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Quality and Financial Impact of Adding Nurse Practitioners to Inpatient Care Teams

Kapu, April N. DNP, RN, ACNP-BC, FAANP; Kleinpell, Ruth PhD, RN, FAAN, FCCM; Pilon, Bonnie DSN, NEA-BC, FAAN

Journal of Nursing Administration: February 2014 - Volume 44 - Issue 2 - p 87–96
doi: 10.1097/NNA.0000000000000031

OBJECTIVE The purpose of this project was to examine the financial impact of adding nurse practitioners (NPs) to inpatient care teams at Vanderbilt University Hospital.

BACKGROUND National initiatives targeting quality, safe, and cost-effective healthcare have created the optimal environment for NPs to showcase their abilities and contributions. Identifying outcomes that are directly affected by NPs and quantifying data in terms of dollars can be affirmation for the contribution of the NP practice. Value can be garnered in terms of revenue generation and cost-effectiveness of hiring NP providers; however, a considerable financial impact can be in cost avoidance and cost savings through NP-associated outcomes of care.

METHODS This was a retrospective, secondary analysis of return on investment after adding NPs to 5 teams. Software was used to abstract billing, acuity, and length of stay (LOS) data and NP-associated quality metrics. Billing data, LOS, and risk-adjusted LOS data for designated years before and after adding NPs were compared.

RESULTS Gross collections compared with expenses for 4 NP-led teams for 2 year time periods were 62%, 36%, and 47%, and +32%. Average risk-adjusted LOS for the 5 time periods after adding NPs decreased and charges decreased, thus demonstrating less resource use. Most clinical outcomes improved beyond preproject baselines.

CONCLUSION This project demonstrated the value of adding NPs to inpatient care teams by means of generated revenue, reduction in LOS, and standardization of quality care.

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Author Affiliations: Assistant Director for Advanced Practice Nursing (Dr Kapu), Vanderbilt University Hospital, and Assistant in Division of Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee; Director (Dr Kleinpell), Center for Clinical Research and Scholarship, Rush University Medical Center, and Professor, College of Nursing, Rush University, Chicago, Illinois; Professor, Health Systems Management (Dr Pilon), and Senior Associate Dean, Clinical and Community Partnerships, School of Nursing, Vanderbilt University,Nashville, Tennessee.

The authors declare no conflicts of interest.

Correspondence: Dr Kapu, Vanderbilt University Hospital, MCN AA1204 1161 21st Avenue South, Nashville, TN 37232-2102 (

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