Skip to main content
SpringerLink
Log in

Incorporating Advanced Practice Practitioners in the ICU

  • Chapter
  • First Online:
Book cover Principles of Adult Surgical Critical Care

  • 2208 Accesses

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Ford LC. Reflections on 50 years of change. J Nurse Pract. 2015;27:294–5.

    Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  4. American Association of Nurse Practitioners (AANP). Nurse Practitioner Fact Sheet. http://www.aanp.org/all-about-nps/np-fact-sheet. Accessed 20 June 2015.

  5. American Academy of Physician Assistants (AAPA). What is a physician assistant? https://www.aapa.org. Accessed 20 June 2015.

  6. American Academy of Physician Assistants (AAPA). Physician assistants in the ICU: a Critical Presence. https://www.aapa.org. Accessed 29 June 2015.

  7. American Nurses Credentialing Center. 2013 certification data report. Silver Spring: American Nurses Credentialing Center; 2014.

    Google Scholar 

  8. Kleinpell R. Acute care nurse practitioner practice: results of a 5 year longitudinal study. Am J Crit Care. 2005;14:211–9.

    Article  PubMed  Google Scholar 

  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. 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. 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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  14. Meyer SC, Miers LJ. Cardiovascular surgeon and acute care nurse practitioner: collaboration on postoperative outcomes. AACN Clin Issues. 2005;16:149–58.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  21. Costa DK, Wallace DT, et al. NP/PA staffing and critical care mortality. Chest. 2014;146(6):1566–73.

    Article  PubMed  PubMed Central  Google Scholar 

  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. 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).

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  25. Kapu AN, Thomson-Smith C, Jones P. NPs in the ICU: the Vanderbilt initiative. Nurse Pract. 2012;10(37):46–52.

    Article  Google Scholar 

  26. http://www.emoryhealthcare.org/critical-care, http://carolinashealthcare.org/center-for-advanced-practice.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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 

Download references

Author information

Authors and Affiliations

  1. Center for Clinical Research & Scholarship, Rush University Medical Center, Rush University College of Nursing, Chicago, IL, 60612, USA

    Ruth Kleinpell PhD, RN, FCCM

  2. NP/PA Critical Care Residency Program, Emory Healthcare, Emory Critical Care Center, Atlanta, GA, 30308, USA

    W. Robert Grabenkort PA, MMSC, FCCM

Authors
  1. Ruth Kleinpell PhD, RN, FCCM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Robert Grabenkort PA, MMSC, FCCM
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruth Kleinpell PhD, RN, FCCM .

Editor information

Editors and Affiliations

  1. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Niels D. Martin

  2. Trauma, Surgical Critical Care, Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Lewis J. Kaplan

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Kleinpell, R., Grabenkort, W.R. (2016). Incorporating Advanced Practice Practitioners in the ICU. In: Martin, N.D., Kaplan, L.J. (eds) Principles of Adult Surgical Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-33341-0_48

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33341-0_48

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33339-7

  • Online ISBN: 978-3-319-33341-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation