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Small Hospital Recognizes the Value of NPs

A community hospital realizes the value in growing its in-house NP staff.

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Eight years ago, I transferred from a large academic facility to a 55-bed community hospital, Houston Methodist Sugar Land Hospital. I was to be the first acute-care nurse practitioner for the Sugar Land, Texas, facility. My dream was to develop a group of NPs who would practice to the full extent of their education and training. However, I found myself faced with physicians who had never worked with nurse practitioners and were not interested in doing so. I had a decision to make. I could either quit or develop resilience and prove that nurse practitioners were not only useful but also necessary in the community hospital setting. I chose the latter.

Critical Care Experts
Within the year, the chief nursing officer approved four more NP positions, allowing us to cover the hospital 24/7. We would serve as the ICU experts. Additionally, all of the NPs were procedure capable, able to place central lines and arterial lines. It was at about that time we were given the task of initiating and developing a rapid response team. Soon we were treating emergencies, placing lines and communicating critical findings to physicians.

Through gradual expansion, the hospital became a 243-bed facility, and the NP service grew to seven NPs. In addition to our ICU and rapid response duties, we became instrumental in other hospital initiatives, such as STEMI and stroke teams, and responded to episodic calls throughout the hospital. It wasn't long before we had more than 100 delegating physicians who wanted to use the NP service for everything from Tylenol orders (especially at night) to central line placement.

NPs at Houston Methodist Sugar Land HospitalSoon, our facility was invited to participate in a multicenter, grant-supported study to evaluate a screening tool for sepsis. The NP service took on the task of serving as the second-level responders to evaluate patients showing signs of sepsis. Through grant support, we grew again. This increased our visibility throughout the hospital. We had become an essential service.

Supporting Additional Clinicians
To provide the best evidence-based treatment modalities, we thought it was important to stay abreast of research and medical literature. The NPs often educated each other and the clinical nursing staff on the latest treatment and research available. One of the NPs initiated a journal club. We have found this supports two goals: increasing our knowledge and increasing our teamwork.

In 2016, our facility is establishing an additional 20-bed intensive care unit and 84 medical surgical beds. The NP service will work with a newly hired intensivist group to provide comprehensive care to our ICU patients. We will continue our other functions, and we will be hiring additional NPs, bringing the total to 15.

SEE ALSO: Leaders and Communication

Dream Fulfilled
From our humble beginnings of a 55-bed community hospital with one NP, to our soon-to-be 347-bed facility with 15 NPs, we have grown into a robust nurse practitioner team. In 2015, we performed more than 950 procedures. We answer approximately 50 Rapid Response calls per month and are involved in approximately 10 Code Blue alerts per month. We are instrumental in developing protocols for our facility, including those surrounding therapeutic hypothermia, glucose management and blood conservation. We are highly visible and available to the clinical nursing staff.

Members of the NP service have proven they have initiative and passion for what they do. We are allowed to function to the full extent of our education and training. We are well-respected and valued by administration, the nursing staff and the physician staff. We are now a hard-wired service to the hospital.

Elizabeth A. Gonzales is the director of the nurse practitioner service at Houston Methodist Sugar Land Hospital in Sugar Land, Texas.

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