Registed Nurses' Association of Ontario

Publications & Resources

Nurse Practitioner Hospital Inpatient Practice Elements

NPs manage and provide care for both inpatient and outpatient populations, collaborating and consulting with physician colleagues and the inter-professional team as needed to address patient care needs. Treatment and discharge planning is one of several components within a comprehensive plan of care that is developed by NPs in consultation with the inter-professional team in the hospital setting. Currently, collaboration focuses on treatment and discharge with admission to follow July 1, 2012.

A central part of the NP role is to actively involve patients and families in the process of developing a therapeutic plan of care and monitoring patients' response of treatment progress towards specific goals. NPs assess patients' and their readiness for discharge throughout the hospital stay and work with inter-professional care teams to ensure discharge arrangements align with a safe transfer of accountability to the primary (or other) care provider.

NP accountabilities for treatment and discharge vary in different settings. Depending on both the complexity of coordinating the discharge or transition as well as access to members of the inter-professional teams (that may or may not include discharge planners), treatment and discharge may include:

  • Comprehensive care planning, treatment and assessment of readiness for discharge,
  • Plan to transfer care to the right provider, at the right time, to the right place,
  • Development and communication of the discharge plan with patients, families and the inter-professional team,
  • Communication of transfer of accountability to another care setting / care provider or coordination of care services in the community,
  • Writing the discharge order and completing the prescriptions and appropriate chart documentation (e.g., health record summary), and
  • Medication reconciliation.

NPs in many areas are already performing many of these functions through cumbersome “work arounds”, using medical directives to meet patient and system requirements. Hospital adoption of NP treatment and discharge enables NPs to focus on more direct processes that improve the effectiveness and efficiency of discharge while ensuring full accountability during the discharge process. Hospitals have an ideal opportunity to use this formal legislative authority to maximize the scope of NPs practice contributions and to explore innovative ways to improve admit, treat and improve inpatient processes within the inter-professional team.

When preparing for adoption of NP authority, organizations should examine existing admission, treatment and discharge practices and consider how adoption of NP authority could increase the efficiency and effectiveness of current care processes. Hospitals should examine the role and accountabilities of all healthcare team members and clearly identify the NP role and responsibilities within their own particular inter-professional teams. Key Questions for Hospitals to Consider when Implementing NP Inpatient Authority, are provided within this toolkit. Similarly, Tools for NP Implementation, which facilitate inpatient care processes and include discharge check lists, care maps, and other forms of tracking tools, are also included in this Toolkit. These tools compare patient's progress to established goals in their health record. Such leading practices keep the entire healthcare team aware of each patient's readiness for transfer of care to another provider and discharge from the hospital setting.