Nurse Practitioners Playing Larger Role in Critical Care Services
Frontline Medical News reports on the expanded roles and responsibilities nurse practitioners are assuming in the provision of critical care services in an interview with Thomas Farley, RN, NP, ACNP-BC, co-Director, of the Surgical and Critical Care NP Fellowship Program at UCSF:
At the University of California, San Diego, Critical Care Summer Session, Mr. Farley described the expanded role nurse practitioners (NPs) have played in critical care services for about a decade at the University of California, San Francisco (UCSF). In 2004, Dr. Michael Matthay, a pulmonologist, and Dr. Michael Gropper, a critical care anesthesiologist, spearheaded an effort to hire four NPs to work in the university’s medical-surgical intensive care unit (ICU). “At the time, there were increasing limitations on physician trainees, both in the number of trainees and their work-hour restrictions that were becoming more tight,” recalled Mr. Farley of the UCSF School of Nursing. “The goal was to provide critical care at the bedside 24 hours per day, which is in line with the Leapfrog Group recommendations for critical care services. At the time, they had 60 adult ICU critical care beds.”
Today, 18 NPs work in adult ICUs at UCSF, with expansion to 76 adult critical care beds, including the medical-surgical ICU, cardiothoracic ICU, and neuro ICU. “Initially the NPs were integrated with medical residents,” Mr. Farley said. “Now there are teams that don’t have residents, so it’s an NP paired with an attending physician, or sometimes a fellow. There are always two NPs on service. Usually, during the day we have four NPs on, with two on at night.” The program was described in 2011 (ICU Director 2011;2:16-19).
Practice trends driving the need for NPs in critical care include the increasing demand for intensivists and a reliance on a team-based approach to care delivery, “understanding that a single provider cannot provide all the needs that any individual critical care patient has,” Mr. Farley explained. “I think we’re a little slow to incorporate the use of nurse practitioners on the West Coast. It’s certainly been done for quite some time on the East Coast.”