Supplementing Intensivist Staffing With Nurse Practitioners: Literature Review

2017 ◽  
Vol 28 (2) ◽  
pp. 111-123 ◽  
Author(s):  
Tracie White ◽  
Justin Kokiousis ◽  
Stephanie Ensminger ◽  
Maria Shirey
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
The United States ◽  
Work Hours ◽  
Evidence Based ◽  
Intensive Care Unit Team ◽  
Staffing Model

In the United States, providing health care to critically ill patients is a challenge. An increase in patients older than 65 years, a decrease in critical care physicians, and a decrease in work hours for residents cause intensivist staffing issues. In this article, use of nurse practictioners to fill the intensive care unit intensivist staffing gap is assessed and evidence-based recommendations are identified to better incorporate nurse practitioners as part of intensive care unit intensivist staffing. The literature reveals that when nurse practitioners are part of a staffing model, outcomes are either positively impacted or no different from physician outcomes. However, successfully integrating nurse practitioners into an intensive care unit team is not adequately discussed in the literature. This gap is addressed and 3 mechanisms to integrate nurse practitioners into the intensive care unit are identified: (1) use of a multidisciplinary staffing model, (2) completion of onboarding programs, and (3) evaluation of nurse practitioner productivity.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

scholarly journals Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence

2018 ◽  
Vol 38 (6) ◽  
pp. e1-e4 ◽  
Author(s):  
Christina Canfield ◽  
Sandra Galvin
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Health Care Professionals ◽  
Health Care Organizations ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Perception Of Support ◽  
Evidence Based Care

Since 2010, health care organizations have rapidly adopted telemedicine as part of their health care delivery system to inpatients and outpatients. The application of telemedicine in the intensive care unit is often referred to as tele-ICU. In telemedicine, nurses, nurse practitioners, physicians, and other health care professionals provide patient monitoring and intervention from a remote location. Tele-ICU presence has demonstrated positive outcomes such as increased adherence to evidence-based care and improved perception of support at the bedside. Despite the successes, acceptance of tele-ICU varies. Known barriers to acceptance include perceptions of intrusiveness and invasion of privacy.

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

2005 ◽  
Vol 14 (2) ◽  
pp. 121-130 ◽  
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.

Critical Care Clinicians’ Knowledge of Evidence-Based Guidelines for Preventing Ventilator-Associated Pneumonia

2010 ◽  
Vol 19 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Mohamad F. El-Khatib ◽  
Salah Zeineldine ◽  
Chakib Ayoub ◽  
Ahmad Husari ◽  
Pierre K. Bou-Khalil
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Care Providers ◽  
Care Experience ◽  
Respiratory Therapists ◽  
Evidence Based Guidelines

Background Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.Objective To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.Methods Ten physicians, 41 nurses, and 18 respiratory therapists working in the intensive care unit of a major tertiary care university hospital center completed an anonymous questionnaire on 9 nonpharmacological guidelines for prevention of ventilator-associated pneumonia.Results The mean (SD) total scores of physicians, nurses, and respiratory therapists were 80.2% (11.4%), 78.1% (10.6%), and 80.5% (6%), respectively, with no significant differences between them. Furthermore, within each category of health care professionals, the scores of professionals with less than 5 years of intensive care experience did not differ significantly from the scores of professionals with more than 5 years of intensive care experience.Conclusions A health care delivery model that includes physicians, nurses, and respiratory therapists in the intensive care unit can result in an adequate level of knowledge on evidence-based nonpharmacological guidelines for the prevention of ventilator-associated pneumonia.

scholarly journals Institutional Challenges and Solutions to Evidence-Based, Patient-Centered Practice: Implementing ICU Diaries

2020 ◽  
Vol 40 (5) ◽  
pp. 47-56
Author(s):  
Julie Rogan ◽  
Megan Zielke ◽  
Kelly Drumright ◽  
Leanne M. Boehm
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
The United States ◽  
Evidence Based ◽  
Patient Privacy ◽  
Patient Centered ◽  
Barriers To Implementation ◽  
Institutional Challenges

Background Although diaries are an evidence-based practice that improves the quality of life of patients in an intensive care unit and their loved ones, centers in the United States are struggling to successfully implement diary programs in intensive care units. Currently, few published recommendations address how to facilitate implementation of a diary program, and how to effectively sustain it, in an intensive care unit. Objectives To discuss challenges with implementing diary programs in intensive care units at 2 institutions in the United States, and to identify solutions that were operationalized to overcome these perceived difficulties. Methods The teams from the 2 institutions identified local barriers to implementing diaries in their intensive care units. Both groups developed standard operating procedures that outlined the execution and evaluation phases of their implementation projects. Results Barriers to implementation include liability and patient privacy, diary program development, and implementation and sustainability concerns. Various strategies can help maintain clinical and family member engagement. Conclusion Through a team’s sustained dedication and a diligent assessment of perceived obstacles, a diary program can indeed be implemented within an intensive care unit.

scholarly journals Nurse Practitioners and Interdisciplinary Teams in Pediatric Critical Care

2018 ◽  
Vol 29 (2) ◽  
pp. 138-148 ◽  
Author(s):  
Kristin H. Gigli ◽  
Mary S. Dietrich ◽  
Peter I. Buerhaus ◽  
Ann F. Minnick
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Pediatric Intensive Care Unit ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Pediatric Intensive Care ◽  
Intensive Care Unit Nurse ◽  
Labor Inputs ◽  
Medical Directors

Objective: To describe the members of pediatric intensive care unit interdisciplinary provider teams and labor inputs, working conditions, and clinical practice of pediatric intensive care unit nurse practitioners. Methods: A national, quantitative, crosssectional, descriptive postal survey of pediatric intensive care unit medical directors and nurse practitioners was administered to gather information about provider-team members, pediatric intensive care unit nurse practitioner labor inputs, working conditions, and clinical practice. Descriptive statistics, cross-tabulations, and χ2 tests were used. Results: Responses from 97 pediatric intensive care unit medical directors and 59 pediatric intensive care unit nurse practitioners representing 126 institutions were received. Provider-team composition varied between institutions with and without nurse practitioners. Pediatric intensive care units employed an average of 3 full-time nurse practitioners; the average nurse practitioner-to-patient ratio was 1 to 5. The clinical practice reported by medical directors was consistent with practice reported by nurse practitioners. Conclusion: Nurse practitioners are integrated into interdisciplinary pediatric intensive care unit teams, but institutional variation in team composition exists. Investigating models of care contributes to the understanding of how models influence positive patient and organizational outcomes and may change future role implementation.

A Competency-Based Curriculum for Critical Care Nurse Practitioners’ Transition to Practice

2018 ◽  
Vol 27 (5) ◽  
pp. 398-406
Author(s):  
R. Scott Kopf ◽  
Penni I. Watts ◽  
Eileen S. Meyer ◽  
Jacqueline A. Moss
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nurse Practitioners ◽  
Qualitative Data ◽  
The United States ◽  
New Graduate Nurse ◽  
New Graduates ◽  
Graduate Nurse ◽  
New Graduate ◽  
Competency Based

Background Nearly one-third of new-graduate nurse practitioners report undergoing no formal orientation process, and postcertification orientation processes vary. A validated curriculum would address the need for structured training to enhance new graduates’ practice transition. Methods A competency-based practice transition curriculum for intensive care unit nurse practitioners was created using a literature review and expert panels. Competencies were established that were based on clinical categories essential to nurse practitioner practice in the intensive care unit and adapted from existing Accreditation Council for Graduate Medical Education training, aligned with the precertification nursing curriculum. Participants recruited from academic and clinical backgrounds were asked to rank curriculum items using a 4-point Likert scale. Competencies were refined on the basis of participants’ survey feedback. Results A total of 31 participants from academic medical centers and schools of nursing throughout the United States responded to the request for competency validation; 29% of participants provided qualitative data. All 9 competency topics received a mean rating greater than 3.5 and were deemed valid. Using the combined quantitative and qualitative data, a final set of competencies for nurse practitioners in the intensive care unit was developed. Conclusions The curriculum developed and validated in this study can become the basis for practice transition for novice nurse practitioners. The curriculum is adaptable and can be used for surgical and medical intensive care units. As refined, the competencies provide a validated foundation for training of new-graduate nurse practitioners in the intensive care unit.

Preventing Surgical Site Infections Related to Abdominal Drains in the Intensive Care Unit

2018 ◽  
Vol 38 (4) ◽  
pp. 20-26 ◽  
Author(s):  
Krystal Orth
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Surgical Site Infections ◽  
Nursing Interventions ◽  
Evidence Based ◽  
Health Care Associated Infections ◽  
Immunocompromised State ◽  
Practice Literature ◽  
Drain Management

Surgical site infections are significant contributors to health care–associated infections. Nursing interventions may help decrease the incidence of surgical site infections, particularly in regards to the management of postsurgical abdominal drains. This comprehensive guide, compiled from evidence-based practice literature, is intended for nurses to use to reduce surgical site infections secondary to postsurgical abdominal drains. This article focuses on drain management in intensive care unit patients, who are at risk for infection because of their immunocompromised state.

Parameters of bed occupancy of intensive care units in Hungary

2011 ◽  
Vol 152 (24) ◽  
pp. 946-950 ◽  
Author(s):  
Miklós Gresz
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Insurance ◽  
Intensive Care Units ◽  
Emergency Care ◽  
Present Author ◽  
Bed Occupancy ◽  
National Network ◽  
Bed Capacity

According to the Semmelweis Plan for Saving Health Care, ”the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present”. Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed. Orv. Hetil., 2011, 152, 946–950.

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