Nurse-sensitive outcomes of advanced practice

Advanced practice nurses (APNs) in the USA are registered nurses who hold m asters or doctoral degrees in a specialized area of nursing. They provide a dvanced clinical care to clients, manage health care systems and influence health care decision-making through expert clinical reasoning and research and theory-based action. APN impact on health care outcomes is supported by studies using physician-focused indicators, although a few studies have id entified several that are sensitive to or reflective of advanced practice n ursing. A modified Delphi survey was conducted during May 1997 - December 1 998 to determine the outcome indicators APNs recommend for use in measuring their effect on care delivery outcomes. A convenience sample of 66 APNs at tending a statewide outcomes conference identified 27 potential outcome ind icators. These indicators were included in a mailed survey sent to APNs wor king in Tennessee. Respondents were asked to rate each indicator for validi ty, sensitivity, feasibility, utility and cost. In the second round of the survey, they were asked whether or not they agreed with the rank ordering o f indicators, which was determined by the means calculated from responses i n the first round. The 10 highest ranked indicators were satisfaction with care delivery, symptom resolution/reduction, perception of being well cared for, compliance/adherence with treatment plan, knowledge of patients and f amilies, trust of care provider, collaboration among care providers, freque ncy and type of procedures ordered and quality of life. APNs identified bot h direct and indirect measures of effect on care delivery outcomes. Some of these are currently used as indicators of advanced practice, but many are not. Additional research is needed to determine whether the indicators prop osed are valid and sensitive to advanced practice care by nurses.