The impact of a 'resident replacement' nurse practitioner on an Academic Pediatric Neurosurgical service

The introduction of 80-hour workweek limitations has challenged resident training programs with creative scheduling while maintaining comprehensive training experiences. The work hour restrictions may be more adaptable to a medical service, but have been very challenging to an academic surgical program. The particular challenges include maximizing academic learning opportunities, operating room experiences and direct bedside patient care while adhering to the 80-hour restriction. This paper examines the addition of a pediatric nurse practitioner (NP) to a pediatric neurosurgical academic program in response to the resident work hour restrictions.

A survey questionnaire asking for responses to questions on a 1-10 rating scale was distributed to physicians, nurses and allied care providers approximately 1 year after addition of the NP. Participants were asked to rate satisfaction with the service's availability, responsiveness and assessment of patient clinical satisfaction prior to the addition of the NP and at the time of questionnaire distribution. In addition, the hospital paging log was reviewed over a several-month epoch before and after addition of the NP. Finally, the number of quality assurance sentinel events was reviewed for the year prior to and the year after the initiation of the NP program.

The satisfaction scores in all categories, including overall satisfaction, significantly improved (p < 0.001) after the addition of the NP to the neurosurgery service. Also, during the NP on-duty coverage hours, the number of paging calls received by the residents was reduced commensurate to the large number of calls received by the NP. This change was presumed to be due to the confidence of other services in obtaining a timely and appropriate response. Finally, the number of sentinel event reports remained stable.

The addition of an NP in response to resident training changes has been a positive influence on satisfaction with the pediatric neurosurgical service while reducing the reliance on residents for bedside clinical care. Patient safety appears not to have been affected. Presumably, this response to resident work hour limitations will provide the needed time to enhance resident didactic and intraoperative training experiences.