Nurse Practitioner in Emergency:
The Bethesda Hospital Experience
Patti Fries
Facility Manager
Bethesda Hospital/Bethesda Place
204-346-5150
Bethesda Hospital
• 64 Acute care beds,
including medicine,
surgery, obstetrics
• Surgical Program
with some Ortho
• 20 Rehabilitation
beds with Rehab
Therapy Services
• Cancer Care
Emergency
Department
• See ~25 000
patients per year
• 2 beds in
resuscitation room
• 3 private rooms
• 2 stretchers with
privacy curtains
• 2 hallway
stretchers
Staffing
• 2-3 RN’s / shift
• 1 physician 24
hours per day, with
second physician
1400-2200 h daily
• One NP Monday –
Friday 0800-1600 h
• One CRN Monday –
Friday 0900-1545 h
How Did This Come To Be?
• Need identified by current NP who was
working in ER as a casual nurse while
a student in the NP program.
• Together with Facility Manager, a
proposal was written and presented to
Manitoba Health.
• Pilot project for 0.8 EFT started July
17, 2006, became a full-time
permanent position July 17, 2008.
Why Did We Need An NP?
• Recognized need for alternate practitioner
to provide care for less urgent patient
population
• Improve patient flow in a busy ER
• Decrease workload on existing practitioner
thereby improving overall wait times.
ER Visits
• 125% increase since 1987/86
• 35% increase since 1996/1997
• 23,500 or 64 pts./day from 2004/05 with
slight decrease (alternate space)
• 2/3 of region’s population increase; 29%
increase since 1998
• Acuity (Level 1-3) 97% increase 2000 –
2004 with 200% increase from 2003 - 2005
Integration of the Role
• Informal integration and education by NP
while current staff nurse attending school
and during practicum
• Physician coach/mentor who completed
chart audits
• Manitoba Health deliverables
• 360° evaluation by peers
• Collaborative Practice Agreement
• Presentation by WRHA NP to all staff
Successes &
Challenges
What Made It A Success?
• Existing staff member
• Supportive team – physicians,
allied health, management
• NP’s key role in initiating
support for proposal
• Advanced critical skill base
with pediatric specialty
• Team player
• Commitment to best practice
and high standard of care
What Were The
Challenges?
• Lack of understanding of
role, on both sides
– Treating NP as NP and not a
staff nurse
• Some insurance
companies,
– Paving way for new position
organizations not
– Slight transition with
assessments and writing
accepting NP
orders
signatures (i.e. MPIC)
• Unable to write Rx
independently for some
items (i.e. air cast)
• Some specialists not
wanting to discuss
referral from NP (i.e.
orthopedic surgery
referral)
Supporting the NP
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Flexibility of both NP and management
ER Team support
Dedicated office space with computer
Protected administration/education/research time
Education support
Inclusion on teams where input sought
– Nursing Practice
– ER/EMS
– NP Implementation (new)
– Pandemic Planning
– Primary Care Planning