The Role of the Advanced Practice Nursing in Critical Care. Ruth M. Kleinpell PhD RN FCCM Rush University Medical Center Chicago Illinois USA

Transcription

1 The Role of the Advanced Practice Nursing in Critical Care Ruth M. Kleinpell PhD RN FCCM Rush University Medical Center Chicago Illinois USA

2 Introduction Advanced Practice Nursing (APN) roles are developing in many countries The APN role is advancing globally due to: Increasing healthcare needs Rising public expectations for health care Mounting healthcare costs

3 Definitions of Advanced Practice Nursing (APNs) RNs who have acquired: Advanced Knowledge Clinical Judgment Complex Decision Making Skills Clinical Competences for Expanded Practice International Council of Nurses Master s Level Education

4 APN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at the post-graduate level

5 Advanced Practice Nursing 4 Traditional Roles Certified Registered Nurse Anesthetist (CRNA) Certified Nurse Midwife (CNM) Clinical Nurse Specialist (CNS) Nurse Practitioner (NP)

6 APN Specialty Areas N= 210,000 APNs in US 6% 19% NP CNS 9% 66% CNM CRNA American Nurses Association:

7 Practice Settings of NPs Percent Private Physician Hospital Outpatient Hospital Inpatient Long Term Care HMO Public Health Emergency American Association of Nurse Practitioners National Sample Survey Goolsby. J Am Acad Nurs Pract 2005;17:337-41

8 NP Specialty Areas Percent Family Adult Women's Hlth Peds Acute Geront Psych Neonatal ER Goolsby MJ. J Am Acad Nurs Pract 2005;17:337-41

9 Practice Settings of ACNPs VA Settings 6% HMO 2% ER 2% N=635 AANP Sample Survey Hospital Outpatient 11% Physician Practice 17% Hospital Inpatient 62% Goolsby MJ J Am Acad Nurs Pract 2006;18(9):393-4.

10 Acute Care Nurse Practitioner Practice is based on state regulations States often require collaborative practice agreement with MD ACNPs Are master s degree prepared Have specialty training in acute care Have prescriptive authority Are credentialed for performing procedures

11 APN Regulation Written collaborative practice agreement N=23 Requirement for MD involvement (not written) N=4 Pearson L Am J NP No requirement for MD supervision N=24 states

12 APN Prescribing Privileges Pearson L Am J NP Written MD Collaborative Agreement N=34 No requirement for MD Agreement N=16

13 Position Components Physical Exams 95% Writing Orders 94% Histories 93% Rounding 86% Procedures 82% Initiate Transfers 75% Consultations 70% Discharge Summaries 70% AANP National Sample Survey 2009;

14 Activities/Procedures Performed by ACNPs N= Discuss Care w ith Family Order/Interpret Lab Tests Order/Interpret X- rays Initiate Specialty Consult Initiate Discharge Planning Series Kleinpell, R. AJCC, :

15 International Council of Nursing (ICN) Survey of 18 countries on APN role 75% stated that formal recognition of the NP/APN exists in their country by the government, hospital/health care agency or professional nursing organization 58% have formal NP/APN programs in their country 14 different titles identified for APN role Pulcini J, et al. ICN 2007

16 Countries Represented in ICN Survey Argentina Ireland Australia Nepal Bahrain Netherlands Botswana Singapore Canada South Africa China Hong Kong Switzerland Ethiopia Tanzania Finland United Kingdom France USA Pulcini J, et al. ICN 2007

17 Global APN Development Australia Nurse Practitioner (NP) Bahrain Specialist Nurse Botswana Family Nurse Practitioner Canada Clinical Nurse Specialist, APN, NP France Specialty Nurse Hong Kong APN, NP Iceland - APN Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

18 Global APN Development Ireland - APN Japan Certified Nurse Specialist Jordan Nurse Specialist Korea - APN Macao Specialist Nurse Netherlands Nursing Specialist New Zealand Nurse Practitioner Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

19 Global APN Development Philippines Clinical Nurse Specialist (CNS) Thailand CNS, NP Taiwan APN Singapore _ APN Sweden APN, NP Switzerland APN, CNS Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

20 Global APN Development Republic of South Africa APN UK APN, NP, Nurse Consultant USA APN, CNS, NP, CNM, CRNA Western Pacific NP Samoa, Fiji, Cook Vanuatu, Kiribati Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

21 APN Practice Settings Primary Care Australia Bahrain Botswana Canada Ireland New Zealand Philippines Republic of South Africa Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

22 APN Practice Settings Primary Care United Kingdom United States Western Pacific: Samoa, Fiji, Cook Vanuatu, Kiribati Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

23 APN Practice Settings Hospital Bahrain Canada Hong Kong Iceland Japan Macau Netherlands Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

24 APN Practice Settings Hospital New Zealand Philippines Republic of South Africa Singapore Switzerland Taiwan United Kingdom United States Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

25 APN Practice Settings Hospital APN Role in ICU: Comprehensive patient assessment Family education Grief counseling for family members Consultations with medical staff Initiation of advanced directives Staff nurse education Research & QI projects Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

26 Developing APN Role Essential Considerations Scope of Practice Educational Standards Regulatory/Legislative Framework Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

27 Developing APN Role Essential Considerations APN Role What is health are context priorities, goals, unmet needs What will the APN role be? Function Education Number required Career pathway Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

28 Role Challenges Gaining Acceptance Overcoming Legislative & Regulatory Barriers Providing education pertinent to scope of practice Negotiating career pathways Identifying role components Schober M, Affara FA 2006 ICN Advanced Nursing Practice. Blackwell Publishing

29 Implications for Advancing APN Practice Areas of focus: Identify additional areas for possible APN roles Provide education and training for APN Support development of APN

30 Summary The APN role is expanding globally The APN role in critical care offers the opportunity for advancing nursing practice And promoting best patient care