Populations Presenting to the ED
From a national perspective, little is known about the patients NPs assess, diagnosis and treat in the ED. Common injuries or illnesses include lacerations; injuries to the head, neck, face, eye and extremities; chest pain; flank pain; muscle-skeletal pain; earaches; sore throats; respiratory, genitourinary or digestive complaints; fever; and edema.¹¹ Populations treated range in age from less than 1 year to 95 years, and they represent a variety of ethnicities and cultures.

Patients present to the emergency department without insurance about twice as often as those patients with private insurance. Nurse practitioners do not see a disproportionate number of minority or economically disadvantaged patients. Approximately a half a million visits to the ED in 2005 were made by the homeless, while one out of five U.S. residents presented to the ED for treatment. Patients spend an average of 56.3 minutes waiting to be seen by a physician or other health care provider. The average amount of time spent in the ED is 3.3 hours.⁷

The increased acuity of patients, shortage of primary care physicians, increasing medical costs, decreased medical insurance coverage and lack of access to primary care physicians are all variables that increase the influx of patient visits to emergency departments. The chief complaints of one-fifth of all visits to the ED are abdominal pain, chest pain, fever and cough.⁷ Out of 20 leading principal reasons for visits to the ED, stomach and abdominal pain, cramps and spasms made up 6.7% of the chief complaints.^7,12

One study of the role and function of NPs in the ED found insufficient research available.⁹ The value of NPs' expertise, knowledge and skill is recognized as imperative to improve levels of service, efficiency and patient satisfaction in this environment. An international literature review was conducted and the data summarized. The review concluded that internationally the role of the NP is appealing, although the role needs to be better defined. The international literature acknowledges that NPs are able to meet patient satisfaction needs as well as house officers. They bring patient education, counseling, advocacy, collaboration and comprehensive, holistic care along with decreased waiting times. These indicators not only improve patient's satisfaction, but compliance with treatment, as well.¹³

Outcomes
Nurse practitioners provide a partial solution to the increasing influx of ED patients, offering safe and effective care to urgent and emergent patients presenting with minor injuries and health complaints. As many as 30% of the patients presenting to the ED do not need to be seen by a physician, but can be treated through established protocols by a nurse practitioner. Benefits from employing skilled NPs include reduced waiting times and augmented holistic care, allowing for more efficient use of physicians' time for patients requiring emergent medical attention.^1,14

Patient satisfaction with NPs and other health care providers is an important indicator for care. Patient satisfaction leads to greater compliance with health care strategies. Understanding patient satisfaction is critical if compliance with plan of care and treatment is expected.¹³ Patients evaluate their treatment in relation to the communication skills and courtesy of the provider. These encompass patient perceptions of the way providers recognize their problems, providers' ability to explain care using simple language, and providers' time spent with them; these factors ensure confidence in the provider.^4,12,15

Patients who feel valued, who are encouraged to become active participants in health care decisions and plan of care, are more apt to follow treatments. They also follow up with referrals and have increased satisfaction with their provider.¹³ A comprehensive literature review concluded that patients accept and are satisfied with the interpersonal communication skills and quality of care by NPs.³

Recognized as a viable resource, NPs enhance health care by increasing patient choices, reducing waiting times, improving patient access and improving efficiency of emergency physicians - leading to greater patient satisfaction.⁴ Nurse Practitioners have equivalent patient satisfaction scores when compared with physicians or other traditional health care professionals in the ED setting.³

Opportunities for Role Expansion
Nurse practitioners provide high quality, cost effective care in the ED.^12,15 There is an opportunity for NPs to alleviate the high demands and scarcity of emergency physicians facing emergency departments across the nation today.¹⁶

Nurse practitioners have become a valuable human resource in the ED. According to a 4-year research study, NPs saw approximately 5.76 million patients in the ED between 1997 and 2000.^6,11 NPs are less expensive than physicians; they evaluate, treat and discharge a significant volume of patients efficiently while providing holistic, competent care. The use of NPs in the ED lowers the cost of health care and improves productivity.

Nurse practitioners are also more plentiful, with an estimated workforce of 300,000 by 2012. ACEP argues that the NP workforce is becoming invaluable with an increasingly significant role in emergency medicine.⁶ The number of NPs employed in an ED setting, nationwide, as of October 2007, is unknown, but a 2005 study estimated that of the NPs employed in EDs, 69% are family NPs and 15% emergency NPs.^10,12 In 2003, an NP working in an emergency department made an average of $80,697, almost $7,000 higher than the neonatal units, one of the most lucrative settings for NPs in the past.