3B A Role for NPs in the ICU A Role for NPs in the ICU.pdf · A Role for Nurse Practitioners in the ICU: ... • The expanded role provides professionalThe expanded role provides

A Role for Nurse A Role for Nurse Practitioners in the ICU: Practitioners in the ICU: Ad ti f ChAd ti f ChAdvocating for ChangeAdvocating for Change

Sarah Crowe, RN, MN, CNCC(C)Sarah Crowe, RN, MN, CNCC(C)

Why?Why?Why?Why?•• Many regions of Canada and many areas in theMany regions of Canada and many areas in theMany regions of Canada, and many areas in the Many regions of Canada, and many areas in the

hospital already have nurse practitioners as part hospital already have nurse practitioners as part of their teams; for those areas that do not utilizeof their teams; for those areas that do not utilizeof their teams; for those areas that do not utilize of their teams; for those areas that do not utilize Nurse Practitioners in the Intensive Care Unit, Nurse Practitioners in the Intensive Care Unit, why now?why now?why now?why now?

•• The dynamic state of critical care along withThe dynamic state of critical care along withThe dynamic state of critical care, along with The dynamic state of critical care, along with increased demand for services often leaves the increased demand for services often leaves the multidisciplinary team struggling to manage theirmultidisciplinary team struggling to manage theirmultidisciplinary team struggling to manage their multidisciplinary team struggling to manage their patients while ensuring availability and patients while ensuring availability and excellence is provided to allexcellence is provided to allexcellence is provided to all.excellence is provided to all.

Why Nurse Practitioners?Why Nurse Practitioners?Why Nurse Practitioners?Why Nurse Practitioners?

•• The aging patient population, limited resources, and The aging patient population, limited resources, and g g p p p , ,g g p p p , ,increasing complexity and acuity of patients requires increasing complexity and acuity of patients requires that we look at new and imaginative ideas to ensure all that we look at new and imaginative ideas to ensure all p ti t h t mpr h i ppr pri tp ti t h t mpr h i ppr pri tpatients have access to comprehensive, appropriate, patients have access to comprehensive, appropriate, universal care.universal care.

•• As highly specialized ICU nurses one way we canAs highly specialized ICU nurses one way we canAs highly specialized ICU nurses one way we can As highly specialized ICU nurses one way we can advocate for our patients, is by advocating for advocate for our patients, is by advocating for ourselves. Training ICU nurses to be acute care nurse ourselves. Training ICU nurses to be acute care nurse

i i (ACNP ) i i i d ill h lli i (ACNP ) i i i d ill h llpractitioners (ACNPs) is innovative and will challenge practitioners (ACNPs) is innovative and will challenge the existing boundaries of existing nursing practice and the existing boundaries of existing nursing practice and current health care delivery in many areas.current health care delivery in many areas.y yy y

•• Nursing has recognized that the needs of acutelyNursing has recognized that the needs of acutelyNursing has recognized that the needs of acutely Nursing has recognized that the needs of acutely ill patients are not being adequately met, and ill patients are not being adequately met, and that NPs have a scope of practice that ifthat NPs have a scope of practice that ifthat NPs have a scope of practice that if that NPs have a scope of practice that if maximized can meet the needs of the patient, maximized can meet the needs of the patient, the medical system and the needs of nursesthe medical system and the needs of nursesthe medical system, and the needs of nurses.the medical system, and the needs of nurses.

•• (Becker, Kaplow, Muenzen, & Hartigan, 2006). (Becker, Kaplow, Muenzen, & Hartigan, 2006).

The Role of the ACNP in the ICUThe Role of the ACNP in the ICUThe Role of the ACNP in the ICUThe Role of the ACNP in the ICU

•• NPs are “registered nurses with additionalNPs are “registered nurses with additionalNPs are registered nurses with additional NPs are registered nurses with additional educational preparation and experience who educational preparation and experience who possess and demonstrate the competencies topossess and demonstrate the competencies topossess and demonstrate the competencies to possess and demonstrate the competencies to autonomously diagnose, order, and interpret autonomously diagnose, order, and interpret diagnostic tests prescribe pharmaceuticals anddiagnostic tests prescribe pharmaceuticals anddiagnostic tests, prescribe pharmaceuticals, and diagnostic tests, prescribe pharmaceuticals, and perform specific procedures within their perform specific procedures within their legislative scope of practice” (CNA 2009)legislative scope of practice” (CNA 2009)legislative scope of practice (CNA, 2009).legislative scope of practice (CNA, 2009).

NPs in the ICUNPs in the ICUNPs in the ICUNPs in the ICU

•• Perform consultations / receive referralsPerform consultations / receive referrals//•• Research patient historiesResearch patient histories•• Perform physical examsPerform physical examsp yp y•• Order & interpret diagnostic testsOrder & interpret diagnostic tests•• Prescribe medicationsPrescribe medications•• Coordinate patient careCoordinate patient care•• Make referrals to & collaborate with other specialists as Make referrals to & collaborate with other specialists as

neededneeded•• Meet with familiesMeet with families

NPs in the ICUNPs in the ICUNPs in the ICUNPs in the ICU

•• With appropriate training ACNPs can also beWith appropriate training ACNPs can also beWith appropriate training ACNPs can also be With appropriate training ACNPs can also be trained to perform advanced skills such as:trained to perform advanced skills such as:

Chest tube insertionsChest tube insertions–– Chest tube insertionsChest tube insertions–– Arterial puncturesArterial punctures

Central eno s catheter insertionsCentral eno s catheter insertions–– Central venous catheter insertionsCentral venous catheter insertions–– IntubationsIntubations

V ilV il–– Ventilator management Ventilator management –– Many other advanced skillsMany other advanced skills

The Benefits of ACNPs in the ICUThe Benefits of ACNPs in the ICUThe Benefits of ACNPs in the ICUThe Benefits of ACNPs in the ICU

•• There are many different benefits that supportThere are many different benefits that supportThere are many different benefits that support There are many different benefits that support the introduction of ACNPs into the ICU.the introduction of ACNPs into the ICU.

•• The benefits can be divided into two mainThe benefits can be divided into two main•• The benefits can be divided into two main The benefits can be divided into two main groups: professional benefits to nursing, and the groups: professional benefits to nursing, and the direct benefits to the patient populationdirect benefits to the patient populationdirect benefits to the patient population.direct benefits to the patient population.

Professional EmpowermentProfessional EmpowermentProfessional EmpowermentProfessional Empowerment

•• ACNPs allow nurses to have a voice and a scopeACNPs allow nurses to have a voice and a scopeACNPs allow nurses to have a voice and a scope ACNPs allow nurses to have a voice and a scope of practice that reflects their knowledge and of practice that reflects their knowledge and experience baseexperience baseexperience base.experience base.

•• The role of the ACNP is highly autonomous, The role of the ACNP is highly autonomous, maximizing the knowledge and skill setmaximizing the knowledge and skill setmaximizing the knowledge and skill set maximizing the knowledge and skill set possessed by such individuals to manage acutely possessed by such individuals to manage acutely ill patients and as a result contribute to theill patients and as a result contribute to theill patients and as a result contribute to the ill patients and as a result contribute to the advancement of the professionadvancement of the profession


•• The expanded role provides professionalThe expanded role provides professionalThe expanded role provides professional The expanded role provides professional autonomy in clinical practice, clinical leadership, autonomy in clinical practice, clinical leadership, and allows for growth enabling nurses toand allows for growth enabling nurses toand allows for growth enabling nurses to and allows for growth enabling nurses to become expert practitioners and researchers in become expert practitioners and researchers in the area of critical carethe area of critical carethe area of critical care.the area of critical care.


•• ICU nurses that have worked with an ACNP haveICU nurses that have worked with an ACNP haveICU nurses that have worked with an ACNP have ICU nurses that have worked with an ACNP have described an increase in their personal knowledge base, described an increase in their personal knowledge base, an increase in their level of job satisfaction, and also an an increase in their level of job satisfaction, and also an improved sense of support for clinical decision making.improved sense of support for clinical decision making.

•• Studies have indicated that bedside critical care nurses Studies have indicated that bedside critical care nurses found sharing their concerns and ideas surrounding found sharing their concerns and ideas surrounding patient care easier when dealing with an ACNP.patient care easier when dealing with an ACNP.

Th l lik l k i h fTh l lik l k i h f–– They were also more likely to speak out in the presence of an They were also more likely to speak out in the presence of an ACNP rather than a physician in order to better advocate for ACNP rather than a physician in order to better advocate for their patients & families their patients & families pp

Patient Care BenefitsPatient Care BenefitsPatient Care BenefitsPatient Care Benefits

•• Numerous studies have indicated that the careNumerous studies have indicated that the careNumerous studies have indicated that the care Numerous studies have indicated that the care provided by teams involving ACNPs is provided by teams involving ACNPs is equivalent or better than care provided byequivalent or better than care provided byequivalent or better than care provided by equivalent or better than care provided by traditional physician lead models.traditional physician lead models.


•• Critical Care Units that have alreadyCritical Care Units that have alreadyCritical Care Units that have already Critical Care Units that have already implemented ACNPs have seen:implemented ACNPs have seen:–– Improved health promotion behaviorsImproved health promotion behaviorsp pp p–– Decreased readmission ratesDecreased readmission rates–– Decreased length of stay in the ICU and decreased Decreased length of stay in the ICU and decreased g yg y

overall length of hospital stayoverall length of hospital stay–– Decreased number of days ventilatedDecreased number of days ventilated–– Decreased complication ratesDecreased complication rates–– Decreased or equivalent mortality ratesDecreased or equivalent mortality rates


•• Improvement of patient outcomes both inImprovement of patient outcomes both inImprovement of patient outcomes, both in Improvement of patient outcomes, both in decrease length of stay and in decreased decrease length of stay and in decreased complication rates also provides further supportcomplication rates also provides further supportcomplication rates, also provides further support complication rates, also provides further support for induction of ACNPs as it is also a cost for induction of ACNPs as it is also a cost effective way of providing high quality care in aeffective way of providing high quality care in aeffective way of providing high quality care in a effective way of providing high quality care in a time of resource shortages thereby ensuring time of resource shortages thereby ensuring greater access to allgreater access to allgreater access to all.greater access to all.


•• A comparison of 2 patient groups over a oneA comparison of 2 patient groups over a oneA comparison of 2 patient groups over a one A comparison of 2 patient groups over a one year period, 1 with an ACNP, and 1 without, year period, 1 with an ACNP, and 1 without, found that the patients in the group with thefound that the patients in the group with thefound that the patients in the group with the found that the patients in the group with the ACNP were hospitalized 2306 days fewer than ACNP were hospitalized 2306 days fewer than the nonthe non--ACNP groupACNP groupthe nonthe non ACNP group.ACNP group.–– With the average daily cost of a Canadian ICU bed at With the average daily cost of a Canadian ICU bed at

approximately $2500 per day this is a potentialapproximately $2500 per day this is a potentialapproximately $2500 per day, this is a potential approximately $2500 per day, this is a potential savings of almost $6 million dollars per year.savings of almost $6 million dollars per year.

Patient BenefitsPatient BenefitsPatient BenefitsPatient Benefits

•• At Surrey Memorial Hospital in the first quarterAt Surrey Memorial Hospital in the first quarterAt Surrey Memorial Hospital in the first quarter At Surrey Memorial Hospital in the first quarter of the 2012/2013 reporting period:of the 2012/2013 reporting period:

Number of ICU admissions: 219Number of ICU admissions: 219–– Number of ICU admissions: 219Number of ICU admissions: 219–– Number of patient days in the ICU: 1258Number of patient days in the ICU: 1258

A erage length of sta 5 74 da sA erage length of sta 5 74 da s–– Average length of stay: 5.74 daysAverage length of stay: 5.74 days–– Number of ventilated days: 731Number of ventilated days: 731

ICU li 26 3%ICU li 26 3%–– ICU mortality rate: 26.3%ICU mortality rate: 26.3%–– Readmission rate: 11.4%Readmission rate: 11.4%

•• Can you imagine all the good an NP in ICU Can you imagine all the good an NP in ICU could do?could do?


•• Patients and their families with ACNPs as partPatients and their families with ACNPs as partPatients and their families with ACNPs as part Patients and their families with ACNPs as part of their care team report improved satisfaction of their care team report improved satisfaction with the care they are provided.with the care they are provided.y py p–– Part of this is the ability to have an ACNP readily Part of this is the ability to have an ACNP readily

available to answer patient & family questions, available to answer patient & family questions, id d id hi d iid d id hi d iprovide status updates, provide teaching, and assist provide status updates, provide teaching, and assist

with case management. with case management. •• In general ACNPs were able to spend more oneIn general ACNPs were able to spend more one•• In general ACNPs were able to spend more one In general ACNPs were able to spend more one

on one time with patients & their families on one time with patients & their families compared to their physician colleagues.compared to their physician colleagues.compared to their physician colleagues.compared to their physician colleagues.


•• The chronically critically ill patient and theirThe chronically critically ill patient and theirThe chronically critically ill patient and their The chronically critically ill patient and their family also reported greater satisfaction with family also reported greater satisfaction with care involving an ACNP as there was improvedcare involving an ACNP as there was improvedcare involving an ACNP as there was improved care involving an ACNP as there was improved continuity of care provided to them.continuity of care provided to them.

•• An ACNPs constant presence in the ICU alsoAn ACNPs constant presence in the ICU also•• An ACNPs constant presence in the ICU also An ACNPs constant presence in the ICU also improved patient care and continuity, as NPs improved patient care and continuity, as NPs were less likely to be distracted by off unitwere less likely to be distracted by off unitwere less likely to be distracted by off unit were less likely to be distracted by off unit responsibilities.responsibilities.


•• Continuity of care is also enhanced by ACNPsContinuity of care is also enhanced by ACNPsContinuity of care is also enhanced by ACNPs Continuity of care is also enhanced by ACNPs being present during off hours and throughout being present during off hours and throughout the nights when residents and physicians werethe nights when residents and physicians werethe nights when residents and physicians were the nights when residents and physicians were less likely to be on the unitsless likely to be on the units

•• The ACNP role is an opportunity to implementThe ACNP role is an opportunity to implementThe ACNP role is an opportunity to implement The ACNP role is an opportunity to implement an advanced nursing role, and in theory should an advanced nursing role, and in theory should never be seen as a solution to physician or never be seen as a solution to physician or p yp yresident shortage. However, because this reality resident shortage. However, because this reality does exist, and in order to ensure patients have does exist, and in order to ensure patients have

h l l f h d hh l l f h d haccess to the level of care they need, the access to the level of care they need, the shortage of traditional care providers creates the shortage of traditional care providers creates the opportunity for nursing to demonstrate the needopportunity for nursing to demonstrate the needopportunity for nursing to demonstrate the need opportunity for nursing to demonstrate the need and benefit of ACNPs to care for critically ill and benefit of ACNPs to care for critically ill patientspatientspatients.patients.

ChallengesChallengesChallengesChallenges

•• Role confusionRole confusionRole confusionRole confusion–– A clear definition of the role, its purpose and scope A clear definition of the role, its purpose and scope

of practice must be made in order to avoid role of practice must be made in order to avoid role conflict / confusion, role overload, and variable conflict / confusion, role overload, and variable acceptance by other multidisciplinary team membersacceptance by other multidisciplinary team membersOft ACNP i t d d i t tOft ACNP i t d d i t t–– Often ACNPs are introduced into a team as a Often ACNPs are introduced into a team as a solution to a specific team dilemma (e.g. overnight solution to a specific team dilemma (e.g. overnight physician coverage), instead of being introduced physician coverage), instead of being introduced p y g ), gp y g ), gwith clearly defined nursing practice goals and an with clearly defined nursing practice goals and an understanding of how this person will function.understanding of how this person will function.

•• The role of the ACNP should be viewed andThe role of the ACNP should be viewed andThe role of the ACNP should be viewed and The role of the ACNP should be viewed and advocated for as a valuable asset in the desire to advocated for as a valuable asset in the desire to provide patients with the best possible careprovide patients with the best possible careprovide patients with the best possible care, provide patients with the best possible care, while also advancing the culture of critical care, while also advancing the culture of critical care, not as a staffing solution to the shortage ofnot as a staffing solution to the shortage ofnot as a staffing solution to the shortage of not as a staffing solution to the shortage of physicians and residentslphysicians and residentsl


•• Stake holder buy inStake holder buy inStake holder buy inStake holder buy in–– Often relates back to a misunderstanding of the Often relates back to a misunderstanding of the

ACNPs roleACNPs role–– This innovative role needs acceptance and support This innovative role needs acceptance and support

by other members of the multidisciplinary team by other members of the multidisciplinary team ( h i i d th id ) th( h i i d th id ) th(physicians, nurses, and other care providers), the (physicians, nurses, and other care providers), the public, and hospital administrationpublic, and hospital administration

–– One of the greatest barriers to overcome is physicianOne of the greatest barriers to overcome is physicianOne of the greatest barriers to overcome is physician One of the greatest barriers to overcome is physician resistance as they often see ACNPs as competition resistance as they often see ACNPs as competition rather than collaborating team members.rather than collaborating team members.


•• Cost of implementation of 24 hours 7 days aCost of implementation of 24 hours 7 days aCost of implementation of 24 hours, 7 days a Cost of implementation of 24 hours, 7 days a week ACNP serviceweek ACNP service

Initial cost of creating an ICU NP service will beInitial cost of creating an ICU NP service will be–– Initial cost of creating an ICU NP service will be Initial cost of creating an ICU NP service will be expensive, but the overall cost when compared to a expensive, but the overall cost when compared to a physician only model is minorphysician only model is minorp y yp y y

–– There are also the cost saving potential associated There are also the cost saving potential associated with improved length of stay, decreased with improved length of stay, decreased p g yp g ycomplication rates, and decreased readmission ratescomplication rates, and decreased readmission rates

ConclusionConclusionConclusionConclusion

•• Despite challenges the overwhelming positiveDespite challenges the overwhelming positiveDespite challenges, the overwhelming positive Despite challenges, the overwhelming positive effects of the addition of an ACNP to the effects of the addition of an ACNP to the multidisciplinary team are clear ACNPs canmultidisciplinary team are clear ACNPs canmultidisciplinary team are clear. ACNPs can multidisciplinary team are clear. ACNPs can provide good quality patient care in the provide good quality patient care in the specialized area of critical care In a time ofspecialized area of critical care In a time ofspecialized area of critical care. In a time of specialized area of critical care. In a time of limited resources, increasing acuity and demand limited resources, increasing acuity and demand for services critically care trained ACNPs willfor services critically care trained ACNPs willfor services, critically care trained ACNPs will for services, critically care trained ACNPs will offer a new way of caring for critically ill offer a new way of caring for critically ill patientspatientspatients.patients.

ReferencesReferencesReferencesReferences

•• Becker, D., Kaplow, R., Muenzen, P.M., and Hartigan, C. (2006). Activities performed by acute Becker, D., Kaplow, R., Muenzen, P.M., and Hartigan, C. (2006). Activities performed by acute and critical care advanced practice nurses: American association of critical care nurse study ofand critical care advanced practice nurses: American association of critical care nurse study ofand critical care advanced practice nurses: American association of critical care nurse study of and critical care advanced practice nurses: American association of critical care nurse study of practice. practice. American Journal of Critical Care, 15American Journal of Critical Care, 15(2), 130 (2), 130 –– 148.148.

•• Bryant Bryant –– Lukosius, D., DiCenso, A., Browne, G., and Pinelli, J. (2004). Nursing practice nursing Lukosius, D., DiCenso, A., Browne, G., and Pinelli, J. (2004). Nursing practice nursing roles: development, implementation, and evaluation. roles: development, implementation, and evaluation. Journal of Advanced Nursing, 48Journal of Advanced Nursing, 48(5), (5), 519 519 ––529. 529. C di N ’ A i i (2009)C di N ’ A i i (2009) P i i Th i iP i i Th i i O A hO A h•• Canadian Nurses’ Association (2009). Canadian Nurses’ Association (2009). Position statement: The nurse practitionerPosition statement: The nurse practitioner. Ottawa: Author. . Ottawa: Author. Retrieved December 9, 2012 from:Retrieved December 9, 2012 from:

•• http://www.nurseone.ca/docs/NurseOne/CNAPrimaryCareToolkit/PS_Nurse_Practitioner_e.phttp://www.nurseone.ca/docs/NurseOne/CNAPrimaryCareToolkit/PS_Nurse_Practitioner_e.pdfdf

•• Christmas A B Reynolds J Hodges S Franklin G A Miller F B Richardson J D andChristmas A B Reynolds J Hodges S Franklin G A Miller F B Richardson J D andChristmas, A.B., Reynolds, J., Hodges, S., Franklin, G.A., Miller, F.B., Richardson, J.D., and Christmas, A.B., Reynolds, J., Hodges, S., Franklin, G.A., Miller, F.B., Richardson, J.D., and Rodriguez, J.L. (2004). Physician extenders impact trauma systems. Rodriguez, J.L. (2004). Physician extenders impact trauma systems. The Journal of Trauma Injury, The Journal of Trauma Injury, Infection, and Critical Care, 58Infection, and Critical Care, 58(5), 917 (5), 917 –– 920 920

•• DiCenso, A., Martin DiCenso, A., Martin –– Misener, R., Bryant Misener, R., Bryant –– Lukosius, D., Bourgeault, I., Kilpatrick, K., Donald, Lukosius, D., Bourgeault, I., Kilpatrick, K., Donald, F., Kaasalainens, S., Harbman, P., Carter, N., Kioke, S., Abelson, J., McKinlay, R.J., Pasic, D., F., Kaasalainens, S., Harbman, P., Carter, N., Kioke, S., Abelson, J., McKinlay, R.J., Pasic, D., W l k B V h J d Ch bW l k B V h J d Ch b S i h R (2010) Ad d i i iS i h R (2010) Ad d i i iWasyluk, B., Vohra, J., and Charbonneau Wasyluk, B., Vohra, J., and Charbonneau –– Smith, R., (2010). Advanced practice nursing in Smith, R., (2010). Advanced practice nursing in Canada: overview of a decision support synthesis. Canada: overview of a decision support synthesis. Nursing Leadership, 23Nursing Leadership, 23, 15 , 15 –– 34. 34.

•• Doiron, M. (2011). Doiron, M. (2011). Drawing the line on end Drawing the line on end –– of of –– life carelife care. Retrieved August 7, 2013 . Retrieved August 7, 2013 from:from:www theglobeandmail com/life/healthwww theglobeandmail com/life/health andand fitness/drawingfitness/drawing thethe lineline onon endend ofoffrom:from:www.theglobeandmail.com/life/healthwww.theglobeandmail.com/life/health--andand--fitness/drawingfitness/drawing--thethe--lineline--onon--endend--ofof--lifelife--care/article534584/care/article534584/

•• Fry, M. (2011). Literature review of the impact of nurse practitioners in critical care Fry, M. (2011). Literature review of the impact of nurse practitioners in critical care services. services. Nursing in Critical Care, 16Nursing in Critical Care, 16(2), 58 (2), 58 –– 66.66.

•• Herrmann L L and Zabramski J M (2005) Tandem practice model: A model forHerrmann L L and Zabramski J M (2005) Tandem practice model: A model for•• Herrmann, L.L., and Zabramski, J.M. (2005). Tandem practice model: A model for Herrmann, L.L., and Zabramski, J.M. (2005). Tandem practice model: A model for physician physician –– nurse practitioner collaboration in a specialty practice, neurosurgery. nurse practitioner collaboration in a specialty practice, neurosurgery. Journal Journal of the American Academy of Nurse Practitioners, 17of the American Academy of Nurse Practitioners, 17(6), 213 (6), 213 –– 28.28.

•• Hoffman, L.A., Tasota, F.J., Zullo, T.G., Scharfenberg, C., and Donahoe, M.P. (2005). Hoffman, L.A., Tasota, F.J., Zullo, T.G., Scharfenberg, C., and Donahoe, M.P. (2005). Outcomes of care managed by an acute care nurse practitioner / attending physicianOutcomes of care managed by an acute care nurse practitioner / attending physicianOutcomes of care managed by an acute care nurse practitioner / attending physician Outcomes of care managed by an acute care nurse practitioner / attending physician team in a subacute medical intensive care unit. team in a subacute medical intensive care unit. American Journal of Critical Care, 14American Journal of Critical Care, 14(2), (2), 121 121 –– 130.130.

•• Kapu, A.N., Thomson Kapu, A.N., Thomson –– Smith, C., and Jones, P. (2012). NPs in the ICU: the Smith, C., and Jones, P. (2012). NPs in the ICU: the Vanderbilt initiative. Vanderbilt initiative. The Nurse Practitioner, 37The Nurse Practitioner, 37(8), 46 (8), 46 –– 52.52.,, ( ),( ),

•• Kleinpell, R.M., Ely, E.W., and Grabenkort, R. (2008). Nurse practitioners and Kleinpell, R.M., Ely, E.W., and Grabenkort, R. (2008). Nurse practitioners and physician assistants in the intensive care unit: an evidence physician assistants in the intensive care unit: an evidence –– based review. based review. Critical Care Critical Care Medicine, 36Medicine, 36(10), 2888 (10), 2888 –– 2897.2897.

•• Lome, B., Stalnaker, A., Carlson, K., Kline, M., and Sise, M. (2010). Nurse practitioners Lome, B., Stalnaker, A., Carlson, K., Kline, M., and Sise, M. (2010). Nurse practitioners –– the core the core of our trauma serviceof our trauma service Journal of Trauma NursingJournal of Trauma Nursing 17(2) 8017(2) 80 –– 8181of our trauma service. of our trauma service. Journal of Trauma Nursing, Journal of Trauma Nursing, 17(2), 80 17(2), 80 81.81.

•• Medeiros, R.S., NeSmith, E.G., Heath, J.A., Hawkins, M.L., Hawkins, D., and Bias, R. (2011). Medeiros, R.S., NeSmith, E.G., Heath, J.A., Hawkins, M.L., Hawkins, D., and Bias, R. (2011). Midlevel health providers impact on ICU length of stay, patient satisfaction, mortality, and Midlevel health providers impact on ICU length of stay, patient satisfaction, mortality, and resource allocation. resource allocation. Journal of Trauma Nursing, 18Journal of Trauma Nursing, 18(3), 149 (3), 149 –– 152. 152.

•• Muscedere, J.G., Martin, C.M., and Heyland, D.K. (2008). The impact of ventilator Muscedere, J.G., Martin, C.M., and Heyland, D.K. (2008). The impact of ventilator –– associated associated i C di h l hi C di h l h J l f C i i l C 23J l f C i i l C 23 55 1010pneumonia on Canadian health care system. pneumonia on Canadian health care system. Journal of Critical Care, 23Journal of Critical Care, 23, 5 , 5 –– 10.10.

•• Papathanassoglou, E.D. (2011). Advanced critical care nursing: a novel role with ancient history Papathanassoglou, E.D. (2011). Advanced critical care nursing: a novel role with ancient history and unprecedented challenges worldwide. and unprecedented challenges worldwide. British Association of Critical Care Nurses, 16British Association of Critical Care Nurses, 16(2), 55 (2), 55 –– 57. 57.

•• Rosenthal, L.D., and Guerrasio, J. (2010). Acute care nurse practitioner as hospitalist: role Rosenthal, L.D., and Guerrasio, J. (2010). Acute care nurse practitioner as hospitalist: role descriptiondescription ACCN Critical Care, 20ACCN Critical Care, 20(2) 133(2) 133 –– 136136description. description. ACCN Critical Care, 20ACCN Critical Care, 20(2), 133 (2), 133 136. 136.

•• Scherr, K., Wilson, D.M., Wagner, J., and Haughian, M. (2012). Evaluating a new rapid response Scherr, K., Wilson, D.M., Wagner, J., and Haughian, M. (2012). Evaluating a new rapid response team: NP team: NP –– led versus intensivist led versus intensivist –– led comparisons. led comparisons. AACN Advanced Critical Care,23AACN Advanced Critical Care,23(1), 32 (1), 32 –– 42.42.

•• Srivastava, N., Tucker, J.S., Draper, E.S., and Milner, M. (2008). A literature review of principles, Srivastava, N., Tucker, J.S., Draper, E.S., and Milner, M. (2008). A literature review of principles, policies, and practice in extended nursing roles relating to UK intensive care policies, and practice in extended nursing roles relating to UK intensive care settings. settings. Journal of Journal of Cli i l N i 17Cli i l N i 17 26712671 26802680Clinical Nursing, 17Clinical Nursing, 17, 2671 , 2671 –– 2680. 2680.

•• Winne, M., Cashavelly, B., Annese, C., Nagel, B., Shiga, T., Chisari, R.G., and Lee, S. (2012). Winne, M., Cashavelly, B., Annese, C., Nagel, B., Shiga, T., Chisari, R.G., and Lee, S. (2012). Implementation of two nurse practitioner inpatient models. Implementation of two nurse practitioner inpatient models. The Journal of Nursing Administration, The Journal of Nursing Administration, 4242(2), 110 (2), 110 –– 116.116.

•• Questions or comments?Questions or comments?Questions or comments?Questions or comments?•• Please feel free to contact me at:Please feel free to contact me at:

[email protected]@shaw.ca

3B A Role for NPs in the ICU A Role for NPs in the ICU.pdf · A Role for Nurse Practitioners in the ICU: ... • The expanded role provides professionalThe expanded role provides

Documents