | 1 381 | 100 | 1 502 | 100 |
Task transfer
NP (N = 32) | PA (N = 21) | |||
---|---|---|---|---|
Hours | % | Hours | % | |
Task substitution | 708 | 51 | 906 | 60 |
Task delegation | 52 | 4 | 34 | 2 |
Additional tasks | 253 | 18 | 129 | 9 |
Other tasks | 368 | 27 | 433 | 29 |
Total | 1 381 | 100 | 1 502 | 100 |
NP | PA | |
---|---|---|
Hours | Hours | |
Administrative | 61 | 91 |
Research | 44 | 48 |
Expertise enhancement | 40 | 38 |
Organizational tasks | 36 | 38 |
Education (teaching) | 40 | 34 |
Consultation between medical specialist and PA/NP | 24 | 48 |
Remainder of the group | 89 | 111 |
Total hours | 368 | 433 |
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Requests for laboratory tests,
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Arranging appointments,
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Consultation (not about individual patients), planning, discharge, etc.
Supervision and collaboration
Discussion
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The administrative systems in the hospitals were not consistently prepared for PAs or NPs that performed independently tasks or procedures.
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PAs and NPs were not always able or willing to fill in the information into the hospital informatics system.
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Sometimes a medical specialty had a policy that did not permit a PA or an NP to document the tasks or procedures.
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PAs and NPs performed a great deal of overhead tasks that do not exist or did not have a category in the administrative system.