CHEST journal paper offers “how to” on creating ICU teams with NPs and PAs
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Integrating nurse practitioners and physician assistants into medical ICU teams, which face a shortage of board-certified critical care physicians, could be a vital key to caring for a rising number of critically ill patients.
But what’s the best way to build a successful team? In a paper in the journal CHEST, UIC Nursing associate dean for practice and community partnerships Carolyn Dickens, PhD ’17, ACNP, FAANP, and her co-authors offer a primer for recruiting and using nurse practitioners and physician assistants in medical ICUs. CHEST is published by the American College of Chest Physicians.
The open access version of the paper, “How I do it: Nurse Practitioners and Physician Assistants: Building a Team and Optimizing Practice in the Medical ICU,” was made available online last month.
UIC Nursing DNP program director Melissa Carlucci, DNP, MS ’10, APRN, FAANP, is senior author and UIC Nursing former executive associate dean Susan Corbridge, PhD ’08, APRN, FAANP, FCCP, FAAN, now chief education and innovation officer at the American Association of Colleges of Nursing, is a co- author. Physician assistants from Stanford Health Care, Amber Beserra, and Cleveland Clinic, Joe Keller, are also co-authors.
Dickens says the audience for the paper is hiring managers in ICUs, typically physician chiefs or department heads. These may be at community hospitals, where they are trying to build a team, or at an academic center, where they are trying to improve an already existing team.
Studies have found that interprofessional teams lead to lower mortality rates and higher patient and staff satisfaction, Dickens says.
“It’s really important to emphasize that we are working as a team,” says Dickens. “In the MICU, where patient conditions can change rapidly and the complexity of care requires input from multiple disciplines, teamwork is so critical.”
According to the paper, key strategies to creating a team with nurse practitioners and physician assistants include identifying candidates with the right credentials, having a structured orientation program, defining roles, establishing clear reporting structures, and providing training for team integration.
Key takeaways from the paper:
- Hiring: ICU hiring managers should look for NPs and PAs with the “trifecta” of qualities, Dickens says. These include the proper education and training to perform within their scope of practice., experience, and skill set. For NPs, acute care certification ensures alignment with scope of practice and the complex needs of patients in critical care settings. An excellent candidate is one who has completed an ICU postgraduate training program for NPs or PAs, according to the paper. There are about 20 of these across the country.
- Orientation: A structured orientation program of 3 to 6 months helps with role transition and job satisfaction. A stepwise approach is often used in which the NP or PA begins by shadowing a physician or experienced advanced practice provider, progressively increasing their level of independence and the number and acuity of patients.
- Patient ratio: Mortality, ICU length of stay, education, staff well-being, and patient care are unfavorably impacted when the intensivist-to-patient ratio exceeds 1:14. The authors recommend integrating NPs and PAs into ICUs with a patient census under 14.
- Roles: The utilization of an NP or PA on such a team can be designed in several different ways to meet the needs of the MICU, including an assignment to manage a portion of the daily census or a dedicated role providing admitting and procedural services, which can add value by limiting disruptions to the rounding team.
- Productivity: Before starting the MICU NP/PA team, methods to measure NP and PA productivity should be established. Using a shared/split billing system when treating patients jointly with physicians can conceal the contributions of NPs and PAs.
- Path to success: Recognizing common challenges, including role clarity and communication, and developing a clear plan when onboarding new NPs/PAs and fellows that includes mentoring and shared learning experiences, is imperative to success.