Advanced practice nursing.
Article Type: Report
Subject: Registered nurses (Practice)
Primary nursing (Practice)
Primary nursing (Innovations)
Medical policy (Laws, regulations and rules)
Author: Scarpinato, Joyce
Pub Date: 03/22/2011
Publication: Name: Journal of the New York State Nurses Association Publisher: New York State Nurses Association Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New York State Nurses Association ISSN: 0028-7644
Issue: Date: Spring-Winter, 2011 Source Volume: 42 Source Issue: 1-2
Topic: Event Code: 200 Management dynamics; 930 Government regulation; 940 Government regulation (cont); 980 Legal issues & crime; 310 Science & research Advertising Code: 94 Legal/Government Regulation Computer Subject: Government regulation
Product: Product Code: 8043110 Nurses, Registered NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Legal: Statute: Affordable Care Act
Accession Number: 278760671
Full Text: Newhouse, R., Stanik-Hutt, J., White, K., Jogantgen, M., Bass, E., Zangaro, G., ... Weiner, J. (2011). Advanced practice nurse outcomes 1990-2008: A systematic review. Nursing Economics, 29(5), 1-21.

The Affordable Care Act of 2010 will enable 32 million more Americans to access health care, increasing the need for providers. Currently, the number of nurse practitioners (NPs) is increasing and the number of physicians choosing to practice in the primary care setting is decreasing (Institute of Medicine, 201 1). This data supports the need to continue educating advanced practice nurses (APN) to meet the healthcare needs of Americans. Furthermore, the data reflects four key messages stated by the Institute of Medicine, suggesting that nurses should practice within their full scope of practice, continue in the lifelong education path, be full partners in the restructuring of the American healthcare system, and advocate in the planning and policy of data collection and information infrastructure.

A systematic review published in Nursing Economics compared healthcare providers' patient outcomes. The authors searched PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Proquest databases for each APN group: NP, clinical nurse specialist, certified nurse midwife (CNM), and certified registered nurse anesthetist. The team identified 69 randomized controlled trials and 49 observational studies conducted in the United States between 1990 and 2008.

An APN technical expert panel identified pertinent systematic review studies and rated the studies. Two evaluators independently rated each article for outcomes in each APN group. A minimum of three studies with a similar outcome was required for inclusion. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to aggregate the outcomes. Effect size was not calculated but significance was identified.

The NP evidence was rated high with outcomes equivalent to medical doctor outcomes. The clinical nurse specialist evidence was high to moderate, and the outcomes reflect lower patient care cost, shorter hospital length of stay, better patient satisfaction, and fewer patient complications. The CNM aggregate evidence was rated high to moderate, and outcomes noted lower rates of caesarean sections, epidurals, and episiotomies, less analgesia used on labor patients, and fewer third- and fourth-degree perineal lacerations. The CNM outcomes comparable to other providers include rates of low Apgar scores, low birth weight, labor augmentation, and labor induction. The CRNA studies did not meet the criteria and were not included.

The systematic review demonstrates that APNs provide safe, quality patient care and supports the role of APNs as equal partners in healthcare reform. APNs must continue, however, to demonstrate effective practice with continued clinical research.


Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press.

Joyce Scarpinato, SUNY Upstate Medical University, Syracuse, NY
Gale Copyright: Copyright 2011 Gale, Cengage Learning. All rights reserved.