30 Acute Care Nurse Practitioners (ACNP): The Intensivist Model

Wednesday, January 20, 2010
Mary Wyckoff, PhD, MSN, ACNP, BC, FNP-BC, NNP, FAANP, CCNS, CCRN , Surgical Intensive Care Unit, Jackson Memorial Hospital, North Miami Beach, FL
Valerie Wells, MSN, APN-BC, CCRN , Surgical Intensive Care Unit, Jackson Memorial Hospital, Miami, FL
Nichole Crenshaw, MSN, ARNP, BC , Surgical Intensive Care Unit, Jackson Memorial Hospital, North Miami Beach, FL
Purpose:
The role of the nurse practitioner is evolving to meet the needs of health care systems and patients. The mandate to limit physician residency hours in the United States has limited the availability of skilled care providers within the acute and critical care settings.

Significance:
The critically chronically ill patients have increased acuity and require ongoing bedside management and intervention. This new complex patient has evolved from a few underlying conditions to a multidimensional patient with chronic conditions, and long term sequelae.

Strategy and Implementation:
In critical care units, this requires high quality, evidence-based bedside care. In the 40-bed SICU of a large academic medical center, the ACNP group has grown from a single nurse practitioner to a group of 16. The role is expansive and encompasses bedside management, education of nurses and resident physicians, and multiple dimensions of family centered care. This role has required increased procedural skills including bedside percutaneous tracheostomy, pulmonary artery catheter placement, intubations, chest tubes and multiple other procedures. The evolution of this program has advanced nursing practice at the bedside and has increased support for nurses in this intense critical care ICU setting. The ACNP service has facilitated a decrease in infection rates, research oriented programs and enhancement of a family centered care environment. This program has also developed an educational program for all ACNPs within an enhanced degree educational program.

Evaluation:
The ACNP's continuous bedside management has enhanced patient outcomes, changed the financial constraints, and decreased patient complications. The knowledge to facilitate the recovery of critically ill individuals is based on organized strategic activity and continuity of care.

Implications for Practice:
The goal of this clinical presentation is to bring to the forefront the advantages of expanding the role of nurse practitioners within acute and critical care settings highlighting the benefits this new role holds for improving outcomes. The discussion will include the development of a fellowship.

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