Provider to patient ratios for nurse practitioners and physician assistants in critical care units.
BACKGROUND
Nurse practitioners and physician assistants are being increasingly integrated into intensive care unit and hospital-based care teams, yet limited information is available on provider to patient ratios.


OBJECTIVE
To determine current provider to patient ratios for nurse practitioners and physician assistants working in intensive and acute care units and to assess factors that affect the ratios.


METHODS
A descriptive study design was used with a Web-based survey of members of the American Association of Nurse Practitioners, American Academy of Physician Assistants, and the Society of Critical Care Medicine.


RESULTS
Responses were received from 222 nurse practitioners and 211 physician assistants from all but 8 of the 50 United States and from Canada. Mean provider to patient ratios in intensive care were 1 to 5 (range, 1 to 3 - 1 to 8). In pediatric intensive care, the mean ratio of nurse practitioners to patients was 1 to 4 (range, 1 to 3 - 1 to 8). Factors that affected nurse practitioner and physician assistant provider to patient ratios included patients' severity of illness, number of patients in the unit, number of providers in the unit, patient diagnosis, number of physicians in the unit, time of day, and number of fellows and medical residents on service.


CONCLUSIONS
Additional information on factors influencing provider to patient ratios and specific components of the roles of nurse practitioners and physician assistants will be important to ensure the best utilization of these providers to enable optimal patient care outcomes.
Ruth Kleinpell is director, Center for Clinical Research and Scholarship, Rush University Medical Center; professor, Rush University College of Nursing; and acute care nurse practitioner, Rush Lincoln Park, Chicago, Illinois. Nicholas S. Ward is an intensivist at Rhode Island Hospital and an associate professor of medicine at Warren Alpert Medical School, Brown University, Providence, Rhode Island. Lynn A. Kelso is an assistant professor, University of Kentucky College of Nursing, and an acute care nurse practitioner, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky. Fred P. Mollenkopf, Jr is a physician assistant, Thoracic and Cardiovascular Institute, Lansing, Michigan. Douglas Houghton is an acute care nurse practitioner in the trauma intensive care unit, Jackson Health System, Miami Florida. ruth_m_kleinpell@rush.edu.
Ruth
R
Kleinpell
Ruth Kleinpell is director, Center for Clinical Research and Scholarship, Rush University Medical Center; professor, Rush University College of Nursing; and acute care nurse practitioner, Rush Lincoln Park, Chicago, Illinois. Nicholas S. Ward is an intensivist at Rhode Island Hospital and an associate professor of medicine at Warren Alpert Medical School, Brown University, Providence, Rhode Island. Lynn A. Kelso is an assistant professor, University of Kentucky College of Nursing, and an acute care nurse practitioner, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky. Fred P. Mollenkopf, Jr is a physician assistant, Thoracic and Cardiovascular Institute, Lansing, Michigan. Douglas Houghton is an acute care nurse practitioner in the trauma intensive care unit, Jackson Health System, Miami Florida.
Nicholas S
NS
Ward
Ruth Kleinpell is director, Center for Clinical Research and Scholarship, Rush University Medical Center; professor, Rush University College of Nursing; and acute care nurse practitioner, Rush Lincoln Park, Chicago, Illinois. Nicholas S. Ward is an intensivist at Rhode Island Hospital and an associate professor of medicine at Warren Alpert Medical School, Brown University, Providence, Rhode Island. Lynn A. Kelso is an assistant professor, University of Kentucky College of Nursing, and an acute care nurse practitioner, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky. Fred P. Mollenkopf, Jr is a physician assistant, Thoracic and Cardiovascular Institute, Lansing, Michigan. Douglas Houghton is an acute care nurse practitioner in the trauma intensive care unit, Jackson Health System, Miami Florida.
Lynn A
LA
Kelso
Ruth Kleinpell is director, Center for Clinical Research and Scholarship, Rush University Medical Center; professor, Rush University College of Nursing; and acute care nurse practitioner, Rush Lincoln Park, Chicago, Illinois. Nicholas S. Ward is an intensivist at Rhode Island Hospital and an associate professor of medicine at Warren Alpert Medical School, Brown University, Providence, Rhode Island. Lynn A. Kelso is an assistant professor, University of Kentucky College of Nursing, and an acute care nurse practitioner, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky. Fred P. Mollenkopf, Jr is a physician assistant, Thoracic and Cardiovascular Institute, Lansing, Michigan. Douglas Houghton is an acute care nurse practitioner in the trauma intensive care unit, Jackson Health System, Miami Florida.
Fred P
FP
Mollenkopf
Ruth Kleinpell is director, Center for Clinical Research and Scholarship, Rush University Medical Center; professor, Rush University College of Nursing; and acute care nurse practitioner, Rush Lincoln Park, Chicago, Illinois. Nicholas S. Ward is an intensivist at Rhode Island Hospital and an associate professor of medicine at Warren Alpert Medical School, Brown University, Providence, Rhode Island. Lynn A. Kelso is an assistant professor, University of Kentucky College of Nursing, and an acute care nurse practitioner, Department of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky. Fred P. Mollenkopf, Jr is a physician assistant, Thoracic and Cardiovascular Institute, Lansing, Michigan. Douglas Houghton is an acute care nurse practitioner in the trauma intensive care unit, Jackson Health System, Miami Florida.
Douglas
D
Houghton
D002170:Canada; D003422:Critical Care / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000706:statistics & numerical data; D010823:Physician Assistants / Q000706:statistics & numerical data*; D014481:United States