Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training.
BACKGROUND
Little is known about aspects of practice that differ between acute care nurse practitioners and physicians that might affect patients' outcomes.


OBJECTIVE
To determine if time spent in work activities differs between an acute care nurse practitioner and physicians in training (pulmonary/critical care fellows) managing patients' care in a step-down medical intensive care unit.


METHODS
Work sampling techniques were used to collect data when the nurse practitioner had 6 months' or less experience in the role (T1), after the nurse practitioner had 12 months' experience in the role (T2), and when physicians in training provided care on a rotational schedule (nurse practitioner not present, T3). These data were used to estimate the time spent in direct management of patients, coordination of care, and nonunit activities.


RESULTS
Results for T1 and T2 were similar. When T2 and T3 were compared, the nurse practitioner and the physicians in training spent approximately half their time in activities directly related to management of patients (40% vs 44%, not significantly different). The nurse practitioner spent more time in activities related to coordination of care (45% vs 18%; P < .001) and less time in nonunit activities (15% vs 37%; P < .001).


CONCLUSIONS
The nurse practitioner and the physicians in training spent a similar proportion of time performing required tasks. Because of training requirements, physicians spent more time than the nurse practitioner in nonunit activities. Conversely, the nurse practitioner spent more time interacting with patients and patients' families and collaborating with health team members.
D000208:Acute Disease / Q000451:nursing*; D000368:Aged; D002983:Clinical Competence; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010414:Pennsylvania; D010820:Physicians / Q000706:statistics & numerical data*; D013996:Time and Motion Studies