ENERO 2018 N° 1 Volumen 8

Advanced Practice Nurses to improve the outcomes in hospitalized patients: a systematic review

Section: Reviews

How to quote

Riviotta Amy L, Galiano A. Enfermeras de práctica avanzada para mejorar los resultados de los pacientes hospitalizados: una revisión sistemática. Rev. iberoam. educ. investi. Enferm. 2018; 8(1):48-61.


1 Amy L Riviotta, 2 Alejandra Galiano 


1 Enfermera docente, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo. Bachelor of Science in Nursing, Registered Nurse. Magíster en Práctica Avanzada de Enfermería. Santiago, Chile.2 Enfermera. Magíster en Salud Pública. Coordinadora de Investigación de Clínica Universidad de los Andes. Santiago, Chile.

Contact email: a.riviotta@udd.cl


The concept of Advanced Practice Nurses first appeared over 50 years ago in North America, due to the need for more highly-qualified professionals to assist with patient care and management, thus improving the quality of care. Its success has led to an international growth of the profession, with evidence of good outcomes in Primary Care. A systematic review was conducted in order to search for evidence supporting the incorporation of Advanced Practice Nurses in healthcare teams, to achieve an improvement in the outcomes of hospitalized patients. There was a search for research articles, without date limitations, in six major databases. In the first selection, 18,346 articles were found; after applying different screening criteria in terms of title, abstract and selection and exclusion criteria, 19 articles were retrieved: seven clinical trials, nine observational studies, and three reviews. Article selection criteria for critical analysis were established, and the analysis was conducted with a modified Jadad Scale. Outcomes from all studies showed evidence that the use of Advanced Practice Nurses in the hospital setting, either alone or in collaboration with medical teams, does not compromise the outcomes in hospitalized patients, and can even improve mortality and morbidity rates, reduce days of hospitalization and costs, and increase patient satisfaction. The incorporation of Advanced Practice Nurses to healthcare teams could be considered in order to reduce costs and improve the access and quality of healthcare in Latin America.


advanced practice nursing; evaluation of outcomes (healthcare); quality of healthcare; clinical nurses; practicing nurses; hospitalization

Versión en Español


Enfermeras de práctica avanzada para mejorar los resultados de los pacientes hospitalizados: una revisión sistemática

Artículo completo no disponible en este idioma / Full article is not available in this language


  1. International Council of Nurses. ICN Nurse Practitioner/Advanced Practice Nursing Network. [internet]. [cited 21 dic 2017]. Available from: http://international.aanp.org/Practice/APNRoles
  2. American Nurses Association. Advanced Practice Nurses [internet]. [cited 21 dic 2017]. Available from: http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses
  3. National Council of State Boards of Nursing. APRNs in the U.S. [internet]. [cited 21 dic 2017]. Available from: https://www.ncsbn.org/aprn.htm
  4. Canadian Nurses Association. Advanced Practice Nursing: A National Framework [internet]. [cited 21 dic 2017]. Available from: https://cna-aiic.ca/~/media/cna/page-content/pdf-en/anp_national_framework_e.pdf
  5. Leyva-Moral JM. La enfermería de práctica avanzada: un futuro no muy lejano. Rev ROL Enferm [internet] 2012 [citado 21 dic 2017]; 35(1):4. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=3811999
  6. Sheer B, Wong FK. The development of advanced nursing practice globally. J Nurs Scholarsh. 2008; 40(3):204-11.
  7. American Nurses Association. Advanced practice nursing: a new age in health care. American Nurses Association Backgrounder 2011 [internet]. [cited 21 dic 2017]. Available from: http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/MediaBackgrounders/APRN-A-New-Age-in-Health-Care.pdf
  8. Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY, Cleary P, et al. Primary care outcomes in patients treated by nurse practitioners or physicians. JAMA [internet]. 2000 [cited 21 dic 2017]; 283(1):58-68.
  9. Arts EE, Landewe-Cleuren SA, Schaper NC, Vrijhoef HJ. The cost-effectiveness of substituting physicians with diabetes nurse specialists: a randomized controlled trial with 2-year follow-up. J Adv Nurs. 2011; 68(6):1224-34.
  10. Dierick-van Daele AT, Metsemakers JF, Derckx EW, Spreeuwenberg C, Vrijhoef HJ. Nurse practitioners substituting for general practitioners: randomized controlled trial. J Adv Nurs [internet]. 2009 [cited 2015 May 3]; 65(2):391-401. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19191937
  11. Ingersoll GL. Evaluating the impact of a clinical nurse specialist. Clin Nurse Spec [internet].1988 [cited 21 dic 2017]; 2(3):150-5. Available from: http://journals.lww.com/cns-journal/Abstract/1988/00230/Evaluating_the_Impact_of_a_Clinical_Nurse.12.aspx
  12. Brassard A. Making the case for NP’s as primary care providers. AM Nurse [internet]. 2013 [cited 21 dic 2017]. Available from: http://www.theamericannurse.org/index.php/2013/07/01/making-the-case-for-nps-as-primary-care-providers/
  13. Institute of Medicine of the National Academies. The Future of Nursing: Leading Change, Advancing Health.  
    [internet]. Washington DC: The National Academies Press; 2011. [cited 21 dic 2017]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209880/
  14. Cassiani SD, Zug KE. The advanced practice nursing role in Latin America: challenges, opportunities and implications for universal health coverage. Investig Enferm Imagen Desarr [internet]. 2015 [cited 21 dic 2017]; 17(1):9-11.
  15. Pan American Health Organization. Human Resources for Health: Increasing Access to Qualified Health Workers in Primary Health Care-Bases Health Systems. Resolution CD52. R13. 52nd Directing Council. 5th Session of the Regional Committee.  [internet]. Washington DC: 2013. [cited 21 dic 2017]. Available from: http://apps.who.int/iris/handle/10665/168036
  16. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds JM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clin Trials. 1996; 17:1-12.
  17. Newhouse R, Stanik-Hutt J, White K, Johantgen M, Bass E, Zangaro G, et al. Advanced practice nurse outcomes 1990-2008: a systematic review. Nurs Econ [internet]. 2011 [cited 21 dic 2017]; 29(5):230-50. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22372080
  18. Cowan MJ, Shapiro M, Hays RD, Afifi A. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Adm [internet]. 2006 [cited 21 dic 2017]; 36(2):79-85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16528149
  19. Ettner SL, Kotlerman J, Afifi A, Vazirani S, Hays RD, Shapiro M, et al. An alternative approach to reducing the costs of patient care? A controlled trial of the multi-disciplinary doctor-nurse practitioner (MDNP) model. Meds Decis Making [internet]. 2006 [cited 21 dic 2017]; 26(1):9-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16495196
  20. Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Effect of a nurse team coordinator on outcomes for hospitalized medicine patients. Am J Med [internet]. 2005 [cited 21 dic 2017]; 118(10):1148-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16194647
  21. Hoffman LA, Tasota FJ, Zullo TG, Scharfenberg C, Donahoe MP. Outcomes of care managed by an Acute Care Nurse Practitioner/Attending Physician team in a subacute medical intensive care unit. Am J Crit Care [internet]. 2005 [cited 21 dic 2017]; 14(2):121-30. Available from: http://ajcc.aacnjournals.org/content/14/2/121.long
  22. Ploro MH, Landefeld S, Brennan PF, Daly B, Fortineky RH, Kim U, et al. Outcomes-based trial of an inpatient nurse practitioner service for general medical patients. J Eval Clin Pract [internet]. 2001 [cited 21 dic 2017]; 7(1):21-33. Available from: http://www.mc.vanderbilt.edu/documents/CAPNAH/files/Mentoring/Section%205/Outcomes%20based%20trial%20of%20Inpt_NP%20Svc%20for%20Gen_Med_Pts.pdf
  23. Goldie C, Prodan-Bhalla N, Mackay M. Nurse practitioners in postoperative cardiac surgery: are they effective? Can J Cardiovasc Nurs [internet]. 2012 [cited 21 dic 2017]; 22(4):8-15. Available from: https://www.researchgate.net/publication/236044361_Nurse_practitioners_in_postoperative_cardiac_surgery_are_they_effective
  24. Mitchell-DiCenso A, Guyatt G, Marrin M, Goeree R, Willan A, Southwell D, et al. A controlled trial of nurse practitioners in neonatal intensive care. Pediatrics [internet]. 1996 [cited 21 dic 2017]; 98(6):1143-8. Available from: http://pediatrics.aappublications.org/content/98/6/1143.long?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token
  25. McMullen M, Alexander MK, Bourgeois A, Goodman L. Evaluating a nurse practitioner service. Dimensions of Critical Care Nursing [internet]. 2001 [cited 21 dic 2017]; 20(5):30-4. Available from: http://journals.lww.com/
  26. Sise BC, Sise MJ, Kelley DM, Walker SB, Calvo RY, Shackford SR, et al. Resource commitment to improve outcomes and increase value at a level I trauma center. J Trauma. 2011; 70(3):560-68.
  27. Skinner H, Skoyles J, Redfearn S, Jutley R, Mitchell I, Richens D. Advanced care nurse practitioners can safely provide sole resident cover for level three patients: impact on outcomes, cost and work patterns in a cardiac surgery programme. Eur J Cardiothorac Surg. 2013; 43(1):19-22.
  28. Kapu AN, Kleinpell R, Pilon B. Quality and financial impact of adding nurse practitioners to inpatient care teams. J Nurs Adm. 2014; 44(2):87-96.
  29. Morris DS, Reilly P, Rohrbach J, Telford G, Kim P, Sims CA. The Influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma. J Trauma Acute Care Surg. 2012; 73(2):474-78.
  30. Southey D, Mishra PK, Nevill A, Aktuerk D, Luckraz H. Continuity of care by cardiothoracic nurse practitioners: impact on outcome. Asian Cardiovasc Thorac Ann. 2014; 22(8):944-7.
  31. Lambing AY, Adams DL, Fox DH, Divine G. Nurse practitioners' and physicians' care activities and clinical outcomes with an inpatient geriatric population. J Am Acad Nurse Pract. 2004; 16(8):343-52.
  32. Meyer SC, Miers LJ. Cardiovascular surgeon and acute care nurse practitioner: collaboration on postoperative outcomes. AACN Clin Issues [internet]. 2005 [cited 21 dic 2017]; 16(2):149-58. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15876882
  33. Collins N, Miller R, Kapu A, Martin R, Morton M, Forrester M, et al. Outcomes of adding acute care nurse practitioners to a Level I trauma service with the goal of decreased length of stay and improved physician and nursing satisfaction. J Trauma Acute Care Surg [internet]. 2014 [cited 21 dic 2017]; 76(2):353-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24398767
  34. Edkins RE, Cairns BA, Hultman SC. A Systematic Review of Advanced Practice Providers in Acute Care options for a new model in a burn intensive care unit. Ann Plast Surg [internet]. 2014 [cited 21 dic 2017]; 72(5):1-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24509138
  35. Fry M. Literature review of the impact of nurse practitioners in critical care services. Nurs Crit care [internet]. 2011 [cited 21 dic 2017]; 16(2):58-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21299758
  36. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ [internet]. 2002 [cited 21 dic 2017]; 324:819. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11934775
  37. Laurant M, Reeves D, Hermens R, Braspenning J, Grol R, Sibbald B. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Reviews [internet]. 2005 [cited 21 dic 2017]; 18:(2):CD001271. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15846614