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Detecting physiological instability for early intervention is associated with improved outcomes; however, less nighttime availability of healthcare providers may delay detection of changes and subsequent treatment. The purpose of this study was to report clinicians' perceptions of satisfaction and patient safety associated with a nocturnal acute care nurse practitioner program. Data were collected before program initiation and after 12 months. Improvements included provider communication, more timely bedside evaluations, and a more supportive night care environment.
Nursing surveillance has been defined historically to encompass the monitoring of alarms (Henneman et al., 2012) and performance and interpretation of fundamental nursing care, including physical assessments (Douglas et al., 2016) broadly. Daytime and nighttime nursing surveillance requirements are the same, but barriers differ. During the day, nursing workload is compounded by the intensity of interprofessional rounding and more frequent medication administration, higher visitor presence, and changes in active care plans. During nighttime care, fewer clinicians typically are available, and intensity of nursing surveillance varies by the hour, including clusters of surveillance activity during shift changes (Hands et al., 2013; Moshynskyy et al., 2020).
Despite nighttime monitoring during hospitalization, severe physiological deterioration can occur in the acute care setting. Detecting physiological instability for early intervention is associated with improved outcomes (Churpek et al., 2016); however, less nighttime availability of healthcare providers may delay detection of changes and subsequent treatment. Acute care nurse practitioners (ACNPs) are adept at assessing risk factors for physiological deterioration (American Association of Colleges of Nursing, 2021); the literature suggests quantifiable judgments of inpatient stability are similar across physician and advanced practice nurse provider roles (Edelson et al., 2011; Rojas et al., 2020). ACNPs may impact care delivery proactively through on-site nighttime surveillance rounding.
Purpose
The purpose of this study was to describe clinicians' perceptions of satisfaction, patient safety, and efficiency of care associated with implementation of a nighttime ACNP surveillance program in a community hospital.
Review of the Literature
A literature search was conducted via PubMed, Cochrane Collaborative, and CINAHL databases. To capture analyses specific to nightshift, authors searched databases from their inception through May 2020. Key search terms included inpatient, staffing, and advanced practice nursing. Literature on nocturnal care staffing models for the surveillance of patient deterioration in acute care is synthesized.
Earlier detection...