National Nurse Practitioner Week 2020 (NP Week) takes place November 8 - 14. The event, sponsored by the American Association of Nurse Practitioners (AANP), is an annual celebration of the work accomplished by the 290,000 nurse practitioners (NPs) licensed in the U.S. and a reminder to us all about the critical role NPs play in healthcare.
This year's commemoration joins the nursing community to celebrate the International Year of the Nurse and the Midwife. It also coincides with the 200th anniversary of Florence Nightingale's birth and the 100th birthday of Dr. Loretta C. Ford, NP, co-founder of the first NP program at the University of Colorado and early champion of the NP role.
Nurse Practitioners in the ICU
The theme for this year's celebration of NP Week is "NPs Moving Forward: Today. Tomorrow. Together."—and nowhere are we seeing more forward motion in the growth of the profession than in acute care settings.
“Dr. Loretta Ford, EdD, and Dr. Henry Silver, MD, began the first Nurse Practitioner program in 1965 in the area of pediatrics. Over the years this expanded quickly to other primary care areas to include Family Practice and Psych-Mental Health and in the later years Acute Care,” said John Bernhard, ACNP-BC, an ICU Nurse Practitioner with SCP Health, commenting on the profession's growth.
“The Acute Care Nurse Practitioner (ACNP) specialty, now called the Adult Gerontology Acute Care Nurse Practitioner, was created in the 1990’s in response to the growing need for more practitioners in the acute care setting. Before, it was more Family and Adult Nurse Practitioners who helped in the hospital but their training was focused on primary care not acute care needs. The Acute Care NP is uniquely trained to manage and treat the acute care needs of patients from our ER to our ICUs. Within the Acute Care Nurse Practitioner role there is currently further development towards intensivist specialization, such as can be found at Vanderbilt University —and now there is a push for residency programs for NPs with specialization in critical care and other acute care concentrations. I myself was fortunate to attend an Acute Care NP residency in Critical Care at the University of Alabama Birmingham,” said Bernhard
Currently, 28 states, the District of Columbia, and two U.S. territories have implemented Full Practice Authority for NPs, granting patients full and direct access to care offered by these healthcare professionals with several more such as California and Florida recently granting Full Practice Authority to some NPs with stipulations.
NPs in those states now provide a full range of services that include:
- Writing orders
- Performing and interpreting diagnostic tests
- Diagnosing and treating acute and chronic conditions
- Prescribing medications and treatments (NPs hold prescriptive privileges, including controlled substances, in all 50 states and D.C.)
- Managing overall patient care in both outpatient and inpatient settings
- Signature Authority
"NPs are able to expand on their years of nursing experience in various settings," Bernhard said. "There are now a variety of specialties to choose from."
One specialty Bernhard mentioned in particular is the Adult-Gerontology Acute Care Nurse Practitioner Certification (AGACNP).
"This is a more rapidly growing specialty that enables NPs to work in a range of clinical treatment areas, including Urgent Care centers, ICU’s, surgical subspecialties, specialty practice and Emergency Rooms" he said. "It is a significant area of growth."
Acute Care Nurse Practitioners Importance to Hospitals
NPs represent a substantial cost saving to hospitals and medical groups, according to Bernhard.
"NPs are able to bill at 85% of physician Medicare fees but don’t take in 85% of a physician's salary while seeing between 75 to 100% of a physician’s workload," he said. "That is a huge benefit to the hospital, especially in the ICU where nurse practitioners are able to bill critical care time and perform procedures such as central line insertion, bronchoscopy and ventilator management."
He also indicated that nurse practitioners serving in leadership positions benefit hospitals by adding new perspectives, ideas, and innovation. “As the only nurse practitioner to serve as a Program Director of a Hospital Medicine program for four years at SCP Health, my understanding of not only the nursing processes but also medicine processes were instrumental in turning my program around in Arizona,” Bernhard noted. While healthcare positions are often separated out into various columns, the ability and passion that NPs can bring to the table should not be discounted.
NPs have also been instrumental as presidents of medical staffs and members of Medical Executive Committees. Bernhard recalls, “The story of Bob Donaldson, an emergency room NP. He was the medical director of the emergency department and was elected now twice as the President of the Medical Staff at Ellenville Regional Hospital in New York. I think examples of NPs excelling in positions that were once held solely by physicians is further evidence of the value that adding NPs to leadership roles can have on an organization.”
Essential Skills of ICU Nurse Practitioners
Bernhard, who works in an intensive care setting at a local hospital, knows full well the pressures NPs in the ICU face and the skills needed to cope.
"The ICU can present a lot of pressure and stress," he said. "You must be able to maintain a cool, collected head in the midst of chaos while being able to stabilize the patients. How you handle stress and having outlets to relieve it are important.”
Bernhard recommended some additional skills he feels are necessary for success:
Know how to prioritize and be a fan of change. "Nothing ever stays the same in the ICU; things are constantly changing," he stressed. "You need to be a fan of changing conditions”
See all the puzzle pieces and put them together at a high level. "The ICU is not for someone who wants the easy button," he said. "It's meant for those who are high achievers, who like the nitty-gritty details while still being able to put all those little details together to see the larger picture. That can be the difference between saving the patient and not.
Be procedure-oriented and hands-on. "NPs in the ICU have to be able to put in lines, intubate, run codes, manage higher-level medical decision making. Sometimes as an ICU NP you are the only provider present," he emphasized.
Know the meaning of teamwork. “Depending on the situation, ICU NPs could be the team leader sometimes, the facilitator, or the worker bee. The ability to understand your role in the greater team of physicians, NP/PAs, nurses, and allied health for each situation is vitally important.”
Other pointers Bernhard mentioned include:
- Be comfortable with autonomy and collaboration;
- Have a sense of humor;
- Be a good communicator (with the healthcare team, the patient, the family, etc.). Sometimes taking those extra minutes to break a hard concept down will make all the difference to those we care for.
SCP Health Perspective on Nurse Practitioners
SCP Health places a high value on the nurse practitioner profession. NPs are central part of the patient care team and of the healthcare team's foundation. We value their skill and autonomy and support them with tools, education, and leadership opportunities.
Regarding our emphasis on education, Bernhard said, "We take a multimodal approach to education with our new NPs that incorporates both didactic and clinical training. That involves one-to-three months of training with a one-on-one clinical mentor, completing the Society of Critical Care Medicine’s Adult Review course to improve their critical care knowledge, and then a two day in-person procedure lab going over everything from intubation and difficult airways, to central lines and bedside echo.
During the mentorship, the NP is put together with a clinician in their same area. A gradual increase in responsibilities and patient loads is taken in a stepwise fashion. Clinical instruction is given by the clinical mentor and an evaluation is performed at the end of the training.
Work with Us
Our goal at SCP Health is to enable NPs to practice at the top of their license in a team-oriented, collaborative clinical environment with open communication and full physician support.
If you are ready to discover what serving as a nurse practitioner with SCP Health can mean for your career, search our job portal. Perhaps you'll find a position that's just right for you.