Building an ICU NP Intensivist Program

Purpose:
Vanderbilt's Advanced Practice leaders share their experience in the design and implementation of a nurse practitioner intensivist program within each of their adult intensive care units.

Significance:
With the opening of a new critical care tower, effectively doubling bed capacity and exceeding the limits of housestaff capacity, the imperative faced was the need for additional intensivist provider coverage.

Strategy and Implementation:
Staffing models were built envisioning NPs participating in multidisciplinary rounds, working alongside housestaff and taking patients of equal number and acuity. Recruitment was vigorous both internally and nationwide. Successful candidates were a blend of new acute care NP graduates and experienced ICU NPs. As the NPs were expected to provide 24/7 first call coverage, they required extensive education in critical care medicine and training in advanced procedures. Based on the variable experience and education of newly hired NPs, a comprehensive orientation and performance evaluation program was developed. Given our high risk patient population with multiple comorbidities, the NPs were made billing providers and trained to document critical care services. NP specific quality metrics were defined and tracking systems were developed. The NPs received faculty appointments and were encouraged to pursue research projects and publications on their experiences and findings.

Evaluation:
Although coverage was the main driver, their continuous presence in the unit has facilitated patient throughput, adherence to practice guidelines, promoted staff education and provided timely patient interventions that produce better outcomes.

Implications for Practice:
The role of the critical care NP has evolved to partner, collaborator, expert critical care provider and leader. They self-govern with the mandate that patient care and coverage comes first and they are accountable for practice viability whether it is financial or by virtue of quality and safety.