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SAN DIEGO – Nurse practitioners are assuming expanded roles and responsibilities in the provision of critical care services, according to Thomas Farley, R.N., N.P.
At the University of California, San Diego, Critical Care Summer Session, Mr. Farley described the expanded role nurse practitioners (NPs) have played in critical care services for about a decade at the University of California, San Francisco (UCSF). In 2004, Dr. Michael Matthay, a pulmonologist, and Dr. Michael Gropper, a critical care anesthesiologist, spearheaded an effort to hire four NPs to work in the university’s medical-surgical intensive care unit (ICU). "At the time, there were increasing limitations on physician trainees, both in the number of trainees and their work-hour restrictions that were becoming more tight," recalled Mr. Farley of the UCSF School of Nursing. "The goal was to provide critical care at the bedside 24 hours per day, which is in line with the Leapfrog Group recommendations for critical care services. At the time, they had 60 adult ICU critical care beds."
Today, 18 NPs work in adult ICUs at UCSF, with expansion to 76 adult critical care beds, including the medical-surgical ICU, cardiothoracic ICU, and neuro ICU. "Initially the NPs were integrated with medical residents," Mr. Farley said. "Now there are teams that don’t have residents, so it’s an NP paired with an attending physician, or sometimes a fellow. There are always two NPs on service. Usually, during the day we have four NPs on, with two on at night." The program was described in 2011 (ICU Director 2011;2:16-19).
Practice trends driving the need for NPs in critical care include the increasing demand for intensivists and a reliance on a team-based approach to care delivery, "understanding that a single provider cannot provide all the needs that any individual critical care patient has," Mr. Farley explained. "I think we’re a little slow to incorporate the use of nurse practitioners on the West Coast. It’s certainly been done for quite some time on the East Coast."
He said that NPs are already incorporated into critical care delivery programs at Memorial Sloan Kettering Cancer Center and Columbia University, both in New York; Emory University, Atlanta; Henry Ford Hospital, Detroit; the Cleveland Clinic; and Vanderbilt University, Nashville, Tenn. Adopters out West include UCSF, UC Davis; UC Los Angeles; UC Fresno; and Oregon Health & Science University, Portland.
At UCSF, critical care NP duties include a consultative role to admitting services, a consultative role to bedside RNs, guidance of house staff, responding to code blue activations, assisting with rapid response consultations, serving on hospital-wide multidisciplinary committees, precepting adult care NP students, as well as attending morning teaching and monthly morbidity and mortality conferences. Procedures performed include insertion of central venous catheters, arterial catheters, chest tubes, and PICC (peripherally inserted central catheter) lines; lumbar puncture; suture and drain removal; and airway intubation.
The use of NPs in critical care "works because we have appropriate conduits for collaboration and supervision that are explained, understood, and taken to heart," Mr. Farley said. "The NPs need to know that they have supportive attending physicians who will assist them when questions arise. We’ve also had buy-in from the ICU nurses."
A growing body of medical literature suggests that this trend is having an effect. A retrospective study of 600 admissions at two ICUs in New York found that patients managed by nurse practitioner/physician assistant teams had no worse outcomes than patients managed by physicians (Chest 2011;139:1347-53). In addition, a recent survey of critical care program directors at academic medical centers found that 86% believe NPs and other advanced practice providers contribute to the continuity of care, 78% believe they save time during rounds and evaluating new patients, and 73% believe they assist in maintaining work flow (J. Crit. Care 2014; 29:112-5).
In the years ahead, Mr. Farley predicted that NPs and other advanced practice providers "are certainly going to be in the ICU, probably even in greater numbers and perhaps in broader roles than they are now."
Mr. Farley said he had no relevant financial conflicts.
On Twitter @dougbrunk
SAN DIEGO – Nurse practitioners are assuming expanded roles and responsibilities in the provision of critical care services, according to Thomas Farley, R.N., N.P.
At the University of California, San Diego, Critical Care Summer Session, Mr. Farley described the expanded role nurse practitioners (NPs) have played in critical care services for about a decade at the University of California, San Francisco (UCSF). In 2004, Dr. Michael Matthay, a pulmonologist, and Dr. Michael Gropper, a critical care anesthesiologist, spearheaded an effort to hire four NPs to work in the university’s medical-surgical intensive care unit (ICU). "At the time, there were increasing limitations on physician trainees, both in the number of trainees and their work-hour restrictions that were becoming more tight," recalled Mr. Farley of the UCSF School of Nursing. "The goal was to provide critical care at the bedside 24 hours per day, which is in line with the Leapfrog Group recommendations for critical care services. At the time, they had 60 adult ICU critical care beds."
Today, 18 NPs work in adult ICUs at UCSF, with expansion to 76 adult critical care beds, including the medical-surgical ICU, cardiothoracic ICU, and neuro ICU. "Initially the NPs were integrated with medical residents," Mr. Farley said. "Now there are teams that don’t have residents, so it’s an NP paired with an attending physician, or sometimes a fellow. There are always two NPs on service. Usually, during the day we have four NPs on, with two on at night." The program was described in 2011 (ICU Director 2011;2:16-19).
Practice trends driving the need for NPs in critical care include the increasing demand for intensivists and a reliance on a team-based approach to care delivery, "understanding that a single provider cannot provide all the needs that any individual critical care patient has," Mr. Farley explained. "I think we’re a little slow to incorporate the use of nurse practitioners on the West Coast. It’s certainly been done for quite some time on the East Coast."
He said that NPs are already incorporated into critical care delivery programs at Memorial Sloan Kettering Cancer Center and Columbia University, both in New York; Emory University, Atlanta; Henry Ford Hospital, Detroit; the Cleveland Clinic; and Vanderbilt University, Nashville, Tenn. Adopters out West include UCSF, UC Davis; UC Los Angeles; UC Fresno; and Oregon Health & Science University, Portland.
At UCSF, critical care NP duties include a consultative role to admitting services, a consultative role to bedside RNs, guidance of house staff, responding to code blue activations, assisting with rapid response consultations, serving on hospital-wide multidisciplinary committees, precepting adult care NP students, as well as attending morning teaching and monthly morbidity and mortality conferences. Procedures performed include insertion of central venous catheters, arterial catheters, chest tubes, and PICC (peripherally inserted central catheter) lines; lumbar puncture; suture and drain removal; and airway intubation.
The use of NPs in critical care "works because we have appropriate conduits for collaboration and supervision that are explained, understood, and taken to heart," Mr. Farley said. "The NPs need to know that they have supportive attending physicians who will assist them when questions arise. We’ve also had buy-in from the ICU nurses."
A growing body of medical literature suggests that this trend is having an effect. A retrospective study of 600 admissions at two ICUs in New York found that patients managed by nurse practitioner/physician assistant teams had no worse outcomes than patients managed by physicians (Chest 2011;139:1347-53). In addition, a recent survey of critical care program directors at academic medical centers found that 86% believe NPs and other advanced practice providers contribute to the continuity of care, 78% believe they save time during rounds and evaluating new patients, and 73% believe they assist in maintaining work flow (J. Crit. Care 2014; 29:112-5).
In the years ahead, Mr. Farley predicted that NPs and other advanced practice providers "are certainly going to be in the ICU, probably even in greater numbers and perhaps in broader roles than they are now."
Mr. Farley said he had no relevant financial conflicts.
On Twitter @dougbrunk
SAN DIEGO – Nurse practitioners are assuming expanded roles and responsibilities in the provision of critical care services, according to Thomas Farley, R.N., N.P.
At the University of California, San Diego, Critical Care Summer Session, Mr. Farley described the expanded role nurse practitioners (NPs) have played in critical care services for about a decade at the University of California, San Francisco (UCSF). In 2004, Dr. Michael Matthay, a pulmonologist, and Dr. Michael Gropper, a critical care anesthesiologist, spearheaded an effort to hire four NPs to work in the university’s medical-surgical intensive care unit (ICU). "At the time, there were increasing limitations on physician trainees, both in the number of trainees and their work-hour restrictions that were becoming more tight," recalled Mr. Farley of the UCSF School of Nursing. "The goal was to provide critical care at the bedside 24 hours per day, which is in line with the Leapfrog Group recommendations for critical care services. At the time, they had 60 adult ICU critical care beds."
Today, 18 NPs work in adult ICUs at UCSF, with expansion to 76 adult critical care beds, including the medical-surgical ICU, cardiothoracic ICU, and neuro ICU. "Initially the NPs were integrated with medical residents," Mr. Farley said. "Now there are teams that don’t have residents, so it’s an NP paired with an attending physician, or sometimes a fellow. There are always two NPs on service. Usually, during the day we have four NPs on, with two on at night." The program was described in 2011 (ICU Director 2011;2:16-19).
Practice trends driving the need for NPs in critical care include the increasing demand for intensivists and a reliance on a team-based approach to care delivery, "understanding that a single provider cannot provide all the needs that any individual critical care patient has," Mr. Farley explained. "I think we’re a little slow to incorporate the use of nurse practitioners on the West Coast. It’s certainly been done for quite some time on the East Coast."
He said that NPs are already incorporated into critical care delivery programs at Memorial Sloan Kettering Cancer Center and Columbia University, both in New York; Emory University, Atlanta; Henry Ford Hospital, Detroit; the Cleveland Clinic; and Vanderbilt University, Nashville, Tenn. Adopters out West include UCSF, UC Davis; UC Los Angeles; UC Fresno; and Oregon Health & Science University, Portland.
At UCSF, critical care NP duties include a consultative role to admitting services, a consultative role to bedside RNs, guidance of house staff, responding to code blue activations, assisting with rapid response consultations, serving on hospital-wide multidisciplinary committees, precepting adult care NP students, as well as attending morning teaching and monthly morbidity and mortality conferences. Procedures performed include insertion of central venous catheters, arterial catheters, chest tubes, and PICC (peripherally inserted central catheter) lines; lumbar puncture; suture and drain removal; and airway intubation.
The use of NPs in critical care "works because we have appropriate conduits for collaboration and supervision that are explained, understood, and taken to heart," Mr. Farley said. "The NPs need to know that they have supportive attending physicians who will assist them when questions arise. We’ve also had buy-in from the ICU nurses."
A growing body of medical literature suggests that this trend is having an effect. A retrospective study of 600 admissions at two ICUs in New York found that patients managed by nurse practitioner/physician assistant teams had no worse outcomes than patients managed by physicians (Chest 2011;139:1347-53). In addition, a recent survey of critical care program directors at academic medical centers found that 86% believe NPs and other advanced practice providers contribute to the continuity of care, 78% believe they save time during rounds and evaluating new patients, and 73% believe they assist in maintaining work flow (J. Crit. Care 2014; 29:112-5).
In the years ahead, Mr. Farley predicted that NPs and other advanced practice providers "are certainly going to be in the ICU, probably even in greater numbers and perhaps in broader roles than they are now."
Mr. Farley said he had no relevant financial conflicts.
On Twitter @dougbrunk
EXPERT ANALYSIS AT THE UCSD CRITICAL CARE SUMMER SESSION
