When the medical staff executive committee helps chart the future of Akron Children’s Hospital, nurse practitioners sit side by side with doctors as peers.
As the hospital’s pediatric neurosurgeon finishes a complex brain operation, he usually steps back and lets a physician assistant close the child’s head.
And if a cancer patient has a problem in the middle of the night, an advanced-practice nurse or physician assistant often provides the care.
The pediatric hospital increasingly is relying on nurse practitioners and physician assistants to deliver high-level care to its young patients.
Hospitals nationwide are turning to these advanced-practice professionals to care for patients for a number of reasons, industry experts say.
Among the factors contributing to this trend: An anticipated shortage of primary-care doctors, reductions in hours residents can work, and an expected increase in demand for medical services by aging baby boomers as well as people who will be newly insured through health-care reform.
“They’re coming into the spotlight,” said Julie Tsirambidis, a certified nurse practitioner and director of the Advanced Practice Center at Akron Children’s Hospital.
Tsirambidis also is a voting member of the hospital’s medical staff executive committee, which traditionally included doctors who chair departments.
The hospital created the Advanced Practice Center in recent years to oversee recruitment, orientation, professional development and retention of advanced practitioners, who include physician assistants, nurse practitioners, nurse midwives, nurse anesthetists and clinical nurse specialists.
The hospital employs 164 advanced practitioners and is actively recruiting 24 more.
Nurse practitioners (NPs) and physician assistants (PAs) earn at least a master’s degree from an accredited program.
Under state law, both can prescribe a wide variety of medications and provide high levels of patient care. Nurse practitioners are licensed by the Ohio Board of Nursing; physician assistants are licensed by the Ohio State Medical Board.
NPs and PAs are in strong demand and can command healthy salaries.
Forbes magazine recently named physician assistant programs the No. 1 master’s degree for getting a job, citing an expected growth of 39 percent by 2018.
The average yearly total compensation for NPs nationwide is $94,050, according to the American Academy of Nurse Practitioners.
Likewise, physician assistants earn an average base salary of more than $87,000 and more than $89,000 for those who are hospital-based, according to the U.S. Bureau of Labor Statistics. After 10 years in practice, the median salary is $100,000, according to the American Academy of Physician Assistants.
“The supply does not meet the demand,” said Josanne Pagel, executive director of Physician Assistant Services at the Cleveland Clinic. The hospital is offering tuition forgiveness to help attract PAs.
The health system now has more than 40 openings posted for PAs and advanced practice nurses and expects to hire at least 45 more next year.
The Cleveland Clinic Health System says it is Ohio’s largest employer of physician assistants, with about 325 on staff throughout the system. The hospital system also employs about 800 advanced-practice nurses.
When Pagel joined the Cleveland Clinic in the new position eight years ago, the hospital system had about 75 PAs.
The advanced-practice professionals are seen in “every area and discipline” at the Cleveland Clinic, Pagel said. They can educate patients and see those with less serious problems, which frees up doctors’ time to spend with people who have complex problems.
The result has been an increase in patient satisfaction and quality scores, as well as a decrease in average length of stay and readmissions, she said.
In the emergency department, the Cleveland Clinic has created a “low-acuity clinic” staffed by advanced-practice nurses and physician assistants, said James Bryant, the Cleveland Clinic’s associate chief nursing officer of Emergency Services. The hospital started using a “split flow” in the ER at the main hospital this summer to route patients with less serious problems to the low-acuity clinic.
“It’s very much patient-centered,” he said.
The concept is being introduced at other Cleveland Clinic hospitals, including Medina Hospital in November.
The expanded reliance on advanced-practice professionals to provide around-the-clock care at Akron Children’s is necessary, in large part, because of new restrictions on the number of hours doctors-in-training can work.
Starting in July, the Accreditation Council for Graduate Medical Education imposed new standards for the nation’s residency training programs.
As part of those changes, shifts for first-year residents now are limited to 16 hours. For more senior residents, shifts are capped at 28 hours, down from 30.
The accrediting body for the nation’s medical residency programs continues to limit residents’ shifts to about 80 hours a week.
“We started planning for it two years ago,” said Tracey Herstich, a nurse practitioner in the pediatric intensive-care unit at Children’s. She was among those who served on a committee to begin expanding the role of nurse practitioners and other advanced professionals.
Likewise, Akron General Medical Center is increasing the number of advanced-practice nurses from the current 30 in response to the new rules limiting resident hours, hospital spokesman Jim Gosky said.
Cheryl Powell can be reached at 330-996-3902 or email@example.com. Follow Powell on Twitter at twitter.com/abjcherylpowell.