Background. Much controversy exists with the clinical (also known as practice) doctorate in the US. Nursing history shows a fragmentation about standards of education, and no consensus has existed for the doctorally prepared nurse in the practice setting. This inquiry describes the research process of one nursing student in a doctor of nursing program (ND), and the profound research outcomes obtained during the residency process.

  The research process occurred during the final residency year, and was an evaluation study of a comprehensive nurse case manager (NCM) program that was implemented to effect change in the emergency department (ED)—an area of healthcare facing many challenges.   Purpose. This quasi-experimental and descriptive study will evaluate the patient and organizational outcomes of a comprehensive NCM program in the ED as compared to pre-NCM program patient and organizational outcomes.

 

Methods. The ED NCM program was implemented in June 2004 in an urban Level II Trauma Center with significant patient volume. All variables were compared with pre- and post-program implementation measures.         Results/Outcomes.

1. Patients had between 1.8 and 3.2 less visits to the ED after a Care Plan was instituted by the NCM, on average an 81% decrease (n=32, α=0.05, p=0.00).
2. Patients had between $309.55 and $1394.32 less bad debt owed to the hospital, on average a 79% decrease (n=32, α=0.05, p=0.003).
3. Patients had between 0.8 and 1.6 less visits to the ED after a placement intervention (SNF, infusion center, hospice, sub-acute rehab, and home health) was instituted by the NCM, on average a 75% decrease (n=36, α=0.05, p=0.00).
4. Although not statistically significant, patient satisfaction in relation to “discharge procedures” in the ED increased on average by 2.5% (in comparison to 1.2% on the inpatient units) after the implementation of the ED NCM program.