Effects of Professional Autonomy and Leadership Style on the Team-Based Practice of Acute Care Nurse Practitioners in Taiwan

• 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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Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2005.14.2.121 ◽

2005 ◽

Vol 14 (2) ◽

pp. 121-130 ◽

Cited By ~ 68

Author(s):

Leslie A. Hoffman ◽

Frederick J. Tasota ◽

Thomas G. Zullo ◽

Carmella Scharfenberg ◽

Michael P. Donahoe

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Acute Care ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Medical Intensive Care Unit ◽

Care Nurse ◽

Medical Intensive Care ◽

Acute Care Nurse Practitioner ◽

Attending Physician

• Background Many academic medical centers employ nurse practitioners as substitutes to provide care normally supplied by house staff.• Objective To compare outcomes in a subacute medical intensive care unit of patients managed by a team consisting of either an acute care nurse practitioner and an attending physician or an attending physician and critical care/pulmonary fellows.• Methods During a 31-month period, in 7-month blocks of time, 526 consecutive patients admitted to the unit for more than 24 hours were managed by one or the other of the teams. Patients managed by the 2 teams were compared for a variety of outcomes.• Results Patients managed by the 2 teams did not differ significantly for any workload, demographic, or medical condition variable. The patients also did not differ in readmission to the high acuity unit (P = .25) or subacute unit (P = .44) within 72 hours of discharge or in mortality with (P = .25) or without (P = .89) treatment limitations. Among patients who had multiple weaning trials, patients managed by the 2 teams did not differ in length of stay in the subacute unit (P = .42), duration of mechanical ventilation (P = .18), weaning status at time of discharge from the unit (P = .80), or disposition (P = .28). Acute Physiology Scores were significantly different over time (P = .046). Patients managed by the fellows had more reintubations (P=.02).• Conclusions In a subacute intensive care unit, management by the 2 teams produced equivalent outcomes.

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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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Implementation of the Acute Care Nurse Practitioner Role

AACN Advanced Critical Care ◽

10.4037/15597768-1994-3022 ◽

1994 ◽

Vol 5 (3) ◽

pp. 404-407

Author(s):

Lynn A. Kelso ◽

Lori M. Massaro

Keyword(s):

Acute Care ◽

Nurse Practitioners ◽

Nurse Practitioner ◽

Medical Center ◽

Care Nurse ◽

University Of Pittsburgh ◽

Acute Care Nurse Practitioner ◽

The University ◽

Pittsburgh Medical ◽

Practitioner Role

In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center arc described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.

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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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Addition of Acute Care Nurse Practitioners to Medical and Surgical Rapid Response Teams: A Pilot Project

Critical Care Nurse ◽

10.4037/ccn2014847 ◽

2014 ◽

Vol 34 (1) ◽

pp. 51-59 ◽

Cited By ~ 15

Author(s):

April N. Kapu ◽

Arthur P. Wheeler ◽

Byron Lee

Keyword(s):

Acute Care ◽

Nurse Practitioners ◽

Rapid Response Team ◽

Pilot Project ◽

Rapid Response ◽

Therapeutic Interventions ◽

Rapid Response Teams ◽

Care Nurse ◽

Response Team ◽

The Impact

BackgroundVanderbilt University Hospital’s original rapid response team included a critical care charge nurse and a respiratory therapist. A frequently identified barrier to care was the time delay between arrival of the rapid response team and arrival of the primary health care team.ObjectiveTo assess the impact of adding an acute care nurse practitioner to the rapid response team.MethodsAcute care nurse practitioners were added to surgical and medical rapid response teams in January 2011 to diagnose and order treatments on rapid response calls.ResultsIn 2011, the new teams responded to 898 calls, averaging 31.8 minutes per call. The most frequent diagnoses were respiratory distress (18%), postoperative pain (13%), hypotension (12%), and tachyarrhythmia (10%). The teams facilitated 360 transfers to intensive care and provided 3056 diagnostic and therapeutic interventions. Communication with the primary team was documented on 97% of the calls. Opportunities for process improvement were identified on 18% of the calls. After implementation, charge nurses were surveyed, with 96% expressing high satisfaction associated with enhanced service and quality.ConclusionsTeams led by nurse practitioners provide diagnostic expertise and treatment, facilitation of transfers, team communication, and education.

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