Nurse Practitioner Group Research Articles

The quality of home-based primary care delivered by nurse practitioners: A national Medicare claims analysis.

As the US population ages, there is an increasing demand for home-based primary care (HBPC) by those with Alzheimer's/dementia, multiple chronic conditions, severe physical limitations, or those facing end-of life. Nurse practitioners (NPs) are increasingly providing HBPC, yet little is known about their quality of care in this unique setting. This observational study uses Medicare claims data from 2018 to assess the quality of care for high-intensity HBPC users (5 or more visits/year) based on provider type (NP-only, physician (MD)-only, or both NP and MDs). We employ 12 quality measures from 3 care domains: access and prevention, acute care utilization, and end-of-life. Analysis includes bivariate comparisons and logistic regression models that adjust for demographic, clinical, and geographic characteristics. Among the 574,567 beneficiaries with 5 or more HBPC visits, 37% saw an NP, 37% saw a MD, and 27% saw both NPs and MDs. In multivariate models, those receiving HBPC from an NP or both NP-MD are significantly more likely to receive a flu shot than the MD-only group, but less likely to access preventive care. NP-only care is associated with more acute care hospitalizations, avoidable ED visits, and fall-related injuries, but significantly fewer avoidable admissions. For end-of-life care, those with NP-only or both NP-MD care are significantly more likely to have an advanced directive, be in hospice in the last 3 days of life, and more likely to die in hospice. The NP group is also more likely to die in the next year. HBPC patients are complex, with both palliative and curative needs. NPs provide almost half of HBPC in the Medicare program, to patients who are possibly sicker than those treated by physicians, with similar quality to MDs.

Oral Health Knowledge, Attitudes, and Learned Clinical Skills in Pediatric Medicine Residents and Nurse Practitioner Students: A Pre-Post Design.

(1) Background/Objective: California has one of the highest rates of pediatric dental caries in the nation. One way to combat this problem is through non-dental provider training programs that focus on prevention. However, there are limited data on healthcare provider training program integration and evaluation of oral health curricula focused on prevention of early childhood caries. This study will assess the change in healthcare providers' attitudes, knowledge, and skills by implementing an interprofessional educational (IPE) oral health curriculum in medicine and nurse practitioner programs at one university in Southern California. (2) Methods: A mixed method design was employed using a pre- and post-educational survey, and end-of-program focus group interviews. Descriptive statistics and paired t-tests were used to assess group differences and thematic analyses for the focus groups. (3) Results: A total of 81 students (14 pediatric medicine residents, 18 pediatric, and 49 family nurse practitioners) completed the curriculum and surveys. Attitudes related to oral hygiene remained unchanged, with the nurse practitioner group showing improved clinical skills (all questions; p < 0.021). Knowledge scores significantly improved across all groups (paired t-test; p < 0.001). All focus groups expressed the helpfulness of the educational modules, the usefulness of the skills learned, and the benefits of IPE activities. (4) Conclusion: Healthcare providers showed improved oral health knowledge and clinical skills acquired through the oral health program and can serve as a model to educate across disciplines on the prevention of early childhood caries.

The effect of introducing a nurse-practitioner-led peripherally inserted central venous catheter placement program on the utilization of central venous access device: A retrospective study in Japan.

Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated. To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs. Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications. Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; p < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; p < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; p < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; p = .90). This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.

Expanding access to difficult urinary catheter insertion services through a novel nurse practitioner led team.

Within the United States health care system, one of the most common procedures performed daily is urinary catheterization. Oftentimes, the urinary catheter is placed by nursing personnel without any difficulty. Although the procedure is usually simple and routine, there are instances in which placement can be problematic. Urology is one of the smallest surgical subspecialties, with intermittent availability given active commitments in the operating room and clinic. This opened an opportunity for nurse practitioners (NPs) at an urban quaternary care hospital to further enhance their skill set in the care of these patients. Fifteen Rapid Response Team NPs were selected based on specific criteria. Their roles expanded to include consults for difficult urinary catheter insertions. A 2-step training program was implemented for NPs to develop proficiency in inserting urinary catheters in patients with new or known urologic conditions. Of the 391 catheter consults made to the NP group, 73 (18.7%) of them required urology follow-up. This program can benefit patients by potentially reducing catheter-related complications and associated length of stay.

Emergency nurse practitioners’ use of a modified Edinburgh red eye diagnostic algorithm: Prospective observational study

Background:Emergency nurse practitioners have traditionally been reluctant to treat acute red eyes in Hong Kong emergency departments. The Edinburgh Red Eye Diagnostic Algorithm is the only validated tool to assist non‐ophthalmologists to make diagnoses.Objectives:This study investigates the utility of a modified version used by emergency nurse practitioners.Methods:This is a prospective single‐centre cohort study in a university hospital emergency department in Hong Kong, comparing red eye patients seen by emergency nurse practitioners with the aid of the algorithm to patients seen by emergency doctors. Data on patient‐reported symptom severity were obtained on the day of consultation and information on resolution of symptoms at 1 week following emergency department attendance via telephone interviews.Results:A convenience sample of 50 patients was recruited to the emergency nurse practitioner group and 130 patients were recruited to the doctors’ group over 9 weeks. Reductions in symptom severity were seen in both groups (&gt;70% in both groups reported moderate to very severe discomfort on day 0; ~90% in both groups reported none or mild discomfort on day 7). There was no difference between the two groups (p = 0.55, analysis of covariance). Symptom resolution was reported in 96% in the emergency nurse practitioner group and 98.5% in the doctor's group, which was not statistically significant (p = 0.31, χ2 test).Conclusion:Emergency nurse practitioners using the Edinburgh Red Eye Algorithm to manage red eye patients in a Hong Kong emergency department achieve similar patient‐reported outcomes compared to emergency department doctor consultations.

Comparison of Japan nurse practitioner-led care and physician trainee-led care on patients' length of stay in a secondary emergency department: A retrospective study.

AimWe compared Japan nurse practitioner‐led care and physician trainee‐led care in terms of patients' length of stay in a secondary emergency department in Japan.MethodsThis was a retrospective observational study, utilizing medical records. Participants (n = 1419; mean age = 63.9 ± 23.4 years; 52.3% men) were patients transferred to the emergency department by ambulance between April 2016 and March 2018 in western Tokyo. Multiple linear regression analyses were performed, with length of stay as the dependent variable and factors related to the length of stay, including medical care leaders, as the independent variable.ResultsApproximately half of the patients (n = 763; 53.8%) received Japan nurse practitioner‐led care. Patients' length of stay was significantly shorter, by 6 min, in the Japan nurse practitioner‐led care group, compared with the physician trainee‐led care group (unstandardized coefficient: −6.81; 95% confidence interval: −13.35 to −0.26; p < 0.05).ConclusionPatients' shorter length of stay in the Japan nurse practitioner group, compared with the physician trainee group, suggests that Japan nurse practitioners are not inferior to physician trainees in terms of the time spent to manage patients.

A Retrospective Cohort Study of the Impact of Nurse Practitioners on Hospitalized Patient Outcomes.

The role of advanced practice providers has expanded in the hospital setting. However, little data exist examining the impact of these providers. Our purpose was to determine the effect of adding nurse practitioners in a complementary role on the quality and efficiency of care of hospitalized patients. A retrospective cohort study evaluated adult patients admitted by private physicians (without house staff or non-physician providers) to a general medical-surgical unit in an academic medical center. The admissions department allocated patients as beds became available and nurse practitioners were assigned to patients until their caseload was reached. Outcomes included length of hospital stay, in-hospital mortality, admission costs, 30-day readmissions, transfer to a more intensive care level, and discharge order time. Of the 382 patients included in this study, 263 were assigned to the nurse practitioner group. Hospital mortality was lower in the nurse practitioner group [OR 0.11 (95% CI 0.02–0.51)] as was transfer to more intensive care level [OR 0.39 (95% CI 0.20–0.75)]; however, the nurse practitioner group had longer length of stay (geometric mean = 5.80 days for nurse practitioners, 3.63 days for no nurse practitioners; p < 0.0001) and higher cost per patient (geometric mean = USD 6631 vs. USD 5121; p = 0.005). The results were unchanged when models were adjusted for potential confounders. Adding nurse practitioners can yield improved clinical outcomes (lower hospital mortality and fewer transfers to intensive care), but with a potential economic expense (longer hospital stays and higher costs).

Prescriptive practice differences between nurse practitioners and physicians in the treatment of uncomplicated urinary tract infections in the emergency department setting.

Nurse practitioners (NPs) have increasingly broad prescribing authority, yet there is insufficient information available on the prescribing practices of NPs working in the emergency department setting. The purpose of this study was to describe prescriptive practices between two provider groups, NPs and physicians, in an emergency department setting in the United Arab Emirates. This comparison focused on treatment of a common emergency department diagnosis of uncomplicated urinary tract infection (UTI). The investigators reviewed a sample of 690 UTI patients during the period of August 30, 2016 to June 30, 2018. Physician and NP provider groups were then assessed for treatment selection and associated patient outcomes. A Chi-square test was used to compare empiric antibiotic selection using variables of population type, gender, age, and provider type. There were similar prescriptive practices for beta-lactam, nitrofurantoin, and trimethoprim prescriptions. The investigators noted a statistical difference for fluoroquinolone use, with the physician group selecting fluoroquinolones more often than the NP group. Also, fluoroquinolone use within the physician group varied significantly; however, the investigators did not see this within the NP group. The findings support that there is comparable care quality in the treatment of uncomplicated UTIs between physician providers and NPs in this setting. Comparing outcome similarities and differences on a commonly occurring medical problem in the emergency department provides an early look at the value-added services that NPs provide.

635 Cost-Effectiveness of a Heart Failure Nurse Practitioner Service for Patients Hospitalised With Acute Heart Failure

Heart failure (HF) nurse practitioners (NP) are part of the HF specialist workforce however their impact on improving patient outcomes is untested. To determine the cost effectiveness of a HF NP service compared to current practice of no HF NP service from a health system perspective. A post-hoc analysis was undertaken from a pre and post intervention study of a HF NP service. A total of 500 patients admitted to a single centre with acute HF (250 patients in the historical control (HC) and 250 in the prospective HF NP group) were followed up for 12 months post-discharge. Patients were matched on five-year age groups. Economic modelling was used to estimate the cost-effectiveness of a HF NP service. The mean age was 77.7±11years (SD). At 12 months post-discharge, 73.7% of patients in the HF NP group were readmitted compared to 81.7% in the HC (p=0.03). The HF NP group, compared to HC, was more costly ($28693 vs $27788) but more effective (1.97 vs 1.93 QALY). Cost of 12-month readmissions was $20748 in the HF NP group compared to HC of $28682. The HF NP service was cost-effective with a mean ICER of $14170/QALY gained at 12 months with a 100% probability of being cost-effective at a willingness-to-pay threshold of $50000. The HF NP service was cost-effective with a high degree of certainty. The main cost driver was hospital readmissions with the HF NP group experiencing a significantly lower rate of readmissions.

Evaluating emergency nurse practitioner service effectiveness on achieving timely analgesia: a pragmatic randomized controlled trial.

The rapid uptake of nurse practitioner (NP) services in Australia has outpaced evaluation of this service model. A randomized controlled trial was conducted to compare the effectiveness of NP service versus standard medical care in the emergency department (ED) of a major referral hospital in Australia. Patients presenting with pain were randomly assigned to receive either standard ED medical care or NP care. Primary investigators were blinded to treatment allocation for data analyses. The primary outcome measure was the proportion of patients receiving analgesia within 30minutes from being seen by care group. Secondary outcome measures were time to analgesia from presentation and documentation of and changes in pain scores. There were 260 patients randomized; 128 received standard care (medical practitioner led), and 130 received NP care. Two patients needed to be excluded due to incomplete consent forms. The proportion of patients who received analgesia within 30minutes from being seen was 49.2% (n=64) in the NP group and 29.7% (n=38) in the standard group, a difference of 19.5% (95% confidence interval [CI]=7.9% to 31.2%; p=0.001). Of 165 patients who received analgesia, 64 (84.2%) received analgesia within 30minutes in the NP group compared to 38 (42.7%) in the standard care group, a difference in proportions of 41.5% (95% CI=28.3% to 54.7%; p<0.001). The mean (±SD) time from being seen to analgesia was 25.4 (±39.2) minutes for NP care and 43.0 (±35.5) minutes for standard care, a difference of 17.6minutes (95% CI=6.1 to 29.1minutes; p=0.003). There was a difference in the median change in pain score of 0.5 between care groups, but this was not statistically significant (p=0.13). Nurse practitioner service effectiveness was demonstrated through superior performance in achieving timely analgesia for ED patients.

A Novel Finding: The Effect of Nurse Practitioners on the Relation to Quality of Life, Anxiety, and Depressive Symptoms in Vascular Surgery

An increasing number of vascular surgery units expand their team with nurse practitioners (NPs) to optimize patient care. There are no previously performed studies which assessed the influence of NPs on patients' quality of life (QoL), anxiety, and depressive symptom levels. The transition in care from surgeon to NP in the vascular surgery unit of our hospital facilitated the comparison of both groups. A prospective study was undertaken to analyze the effect of NPs on QoL, anxiety, and depressive symptom scores. Two groups were analyzed: a group of patients treated by a vascular surgeon alone (surgeon group) and a group of patients treated by a NP supervised by a vascular surgeon (NP group). Patients completed the short version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF), the State-Trait Anxiety Inventory (STAI), and the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaires both before and after intervention. Two hundred fourteen patients were included in our study. Within groups, there was a significant increase in physical QoL, with 5.2 points in the surgeon group and 4.4 points in the NP group. There was a significant decrease in anxiety scores (-3.8 points in the surgeon group and -5.4 points in the NP group). No differences were found for depressive symptoms. Between groups, no differences were found. The same improvements were found for QoL and anxiety scores in both groups. Vascular NPs are therefore competent to explain procedures and guide patients through vascular interventions.

S81 A randomised controlled study comparing the outcomes of pleural nurse practitioner versus doctors trained to perform pleural procedures for management of pleural effusions

BackgroundFollowing the National Patient Safety Agency alert in the UK thoracic ultrasound (TUS) is strongly recommended for all pleural procedures. This places strains on clinical service delivery. The role of...

AMDA Medical Director of the Year Nominees, 2013

AMDA Medical Director of the Year Nominees, 2013

Investigation of major work stresses and coping styles for psychiatric male nurses in grade III class A hospital

Objective To explore the major work stresses and coping styles of psychiatric male nurses.Methods 95 psychiatric male nurses from a grade Ⅲ class A hospital in Beijing were surveyed by Nurse Job Stressors Questionnaires(NJSQ) and Simplified Coping Style Questionnaire (SCSQ).Results There was no significant difference in the total scores of JSQ among psychiatric male nurses with different position titles ( P＞0.05).However,statistical differences in the scores of work load and work time allocation between nurses-in-charge group,nurses group and nurse practitioners group[ (12.5±2.5) vs (8.7 ±3.7) vs (9.8 ±3.9) ;F=4.311,P＜0.05 ].The scores of married male nurses group in the source of work stress and work time allocation ( 10.6 ± 3.8) were higher than the score of single nurses group (7.8 ± 3.2 ) and showed significant difference (t =-3.198,P＜0.05 ).The scores of experienced male nurses group and unexperienced nurses group in the source of work stress were ( 14.9 ± 4.3 ) and ( 13.0 ± 4.3 ) respectively; the scores in work time allocation were ( 10.8 ± 3.6) and ( 8.5 ± 3.8 ) ; the scores in patients care were ( 19.3 ± 7.0) and ( 16.1± 6.8 ) ; the scores in management and relationships were ( 13.3 ± 5.5 ) and ( 10.7 ± 5.5 ).All the scores of experienced group were significantly higher than the unexperienced group ( t =- 2.230,- 3.021,- 2.229,- 2.268,respectively;P ＜ 0.05 ).There was no significant differences found between the score of coping mode and position title,years of work,marital status,education or age.Conclusions Psychiatric male nurses with different position title,work experience and marital status have more work stress.They should learn self-control,release pressure and cope with it actively. Key words: Psychiatric department; Male nurses; Stress sources; Coping style

Maintenance of lifestyle changes: 3-Year results of the Groningen Overweight and Lifestyle study

ObjectiveThis study aims to evaluate the three-year effect of lifestyle counseling by a nurse practitioner (NP) on physical activity (PA) and dietary intake compared with usual care by a general practitioner (GP). MethodsAt baseline, subjects were randomly allocated to the NP group (n=225) or to the GP group (n=232). The NP group received a low-intensive lifestyle intervention for three years by the NP and the GP group received one consultation by the GP and thereafter usual care. PA and dietary intake were assessed with questionnaires at baseline, 1 year follow-up and 3 year follow-up. ResultsAfter three years, leisure-time activity increased and favorable improvements towards a healthy diet were made for both groups. These three-year changes in PA and diet did not differ significantly between groups. Changes in PA and dietary habits after one year were practically maintained after 3 years, because only small relapses were found. ConclusionAfter three years, subjects were more physically active and had a healthier diet compared to baseline. Lifestyle counseling by NP resulted in similar lifestyle changes compared to GP consultation. Practice implicationsNPs could also advice patients at cardiovascular risk by lifestyle counseling, to possibly reduce GP barriers.

Maintenance of INR consistency during the initiation of warfarin

Background Safe anticoagulation management requires competent prescribers. Pharmacist-led anticoagulation clinics are effective, but data on specialist nurse-led services in the acute setting are scarce. Methods Twenty-eight ambulatory care patients who were referred to our medical day unit for warfarin commencement and stabilisation therapy were enrolled over two separate 1-month periods. One group of patients was treated by a trained nurse practitioner; the other group was treated by different caches of junior doctors. The patients were observed until their INR was stable enough for transfer to the pharmacist-led anticoagulation clinic. INR control in the two groups was compared. Findings There were a total of 195 INR measurements, and the mean number of INR measurements per patient was similar in both groups. The patients treated by the junior doctors were kept in the medical day unit for a longer period, but the mean INR over time in this group was more variable. Conversely, the patients treated by the nurse practitioner group had more consistency and less variation in INR measurements. Interpretation The better INR consistency and minimal variation reported for the nurse-practitioner group implies better control. If we assume that a poorly controlled INR poses a higher clinical risk, then the nurse practitioner dosing regime is a safer option. The current working patterns of junior doctors are not conducive to providing such continuity of care; therefore, in the ambulatory care setting, clinical risks may be reduced if anticoagulation is initiated and stabilised by a designated health-care practitioners with the required competencies and experience.

Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs

In a randomized, controlled trial (RCT) on childhood eczema we reported that substituting nurse practitioners (NPs) for dermatologists resulted in similar outcomes of eczema severity and in the quality of life, and higher patient satisfaction. To determine costs and cost-effectiveness of care provided by NPs vs. dermatologists and to compare our results with those in studies from other countries. We estimated the healthcare costs, family costs and the costs in other sectors alongside the RCT. All the costs were linked to quality of life [Infants' Dermatitis Quality of Life Index (IDQOL), Children's Dermatology Life Quality Index (CDLQI)] and to patient satisfaction (Client Satisfaction Questionnaire-8) to determine the incremental cost-effectiveness ratio (ICER). We also examined all the reported studies on the costs of childhood eczema. The mean annual healthcare costs, family costs and costs in other sectors were €658, €302 and €21, respectively, in the NP group and €801, €608 and €0·93, respectively, in the dermatologist group. The ICER in the NP group compared with the dermatologist group indicated €925 and €751 savings per one point less improvement in IDQOL and CDLQI, respectively, and €251 savings per one point more satisfaction in the NP group at 12 months. The mean annual healthcare costs and family costs varied considerably in the six identified studies. Substituting NPs for dermatologists is both cost-saving and cost-effective. The treatment of choice is that provided by the NPs as it is similarly effective to treatment provided by a dermatologist with a higher parent satisfaction. International comparisons are difficult because the types of costs determined, the units and unit prices, and eczema severity all differ between studies.

Preventing Weight Gain by Lifestyle Intervention in a General Practice Setting

Weight regain after initial loss of weight is common, which indicates a need for lifestyle counseling aimed at preventing weight gain instead of weight loss. This study was conducted to determine whether structured lifestyle counseling by nurse practitioners (NPs) group compared with usual care by general practitioners (GP-UC) in overweight and obese patients can prevent (further) weight gain. A randomized controlled trial in 11 general practice locations in the Netherlands of 457 patients (body mass index, 25-40 [calculated as weight in kilograms divided by height in meters squared]; mean age, 56 years; 52% female) with either hypertension or dyslipidemia or both. The NP group received lifestyle counseling with guidance of the NP using a standardized software program. The GP-UC group received usual care from their GP. Main outcome measures were changes in body weight, waist circumference, blood pressure, and fasting glucose and blood lipid levels after 3 years. In both groups, approximately 60% of the participants achieved weight maintenance after 3 years. There was no significant difference in mean (SD) weight change and change of waist circumference between the NP and GP-UC groups (weight change: NP group, -1.2% [5.8%], and GP-UC group, -0.6% [5.6%] [P = .37]; and change of waist circumference: NP group, -0.8 [7.1] cm, and GP-UC group, 0.4 [7.2] cm [P = .11]). A significant difference occurred for mean (SD) fasting glucose levels (NP group, -0.02 [0.49] mmol/L, and GP-UC group, 0.10 [0.53] mmol/L [P = .02]) (to convert to milligrams per deciliter, divide by 0.0555) but not for lipid levels and blood pressure. Lifestyle counseling by NPs did not lead to significantly better prevention of weight gain compared with GPs. In the majority in both groups, lifestyle counseling succeeded in preventing (further) weight gain. trialregister.nl Identifier: NTR1365.

Changes in lifestyle habits after counselling by nurse practitioners: 1-year results of the Groningen Overweight and Lifestyle study

The Groningen Overweight and Lifestyle (GOAL) study primarily aims at preventing weight gain by nurse practitioners (NP) guided by a standardized computerized software program. Since favourable changes in physical activity (PA) and diet may improve health independently of weight (loss), insight into effects on lifestyle habits is essential. We examined the 1-year effects of lifestyle counselling by NP on PA and diet, compared with usual care from the general practitioner (GP-UC). A randomized controlled trial. Eleven general practice locations in the Netherlands. A total of 341 GOAL participants with overweight or obesity and either hypertension or dyslipidaemia, or both, who completed an FFQ and Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) at baseline and after 1 year. After 1 year, the NP group spent 33 min/week more on walking compared with the GP-UC group who spent -5 min/week on walking (P = 0.05). No significant differences were found between the NP and GP-UC groups on the percentage of persons complying with the PA guidelines. In both groups, nutrient intake changed in a favourable direction and participants complied more often with dietary guidelines, but without overall difference between the NP and GP-UC groups. With the exception of an increase in walking (based on self-reported data) in the NP group, no intervention effects on PA and diet occurred. Positive changes in nutrient intake were seen in both groups.

Participation of an Acute Care Nurse Practitioner Group in a Medical—Surgical Intensive Care Unit

In this article, the authors describe their experience as acute care nurse practitioners (ACNPs) providing immediate, acute clinical care in a medical—surgical intensive care unit of a large private practice tertiary care hospital. ACNPs represent a subset of the growing group of advance practice registered nurses (ACRNs). The role of ACRNs has evolved over time and this article describes the national education and certification requirements for this important group of health professionals. This article describes the details of the efforts to integrate ACNPs into an intensivist-led medical—surgical intensive care unit.