Incorporating Advanced Practice Practitioners in the ICU

  • Ruth KleinpellEmail author
  • W. Robert Grabenkort


The nurse practitioner (NP) and physician assistant (PA) professions began in the 1960s in response to shortages of primary care providers [1]. However, NP and PA roles have expanded over the years to meet patient care needs in specialty and subspecialty areas of practice. Nationally, a growing number of intensive care units (ICUs) are integrating the use of advanced practice providers (APPs) including NPs and PAs as a strategy for meeting ICU workforce needs [2, 3]. Currently, more than 205,000 NPs and more than 93,000 PAs are practicing in the United States [4, 5]. NPs and PAs play an increasing role on ICU teams to assist in direct patient care management in conjunction with the intensivist led team along with other role components including leading quality improvement initiatives, assisting with research studies, and promoting continuity of care in the ICU [5–7]. According to the 2013 AAPA Annual Survey Report (15,025 respondents), 2.3 % of the PA respondents listed the ICU as their primary clinical work setting.


Nurse practitioner Physician assistant Intensive care units (ICUs) Advanced practice providers (APPs) Trauma critical care team 


  1. 1.
    Ford LC. Reflections on 50 years of change. J Nurse Pract. 2015;27:294–5.Google Scholar
  2. 2.
    Pastores SM, O’Connor MF, Kleinpell RM, et al. The ACGME resident duty-hour new standards: history, changes, and impact on staffing of intensive care units. Crit Care Med. 2012;39:2540–9.CrossRefGoogle Scholar
  3. 3.
    Ward N, Afessa B, Kleinpell R, et al. Intensivist/patient ratios in closed ICUs: a statement from the society of critical care medicine taskforce on ICU staffing. Crit Care Med. 2013;41:638–45.CrossRefGoogle Scholar
  4. 4.
    American Association of Nurse Practitioners (AANP). Nurse Practitioner Fact Sheet. Accessed 20 June 2015.
  5. 5.
    American Academy of Physician Assistants (AAPA). What is a physician assistant? Accessed 20 June 2015.
  6. 6.
    American Academy of Physician Assistants (AAPA). Physician assistants in the ICU: a Critical Presence. Accessed 29 June 2015.
  7. 7.
    American Nurses Credentialing Center. 2013 certification data report. Silver Spring: American Nurses Credentialing Center; 2014.Google Scholar
  8. 8.
    Kleinpell R. Acute care nurse practitioner practice: results of a 5 year longitudinal study. Am J Crit Care. 2005;14:211–9.PubMedGoogle Scholar
  9. 9.
    Kleinpell R, Buchman T, Boyle WA (editors). Integrating nurse practitioners and physician assistants in the ICU: strategies for optimizing contributions to care. Society of Critical Care Medicine. Chicago Illinois. 2012.Google Scholar
  10. 10.
    Moote M, Krsek C, Kleinpell R, et al. Physician assistant and nurse practitioner utilization in academic medical centers. Am J Med Qual. 2011;5:1–9.Google Scholar
  11. 11.
    Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the ICU: an evidence based review. Crit Care Med. 2008;26:2888–97.CrossRefGoogle Scholar
  12. 12.
    Gracias VH, Sicoutris CP, Stawicki SP, et al. Critical care nurse practitioners improve compliance with clinical practice guidelines in “semiclosed” surgical intensive care unit. J Nurs Care Qual. 2008;23:338–44.CrossRefGoogle Scholar
  13. 13.
    Gillard JN, Szoke A, et al. Utilization of PAs and NPs at a level 1 trauma center: effects on outcomes. JAAPA. 2011;24(7):34, 40–3.PubMedGoogle Scholar
  14. 14.
    Meyer SC, Miers LJ. Cardiovascular surgeon and acute care nurse practitioner: collaboration on postoperative outcomes. AACN Clin Issues. 2005;16:149–58.CrossRefGoogle Scholar
  15. 15.
    Russell D, VorderBruegge M, Burns SM. Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners. Am J Crit Care. 2002;11:353–62.PubMedGoogle Scholar
  16. 16.
    Edkins RE, Cairns BA, et al. A systematic review of APPs in acute care: options for a new model in a burn ICU. Ann Plast Surg. 2014;72(3):285–8.PubMedGoogle Scholar
  17. 17.
    McMillan MA, Boucher N, Keith D, et al. Maintaining quality of care 24/7 in a nontrauma surgical intensive care unit. J Trauma Acute Care Surg. 2012;73:202–8.CrossRefGoogle Scholar
  18. 18.
    Sise CB, Sise JM, Kelley DM, et al. Resource commitment to improve outcomes and increase value at a level 2 trauma center. J Trauma Inj Infect Crit Care. 2011;70:560–8.CrossRefGoogle Scholar
  19. 19.
    Kapu AN, Wheeler AP, Lee B. Addition of acute care nurse practitioners to medical and surgical rapid response: a pilot program. Crit Care Nurse. 2014;34:51–9.CrossRefGoogle Scholar
  20. 20.
    Kapu AN, Kleinpell R, Pilon B. Quality and financial impact of adding nurse practitioners to inpatient care teams. J Nurs Adm. 2014;44:87–96.CrossRefGoogle Scholar
  21. 21.
    Costa DK, Wallace DT, et al. NP/PA staffing and critical care mortality. Chest. 2014;146(6):1566–73.CrossRefGoogle Scholar
  22. 22.
    Grabenkort WR, Kopan K, Mollenkopf FP, Keith DE. Developing orientation programs for nurse practitioners and physician assistants in the ICU. In: Integrating Nurse Practitioners & Physician Assistants into the ICU. Mount Prospect: Society of Critical Care Medicine; 2012. p. 48–64.Google Scholar
  23. 23.
    Luckianow GM, Piper GL, Kaplan LJ. Bridging the gap between training and advanced practice provider critical care competency. JAAPA. 2015;28(5):1–5 (surgical ICUs).PubMedGoogle Scholar
  24. 24.
    Paton A, Stein D, D’Agostino R, Pastores S, Halpern NA. Critical care medicine advanced practice provider model at a comprehensive cancer center: successes and challenges. Am J Crit Care. 2013;22:439–43.CrossRefGoogle Scholar
  25. 25.
    Kapu AN, Thomson-Smith C, Jones P. NPs in the ICU: the Vanderbilt initiative. Nurse Pract. 2012;10(37):46–52.CrossRefGoogle Scholar
  26. 26.
  27. 27.
    Kleinpell R, Ward NS, Kelso LA, et al. Provider to patient ratios for nurse practitioners and physician assistants in critical care units. Am J Crit Care. 2015;24:e16–21.CrossRefGoogle Scholar
  28. 28.
    Kleinpell R, Ely W, Williams G, et al. Concise review: web-based resources for critical care education. Crit Care Med. 2011;39:541–53.CrossRefGoogle Scholar
  29. 29.
    Kleinpell R, Boyle WA, Buchman T, editors. Meeting 21st-century challenges in critical care delivery and beyond: nurse practitioner and physician assistant providers in the ICU. In: Integrating nurse practitioners and physician assistants in the ICU: strategies for optimizing contributions to care. Mount Prospect: Society of Critical Care Medicine. Chicago Illinois. 2012. p. 1–8.Google Scholar

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Authors and Affiliations

  1. 1.Center for Clinical Research & ScholarshipRush University Medical Center, Rush University College of NursingChicagoUSA
  2. 2.NP/PA Critical Care Residency ProgramEmory Healthcare, Emory Critical Care CenterAtlantaUSA

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