Creating intensive care teams with nurse practitioners and physician assistants
Intensive care teams face a shortage of board-certified critical care physicians to care for critically ill patients. Integrating nurse practitioners and physician assistants into these teams could help.
But what’s the best way to build a successful team? In a paper in the journal Chest, Carolyn Dickens, UIC College of Nursing associate dean for practice and community partnerships, and co-authors offer a primer for recruiting and using nurse practitioners and physician assistants in medical ICUs.
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.
Melissa Carlucci , program director for the College of Nursing doctor of nursing practice, is senior author. Susan Corbridge, chief education and innovation officer at the American Association of Colleges of Nursing, is a co-author. Physician assistants from Stanford Health Care and Cleveland Clinic are also co-authors.
Dickens said 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 existing team.
Studies have found that interprofessional teams lead to lower mortality rates and higher patient and staff satisfaction, Dickens said.
“It’s really important to emphasize that we are working as a team,” Dickens said. “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 nurse practitioners and physician assistants with a “trifecta” of qualities, Dickens said. These include the proper education and training to perform within their scope of practice, experience and skill set. For nurse practitioners, 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 nurse practitioners or physician assistants, according to the paper. There are about 20 of these across the country.
Orientation: A structured orientation program between three and six months helps with role transition and job satisfaction. A stepwise approach is often used in which the nurse practitioner or physician assistant begins by shadowing a physician or experienced advanced practice provider, then progressively increases their level of independence and the number and acuity of patients they see.
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 nurse practitioners and physician assistants into ICUs with fewer than 14 patients.
Roles: The use of a nurse practitioner or physician assistant on such a team can be designed in several ways to meet the needs of the ICU, including an assignment to manage part of the daily number of patients or a dedicated role providing admitting and procedural services.
Productivity: Before starting the nurse practitioner/physician assistant team, methods to measure nurse practitioner and physician assistant productivity should be established. Using a shared/split billing system when treating patients jointly with physicians can conceal the contributions of nurse practitioners and physician assistants.
Path to success: Recognizing common challenges, including role clarity and communication, and developing a clear plan when onboarding new nurse practitioners/physician assistants and fellows that includes mentoring and shared learning experiences, is imperative to success.
