title: An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting.
abstract: OBJECTIVE
  To evaluate the impact of implementing Advanced Nurse Practitioner roles on patients, staff members and organizational outcomes in an acute hospital.
  
  
  BACKGROUND
  The worldwide development of advanced practice roles in nursing has been influenced by increasing demands and costs of health care. A key issue in the UK has been the reduction in hours junior doctors can work. While there is evidence these roles can have a positive impact in a variety of clinical specialties, little is known about the impact advanced nurses substituting for junior doctors can have on patients, staff members and organizational outcomes in general hospital care settings.
  
  
  METHODS
  Collective case study.
  
  
  METHODS
  A collective case study in a district general hospital in England was undertaken in 2011-2012. Interviews with strategic stakeholders (n = 13) were followed by three individual case studies. Each case study represented the clinical area in which the roles had been introduced: medicine, surgery and orthopaedics and included interviews (n = 32) and non-participant observation of practice.
  
  
  RESULTS
  The ANPs had a positive impact on patient experience, outcomes and safety. They improved staff knowledge, skills and competence and enhanced quality of working life, distribution of workload and team-working. ANPs contributed to the achievement of organizational priorities and targets and development of policy.
  
  
  CONCLUSIONS
  ANPs undertaking duties traditionally performed by junior doctors in acute hospital settings can have a positive impact on a range of indicators relating to patients, staff members and organizational outcomes which are highly relevant to nursing.
authors.affiliation: Sheffield Hallam University, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: McDonnell
authors.forename: Emma
authors.initials: E
authors.lastname: Goodwin
authors.forename: Fiona
authors.initials: F
authors.lastname: Kennedy
authors.forename: Kay
authors.initials: K
authors.lastname: Hawley
authors.forename: Kate
authors.initials: K
authors.lastname: Gerrish
authors.forename: Christine
authors.initials: C
authors.lastname: Smith
mesh_terms: D000208:Acute Disease / Q000451:nursing; D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015331:Cohort Studies; D004739:England; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000523:psychology; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D009732:Nursing Care / Q000458:organization & administration* / Q000523:psychology; D019982:Organizational Case Studies; D009937:Organizational Objectives; D006113:United Kingdom
keywords: advanced nurse practitioner; advanced nursing roles; case study; mixed methods; nurses