1
|
Thomas JK, Arnold MA, Woodend KR, Riccioni MJ, Rissmiller BJ. Establishing excellence: Implementation of an onboarding and continuing education curriculum for pediatric intensive care unit nurse practitioners and physician associates. J Am Assoc Nurse Pract 2024; 36:233-240. [PMID: 38011632 DOI: 10.1097/jxx.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023]
Abstract
ABSTRACT This study describes a novel curriculum for onboarding and clinical education for nurse practitioners and physician associates (NPs and PAs) in the pediatric intensive care unit setting. The objective was to provide details on the initial orientation and continuing education program to ensure the attainment of knowledge and skills needed to care for critically ill patients safely and effectively. A needs assessment was completed, and a knowledge gap identified in five themes: (1) in-depth knowledge on common critical care diagnoses; (2) understanding of pathophysiology; (3) disease management processes; (4) critical thinking; and (5) procedure competency. Using Kern 6-step curriculum and the Kirkpatrick evaluation model, we designed a program for orientation and continuing education for critical care NPs and PAs. Transformative learning theory provided the framework for the program because the cyclical steps of disorienting dilemma, critical reflection, discourse, and action were used repeatedly to transform a new graduate to a competent critical care provider and then into an expert who is able to, in turn, teach others. A total of 31 NPs and 5 PAs completed the 12-week orientation phase. Participants reported that the orientation phase was valuable to their educational advancement and increased critical care knowledge. All participants showed improvement in knowledge, skills, and ability to provide competent patient care.
Collapse
Affiliation(s)
- Jenilea K Thomas
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | | | | | | |
Collapse
|
2
|
Paz M, Galdi R, Staller K, Thurler A, Vélez C. The Role of the Advanced Practice Provider in a Subspecialty Practice: Satisfaction and Professionalism, Including COVID-19 Impacts. Gastroenterol Nurs 2023; 46:232-242. [PMID: 37074979 PMCID: PMC10238553 DOI: 10.1097/sga.0000000000000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 04/20/2023] Open
Abstract
The advanced practice provider collaborates with other clinicians and works to educate, advocate, and increase access for patients in the clinical setting. Research has shown that advanced practice providers working collaboratively with physicians yield improved quality of care and outcomes; however, the current level of understanding of this role in gastroenterology has not been explored in detail. Across two academic institutions, we conducted 16 semi-structured interviews to examine how the environment of the gastroenterology department aligns with the professional satisfaction of its advanced practice providers. Thematic saturation was achieved, revealing four themes: (1) productivity of the working relationship; (2) inconsistent understandings of the advanced practice provider role in clinical care; (3) mixed advanced practice provider experience relating to colleague support; and (4) autonomy impacts satisfaction. These themes highlight not only a reasonable degree of advanced practice provider satisfaction, but also the need to engage with colleagues regarding the advanced practice provider role in care to allow for better integration into the overall gastroenterology healthcare team. The results from different institutions suggest the need to interview gastroenterology advanced practice providers in different settings to better understand whether similar themes exist.
Collapse
Affiliation(s)
- Mary Paz
- School of Nursing, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02114
| | - Riya Galdi
- School of Nursing, Massachusetts General Hospital Institute of Health Professions, Boston, MA 02114
| | - Kyle Staller
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Andrea Thurler
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Christopher Vélez
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| |
Collapse
|
3
|
Webb S, Butler J, Williams E, Harbour K, Hammond N, Delaney A. Intensive care nurse practitioners in Australia: A description of a service model in an adult tertiary intensive care unit. Aust Crit Care 2023; 36:133-137. [PMID: 36470778 DOI: 10.1016/j.aucc.2022.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/13/2022] [Accepted: 10/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although well-established internationally, nurse practitioners (NPs) in Australian adult intensive care units (ICUs) are rare. Australian literature clearly highlights the importance of creating ICU NP roles to meet emerging demands. An ICU NP model of care at a metropolitan hospital in Sydney provides care in four core practice areas: complex case management, vascular access, tracheostomy management, and intrahospital transport of critically ill patients. The ICU NPs also provide training and assessment for ICU nurses and medical officers in these same core practice areas and can efficiently meet service gaps in crisis such as the most recent COVID-19 pandemic. RESULTS The ICU NP program described is an innovative model of care that has demonstrated potential benefits to patients and their families. Potential benefits to the healthcare system including supporting advanced practice nursing development in regional and rural Australia and in addressing future ICU workforce issues are also identified. This model of care provides a clear role and structure for the integration of NPs in the adult ICU. Research to evaluate the impact of the role is required and is underway. CONCLUSIONS This model is being used to develop a national adult ICU NP fellowship training program for ICU transitional NPs preparing for endorsement or endorsed NPs who require additional ICU-specific training. This immersive clinical training program combined with didactic learning modules offers a framework to support the implementation of the adult ICU NP role as well as a framework for NP fellowship programs in other specialties.
Collapse
Affiliation(s)
- Sarah Webb
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Jessica Butler
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Elliot Williams
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Kelly Harbour
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
| | - Naomi Hammond
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Critical Care Division, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia.
| | - Anthony Delaney
- Royal North Shore Hospital Intensive Care Unit, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia; Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia; Division of Critical Care, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia.
| |
Collapse
|
4
|
Mahaffey JJ, Selim MA, Kristbaum KA, Mayer J, Martin A, Durazo FA, Hong JC. Evolution of a Transplant Surgery Advanced Practice Provider Practice Model in the Care of High-Acuity Liver Transplant Recipients: A Single-Center Experience. Transplant Proc 2022; 54:2621-2626. [DOI: 10.1016/j.transproceed.2022.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022]
|
5
|
Eaton BC, Vesselinov R, Ahmeti M, Stansbury JJ, Regner J, Sadler C, Nevarez S, Lissauer M, Stout L, Harmon L, Glassett B, Hampton DA, Castro HJ, Cunningham K, Mulkey S, O'Meara L, Dia JJ, Bruns BR. Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey. Am Surg 2020; 87:971-978. [PMID: 33295188 DOI: 10.1177/0003134820956929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A previous single-center survey of trauma and general surgery faculty demonstrated perceived positive impact of trauma and surgical subspecialty service-based advanced practice providers (SB APPs). The aim of this multicenter survey was to further validate these findings. METHODS Faculty surgeons on teams that employ SB APPs at 8 academic centers completed an electronic survey querying perception about advanced practice provider (APP) competency and impact. RESULTS Respondents agreed that SB APPs decrease workload (88%), length of stay (72%), contribute to continuity (92%), facilitate care coordination (87%), enhance patient satisfaction (88%), and contribute to best practice/safe patient care (83%). Fewer agreed that APPs contribute to resident education (50%) and quality improvement (QI)/research (36%). Although 93% acknowledged variability in the APP level of function, 91% reported trusting their clinical judgment. CONCLUSION This study supports the perception that SB APPs have a positive impact on patient care and quality indicators. Areas for potential improvement include APP contribution to resident education and research/QI initiatives.
Collapse
Affiliation(s)
- Barbara C Eaton
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Roumen Vesselinov
- Department of Epidemiology and Public Health, Department of Anesthesiology, 12264University of Maryland, Baltimore, MD, USA
| | - Mentor Ahmeti
- 23506Sanford Medical Center Fargo, ND, USA.,School of Medicine and Health Sciences, 12281University of North Dakota, ND, USA
| | | | | | - Craig Sadler
- 6040Eastern Virginia Medical School, VA, USA.,Norfolk General Hospital, VA, USA
| | | | | | | | | | | | - David A Hampton
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | - Helen J Castro
- Department of Surgery, Section of Trauma and Acute Care Surgery, University of Chicago Medicine and Biological Sciences, IL, USA
| | | | | | - Lindsay O'Meara
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Jose J Dia
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| | - Brandon R Bruns
- 137889R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, MD, USA
| |
Collapse
|
6
|
Envisioning Distinctive Professional Identity for Critical Care Advanced Practice Providers: Fostering Integrative Transformation Beyond Orientation. Pediatr Crit Care Med 2020; 21:e581-e583. [PMID: 32453923 DOI: 10.1097/pcc.0000000000002342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The roles played by nurse practitioners and physician assistants have expanded exponentially during the last decade. Although existing professional advancement models for nurse practitioners/physician assistants have led to enhanced integration in different patient care units, the development of a distinctive professional identity formation is lacking. This perspective proposes a new framework to guide the planning of an educational program that provides not only clinical knowledge and technical skills but also opportunities for enhancing leadership and research skills, along with strong career mentorship. Such a program will lead to formation of a distinctive identity for critical care nurse practitioners and physician assistants, which in turn can improve job satisfaction and employee retention.
Collapse
|
7
|
Thomas JK, Rissmiller BJ, Riccioni MJ, Graf JM. Successful Integration of Advanced Practice Providers Into a Pediatric Academic Community Intensive Care Unit. J Pediatr Health Care 2020; 34:279-282. [PMID: 32111568 DOI: 10.1016/j.pedhc.2020.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/28/2019] [Accepted: 01/02/2020] [Indexed: 10/24/2022]
|
8
|
Vail EA, Nadig NR, Sahetya SK, Vande Vusse LK, Walkey AJ, Liu V, Mathews KS. The Role of Professional Organizations in Fostering the Early Career Development of Academic Intensivists. Ann Am Thorac Soc 2020; 17:412-418. [PMID: 31800295 PMCID: PMC8174059 DOI: 10.1513/annalsats.201908-573ps] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Emily A. Vail
- Assembly on Critical Care Early Career Professionals Working Group, and
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, Texas
| | - Nandita R. Nadig
- Assembly on Critical Care Early Career Professionals Working Group, and
- Members in Transition and Training Committee, American Thoracic Society, New York, New York
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sarina K. Sahetya
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lisa K. Vande Vusse
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Allan J. Walkey
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University, Boston, Massachusetts
| | - Vincent Liu
- Assembly on Critical Care Early Career Professionals Working Group, and
- Division of Research, Kaiser Permanente, Oakland, California
| | - Kusum S. Mathews
- Assembly on Critical Care Early Career Professionals Working Group, and
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, and
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|