Nurse Practitioners at UMMC

Hospital-Based NPs Play a Central Role for Patients

They Act as a Resource for Bedside Nurses

Jessica M. Anderson and Barbara A. Miller

Nurse practitioners such as Barbara A. Miller, MS, CRNP, (right) improve patient satisfaction and serve as a resource for bedside nurses.

Support from nurse practitioners is one thing Jessica M. Anderson, RN, BSN, (left) likes about the Surgical Intermediate Care Unit, where she transferred after finding it to be a good fit.

Patient safety and customer service are among the top priorities at the University of Maryland Medical Center - and nurse practitioners are key to success in those areas.

Each year, new roles have emerged at the Medical Center for nurses in advanced practice, a category that includes the certified registered nurse practitioner (CRNP or NP), clinical nurse specialist (CNS), certified registered nurse-anesthetist (CRNA) and certified nurse-midwife (CNM).

“I think hospitals are finding that there is a huge amount of satisfaction with the nurse practitioner from a patient standpoint, and from a staff point of view,” says Carolyn Ramos, MS, CRNP, a nurse practitioner based on the Surgical Intermediate Care (IMC) Unit.

Lately, NPs have been embraced by the Medical Center for hospital-based services, providing a more holistic approach for patients and an important resource for bedside nurses.

“The whole focus of the nurse practitioner is the patient,” says Mona Bahouth, MSN, CRNP, a nurse practitioner in neurology and special projects manager on the NP role for the Medical Center. In a teaching hospital where residents rotate, NPs offer a stabilizing force, Bahouth says.

“We prescribe medication, order tests and look at X-rays, much the way a physician would. But there is also that patient-centered focus and communication style that is in the tradition of nursing,” Bahouth says. “We’re the glue that makes the whole system work for the patient during a crisis.”

Bahouth came to the Medical Center in 1998 to join the Brain Attack Team. She gradually took on a leadership role in the growing network of nurse practitioners. The NPs now meet often to discuss clinical and professional issues.

The hospital has 76 NPs working in 61 different practice areas, from the Neo-natal ICU to medical and surgical floors and specialty areas such as interventional radiology, cardiac catheterization and intensive care units.“With continuing changes in the health care system, we expect these numbers to continue to grow in order to continue to meet the patient demands,” Bahouth says.

If a unit can be compared to a human cell, the NP would be in the nucleus.

“The patients come to us, and so do the family, the respiratory therapists,the physicians, the bedside nurses, the patient care managers and the bed managers,” says Ramos. “We provide that continuity of care.”

Upon admission to Surgical IMC, patients see the NP. “We help plan the care and eventual discharge, working with a multi-disciplinary team,” Ramos says. “We’re kind of the central go-to people for families, patients, nurses and even residents.” The nurse practitioners examine patients, following the medical model of assessment, treatment and follow-up care, Ramos says. They don’t do the day-to-day bedside nursing, but their care is very much in the nursing tradition.

“We look at the big picture,” says Barbara A. Miller, MS, CRNP, also anurse practitioner on Surgical IMC. “I think nurses tend to look at patients holistically.”

One of the key roles NPs play in the busy unit is to keep an eye on the use of its 10 beds, which are always in demand.

“We help facilitate the patient flow-through,” Ramos says. “We assess early in the day who might be able to move, and screen admissions to make sure the patient is appropriate for this unit.”

The patient flow through the Surgical IMC affects bed management throughout the hospital - sometimes requiring a surgeon to delay a procedure if the patient will need a high level of care post-operatively.

“It can hold up the OR if we’re full,” Ramos says.

In collaboration with the medical directors, the NPs have developed admission criteria for the unit.

“I think the role of nurse practitioners has been very well accepted,” Bahouth says. “When a service starts working with nurse practitioners, they usually say, ‘Why didn’t we do this sooner?’”

By Anne Haddad

This page was last updated on: August 20, 2007.

For more information about becoming a UMMC nurse practitioner and/or to apply visit the Nursing Careers at UMMC section of our Web site.