Acute Care Nurse Practitioners and Physician Assistants in Critical Care

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

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Perceptions of Physicians, Nurses, and Respiratory Therapists About the Role of Acute Care Nurse Practitioners

American Journal of Critical Care ◽

10.4037/ajcc2004.13.6.480 ◽

2004 ◽

Vol 13 (6) ◽

pp. 480-488 ◽

Cited By ~ 30

Author(s):

Leslie A. Hoffman ◽

Mary Beth Happ ◽

Carmella Scharfenberg ◽

Dana DiVirgilio-Thomas ◽

Frederick J. Tasota

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Medical Management ◽

Management Teams ◽

Care Nurse ◽

Respiratory Therapists ◽

Attending Physicians ◽

Weaning Protocols ◽

Family Focus

• Background Information about the contributions of acute care nurse practitioners to medical management teams in critical care settings is limited.• Objective To examine contributions of acute care nurse practitioners to medical management of critically ill patients from the perspectives of 3 disciplines: medicine, respiratory care, and nursing.• Methods Attending physicians, respiratory therapists, and nurses in 2 intensive care units were asked to list 3 advantages and 3 disadvantages of collaborative care provided by acute care nurse practitioners. Qualitative methods (coding/constant comparative analysis) were used to identify common themes and subthemes. Overall response rate was 35% (from 69% for attending physicians to 26% for nurses).• Results Responses were grouped into 4 main themes: accessibility, competence/knowledge, care coordination/communication, and system issues. Acute care nurse practitioners were valued for their accessibility, expertise in routine daily management of patients, and ability to meet patient/family needs, especially for “long-stay” patients. Also, they were respected for their commitment to providing quality care and for their communication skills, exemplified through teaching of nursing staff, patient/family involvement, and fluency in weaning protocols. Physicians valued acute care nurse practitioners’ continuity of care, patient/family focus, and commitment. Nurses valued their accessibility, commitment, and patient/family focus. Respiratory therapists valued their accessibility, commitment, and consistency in implementing weaning protocols.• Conclusion Responses reflected unique advantages of acute care nurse practitioners as members of medical management teams in critical care settings. Despite perceptions of the acute care nurse practitioner’s role as medically oriented, the themes reflect a clear nursing focus.

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A collaborative program for advanced practice in trauma/critical care nursing

Critical Care Nurse ◽

10.4037/ccn1996.16.2.120 ◽

1996 ◽

Vol 16 (2) ◽

pp. 120-127 ◽

Cited By ~ 3

Author(s):

V Keough ◽

J Jennrich ◽

K Holm ◽

W Marshall

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Practice Nurse ◽

Tertiary Care ◽

Standards Of Care ◽

Advanced Practice ◽

Advanced Practice Nurse ◽

Care Nurse

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.

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Acute Care Nurse Practitioners in Oncologic Critical Care: The Memorial Sloan-Kettering Cancer Center Experience

Critical Care Clinics ◽

10.1016/j.ccc.2009.09.003 ◽

2010 ◽

Vol 26 (1) ◽

pp. 207-217 ◽

Cited By ~ 28

Author(s):

Rhonda D'Agostino ◽

Neil A. Halpern

Keyword(s):

Critical Care ◽

Acute Care ◽

Nurse Practitioners ◽

Cancer Center ◽

Care Nurse

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Care activities and outcomes of patients cared for by acute care nurse practitioners, physician assistants, and resident physicians: a comparison

American Journal of Critical Care ◽

10.4037/ajcc1998.7.4.267 ◽

1998 ◽

Vol 7 (4) ◽

pp. 267-281 ◽

Cited By ~ 92

Author(s):

EB Rudy ◽

LJ Davidson ◽

B Daly ◽

JM Clochesy ◽

S Sereika ◽

...

Keyword(s):

Social History ◽

Acute Care ◽

Nurse Practitioners ◽

Active Role ◽

Physician Assistants ◽

Daily Activities ◽

Invasive Procedures ◽

Care Nurse ◽

Resident Physicians ◽

Period Data

BACKGROUND: Little information is available on the practice of acute care nurse practitioners and physician assistants in acute care settings. OBJECTIVES: To compare the care activities performed by acute care nurse practitioners and physician assistants and the outcomes of their patients with the care activities and patients' outcomes of resident physicians. METHODS: Sixteen acute care nurse practitioners and physician assistants and a matched group of resident physicians were studied during a 14-month period. Data on the subjects' daily activities and on patients' outcomes were collected 4 times. RESULTS: Compared with the acute care nurse practitioners and physician assistants, residents cared for patients who were older and sicker, cared for more patients, worked more hours, took a more active role in patient rounds, and spent more time in lectures and conferences. The nurse practitioners and physician assistants were more likely than the residents to discuss patients with bedside nurses and to interact with patients' families. They also spent more time in research and administrative activities. Few of the acute care nurse practitioners and physician assistants performed invasive procedures on a regular basis. Outcomes were assessed for 187 patients treated by the acute care nurse practitioners and physician assistants and for 202 patients treated by the resident physicians. Outcomes did not differ markedly for patients treated by either group. The acute care nurse practitioners and physician assistants were more likely than the residents to include patients' social history in the admission notes. CONCLUSIONS: The tasks and activities performed by acute care nurse practitioners and physician assistants are similar to those performed by resident physicians. However, residents treat patients who are sicker and older than those treated by acute care nurse practitioners and physician assistants. Patients' outcomes are similar for both groups of subjects.

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