Reply to this discussion- Sarah

 Module 7 Discussion
As nurse practitioners (NP) continue to saturate the health system, it’s important to conduct studies in order to evaluate the quality of the primary care provided by them and further compare their care to that of physicians in terms of effectiveness and safety (Woo, Lee & Tam, 2017). The advanced practice registered nurse (APRN) role was first introduced in the 1960s as a solution to the lack of primary care physicians, to meet the primary care needs of the rural and underserved populations.  Primary care has first contact with patients and, subsequently, provides continuity of care within the healthcare system through the coordination of care according to patients’ needs (Woo et al., 2017). To fulfill primary care needs, the NPs are  trained generalists who have a breadth of knowledge to render a wide scope of care (Woo et al., 2017). Furthermore, by the use of organizational, NP-specific, and national-related quality measures can help showcase how NP care improves the quality, safety, and costs of health care (Kleinpell & Kapu, 2017). 
In order to measure and monitor the quality of care delivered and the use of  outcomes  achieved by the APRN, a review of evidence practices on their current state should be conducted. Recently, there were comprehensive and systematic reviews through electronic databases from 2006 to 2016 that identified studies evaluating the impact of advanced practice nursing in the emergency and critical care settings (Woo et al., 2017). The review demonstrated  that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings (Woo et al., 2017).  By looking at these quality indicators, the research proved with quantifiable data the improvements that NPs have towards the healthcare system. Essentially, the use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact and enhance the conduct of an NP outcomes assessment (Kleinpell & Kapu, 2017). Furthermore, evaluating the impact of nurse practitioner practice has become a priority area of focus for demonstrating outcomes (Kleinpell & Kapu, 2017). Several quality measures are available to enable practice-specific evaluation of NP roles and initiatives (Kleinpell & Kapu, 2017). The need to demonstrate outcomes of NP practice remains another ongoing priority area regardless of the clinical practice setting (Kleinpell & Kapu, 2017). These studies and more are sources of how quality measures exist and how they can be used to demonstrate the effectiveness of NP care (Kleinpell & Kapu, 2017). This can lead to a transformation in the healthcare system through effective utilization of the workforce and will alleviate the impending rise in demand for health services (Woo et al., 2017). 
When looking at the population, the prevalence of chronic illness and multimorbidity  continues to rise as its ages, thereby increasing the acuity of care (Woo et al., 2017). However, projected physician requirements showed a continuing shortage (Woo et al., 2017). Among efforts under way to seek innovations to strengthen the workforce, there is growing interest in having APRNs participate largely with patient care (Woo et al., 2017). Therefore, it is necessary to assess the impact of increasing the autonomy of nurses assuming advanced practice roles on patient outcomes (Woo et al., 2017). While ultimately many studies suggest that implementing the NP role in care improves patient outcomes, a receptive context must first be prepared to achieve sustainable change (Woo et al., 2017).  
References
Hamric, B. A., Hanson, M. C., Tracy, F. M., & O’Grady, T. E. (2013). Advanced Practice Nursing: An Integrative Approach (5th ed.). St. Louis, MO: Elsevier. 
Kleinpell, R., & Kapu, A. N. (2017). Quality measures for nurse practitioner practice evaluation. Journal of the American Association of Nurse Practitioners, 29(8), 446–451. https://doi.org/10.1002/2327-6924.12474 
Woo, B., Lee, J., & Tam, W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 63. https://doi.org/10.1186/s12960-017-0237-9 (Links to an external site.) 

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