“The Impact of Nurse Practitioner Services on Cost…”: Article Critique


The objective of the reviewed study is clear. The research attempts to determine the influence of the services delivered by the nursing practitioners on such aspects of health care quality as cost, patient experience, and satisfaction (Jennings, Clifford, Fox, O’Connell, & Gardner, 2015). The study is significant as it is designed to cover some of the most important sides of the health care services quality and client response. The research can make a practical contribution improving the correlation of the health care services’ expenditures and their quality. Besides, it may reveal some of the factors that contribute to the client satisfaction in nursing.


The introduction of the article is preceded by two more paragraphs that outline the research that has been accomplished prior to the reviewed study as well as the contribution of the research to the field of nursing. The introduction itself is rather brief. It begins with the problem statement (the growth of the demand for the emergency department services) that is confirmed by a number of researches the author is referring to. Further, the introduction moves on to the recognized solution of the problem, the addition of the emergency nurse practitioner services. The introduction also presents the main goal of the reviewed study – to evaluate the effectiveness of the emergency nurse practitioner services (Jennings et al., 2015).The introduction is well-organized and to the point.

Literature Review

The study lacks a section called “Literature Review”. The “Background” section contains the information about the previous research and literature review. The background does not contain the descriptions of the works studied by the authors before and during the research. Instead, it provides a deep and detailed description of the existing situation in the field of nursing when it comes to the role of the nurse practitioners, the settings the have to work in, the access of care to the patients. That way, the information the authors obtained from the previous researches, as well as their findings are incorporated into that background section. The works written prior to the reviewed study are synthesized and analyzed. Each of the claims or statements made by the authors is supported by a reference to at least one source. Most of the sources reviewed and used by the authors are quite recent (less than ten years old). The only time when Jennings and colleagues refer to works of the end of the 1990s is when they need to confirm the persistence of the issues they discuss throughout that time. The section does not only present and describe the researched issue, it also points out the gap in the research concerning the effectiveness of the nurse practitioners emphasizing the importance of the study (Jennings et al., 2015).


The method used in the study is systematic review; this means that the team of researchers collected, processed and analyzed a variety of individual studies in order to evaluate the effectiveness of the emergency nurse practitioner services (Jennings et al., 2015). The researchers obtained evidence by means of studying the works of the earlier years and the ones written recently. The study of Jennings and colleagues includes sources dated back to the beginning of the 2000s, as well as the ones from 2013. The information gathered by the researchers was presented through the narrative analysis to provide a better evaluation (Jennings et al., 2015). Besides, since the studied located and processed by the authors were very diverse and could not be compared using a set of fixed criteria, the researchers added a narrative synthesis of the findings followed by a quantitative summary of the obtained results. These are the methodological components presented by the authors. The tools used by Jennings and the team of authors included the Review Instrument (JBIMAStARI) and critical appraisal tools.

The researchers demonstrated that they followed the outlined methods by using a study protocol and the plan of the analysis of the works. Besides, the literature processed by the authors was selected based on a set of inclusion and exclusion conditions. Further, the appropriate studies (both published and unpublished) were searched in various databases (MEDLINE, CINAHL, Embase, and Cochrane) with the help of a tree-step search process and MeSH keywords and terminology (using thesaurus options and synonyms) (Jennings et al., 2015).


The article under analysis is a systematic review, which means that the “participants” in this study were not human beings, but researches and papers. The authors of the article selected and gathered the studies written within the last ten years related to the subject of the effectiveness of the emergency nurse practitioner services. This was done to study the findings of these works and evaluate the current problems and the way they are being addressed. The studies for the research were searched with the help of several databases such as MEDLINE, CINAHL, Embase, and Cochrane, as well as Google search. The works suitable for the research were located by means of application of a number of criteria to detect whether or not the studies were relevant. The sampled works (both published and unpublished) had to be written in the English language. The articles were selected based on their inclusion of the term “nurse practitioner” or its synonyms. Initially, the team of researchers found over a thousand articles that were subsequently reviewed by one of the authors as for their relevance to the subject of the research. The following stages sorted out most of the works. Finally, fourteen papers were deemed as suitable. The sampling method used by Jennings and the team of researchers is non-random, and the size of the sample is rather small, which answers the features of the qualitative sampling procedures.

Data Collection

The data contained in each of the fourteen reviewed studies was sorted based on a set of aspects (aims, data collection methods, participants, and outcomes). This strategy is useful as it helped the researchers outline the common aspects of very different works; and this ensures the deeper understanding of the purposes and findings of the studies, their objectives and the contribution they make to the research. The reviewers were working in turns so that the work of one author was checked by the next one for better accuracy.

Data Analysis

The information selected from each of the reviewed papers is presented in a form of a table so that the reader can follow the process of extraction and analysis. Further, the conclusions based on the findings of each study were made.


The findings of the review are presented divided into several parts corresponding with the goals of the study – cost, quality of care, waiting time, and satisfaction. Discussing each of the aspects, the authors synthesize the information obtained from the review with the previous research.

Conclusion and Implications

The authors present a discussion of the synthesized results and explain how they relate to the practical reality. For example, the researcher emphasize that the aspect of cost-effectiveness of the emergency nurse practitioners’ services is the most practically important when it comes to role assignment and workplace planning (Jennings et al., 2015). At the same time, the authors mention that a focused research of this specific topic needs to be conducted to obtain more detailed information (Jennings et al., 2015). The researchers also discuss the limitations of their systematic review that was short of available research papers to examine the problem in a more thorough manner. That is why Jennings and colleagues had to stick to just a few categories perceived as the nursing care effectiveness determiners.

Overall Critique

The article by Jennings et al. (2015) is a systematic review that targeted the researchers written within the past ten years directed at the analysis of the effectiveness of the emergency nurse practitioner services through analyzing such factors as cost, quality, patient satisfaction, and waiting time. The article provides a clear presentation of the background research and the subject in general. It also describes the data collection and analysis processes in detail and delivers a thoughtful discussion of the findings and their practical implications. The outlay of the study is clear and easy to comprehend, and the subject is important.


Jennings, N., Clifford, S., Fox, A. R., O’Connell, J., & Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review. International Journal of Nursing Studies, 52, 421–435.

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