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Pastores SM, Kvetan V, Coopersmith CM, Farmer JC, Sessler C, Christman JW, D'Agostino R, Diaz-Gomez J, Gregg SR, Khan RA, Kapu AN, Masur H, Mehta G, Moore J, Oropello JM, Price K. Workforce, Workload, and Burnout Among Intensivists and Advanced Practice Providers: A Narrative Review. Crit Care Med 2019; 47:550-557. [PMID: 30688716 DOI: 10.1097/ccm.0000000000003637] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN Data were synthesized from monthly expert consensus and literature review. SETTING Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
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Affiliation(s)
- Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Craig M Coopersmith
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | | | - Curtis Sessler
- Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA
| | - John W Christman
- Division of Pulmonary, Allergy, Critical Care and Sleep, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rhonda D'Agostino
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Sara R Gregg
- Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA
| | - Roozehra A Khan
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - April N Kapu
- Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, TN
| | - Henry Masur
- Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD
| | - Gargi Mehta
- Jay B. Langner Critical Care System, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | - Jason Moore
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John M Oropello
- Division of Critical Care Medicine, Department of Surgery, Mount Sinai Medical Center, New York, NY
| | - Kristen Price
- Department of Critical Care Medicine, MD Anderson Cancer Center, Houston, TX
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White T, Kokiousis J, Ensminger S, Shirey M. Supplementing Intensivist Staffing With Nurse Practitioners: Literature Review. AACN Adv Crit Care 2018; 28:111-123. [PMID: 28592467 DOI: 10.4037/aacnacc2017949] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
In the United States, providing health care to critically ill patients is a challenge. An increase in patients older than 65 years, a decrease in critical care physicians, and a decrease in work hours for residents cause intensivist staffing issues. In this article, use of nurse practictioners to fill the intensive care unit intensivist staffing gap is assessed and evidence-based recommendations are identified to better incorporate nurse practitioners as part of intensive care unit intensivist staffing. The literature reveals that when nurse practitioners are part of a staffing model, outcomes are either positively impacted or no different from physician outcomes. However, successfully integrating nurse practitioners into an intensive care unit team is not adequately discussed in the literature. This gap is addressed and 3 mechanisms to integrate nurse practitioners into the intensive care unit are identified: (1) use of a multidisciplinary staffing model, (2) completion of onboarding programs, and (3) evaluation of nurse practitioner productivity.
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Affiliation(s)
- Tracie White
- Tracie White is Adult Care Nurse Practitioner, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294 . Justin Kokiousis is Family Nurse Practitioner, University of Alabama, Birmingham, Alabama. Stephanie Ensminger is Adult-Gerontology Acute Care Nurse Practitioner, University of Alabama, Birmingham, Alabama. Maria Shirey is Professor and Chair, Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
| | - Justin Kokiousis
- Tracie White is Adult Care Nurse Practitioner, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294 . Justin Kokiousis is Family Nurse Practitioner, University of Alabama, Birmingham, Alabama. Stephanie Ensminger is Adult-Gerontology Acute Care Nurse Practitioner, University of Alabama, Birmingham, Alabama. Maria Shirey is Professor and Chair, Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
| | - Stephanie Ensminger
- Tracie White is Adult Care Nurse Practitioner, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294 . Justin Kokiousis is Family Nurse Practitioner, University of Alabama, Birmingham, Alabama. Stephanie Ensminger is Adult-Gerontology Acute Care Nurse Practitioner, University of Alabama, Birmingham, Alabama. Maria Shirey is Professor and Chair, Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
| | - Maria Shirey
- Tracie White is Adult Care Nurse Practitioner, University of Alabama at Birmingham, 1720 2nd Ave South, Birmingham, AL 35294 . Justin Kokiousis is Family Nurse Practitioner, University of Alabama, Birmingham, Alabama. Stephanie Ensminger is Adult-Gerontology Acute Care Nurse Practitioner, University of Alabama, Birmingham, Alabama. Maria Shirey is Professor and Chair, Acute, Chronic, and Continuing Care, University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama
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Simone S, McComiskey CA, Andersen B. Integrating Nurse Practitioners Into Intensive Care Units. Crit Care Nurse 2018; 36:59-69. [PMID: 27908947 DOI: 10.4037/ccn2016360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
As demand for nurse practitioners in all types of intensive care units continues to increase, ensuring successful integration of these nurses into adult and pediatric general and specialty intensive care units poses several challenges. Adding nurse practitioners requires strategic planning to define critical aspects of the care delivery model before the practitioners are hired, develop a comprehensive program for integrating and training these nurses, and create a plan for implementing the program. Key strategies to ensure successful integration include defining and implementing the role of nurse practitioners, providing options for orientation, and supporting and training novice nurse practitioners. Understanding the importance of appropriate role utilization, the depth of knowledge and skill expected of nurse practitioners working in intensive care units, the need for a comprehensive training program, and a commitment to continued professional development beyond orientation are necessary to fully realize the contributions of these nurses in critical care.
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Affiliation(s)
- Shari Simone
- Shari Simone is a senior nurse practitioner clinical program manager, Women and Children's Services, a pediatric critical care nurse practitioner, University of Maryland Medical Center, Baltimore, Maryland, and an assistant professor, University of Maryland School of Nursing, Baltimore, Maryland. .,Carmel A. McComiskey is the director of nurse practitioners and physician assistants, University of Maryland Medical Center, and an assistant professor, University of Maryland School of Nursing. .,Brooke Andersen is a nurse practitioner clinical program manager, R. Adams Cowley Shock Trauma Center critical care units, and an adult acute care nurse practitioner, University of Maryland Medical Center.
| | - Carmel A McComiskey
- Shari Simone is a senior nurse practitioner clinical program manager, Women and Children's Services, a pediatric critical care nurse practitioner, University of Maryland Medical Center, Baltimore, Maryland, and an assistant professor, University of Maryland School of Nursing, Baltimore, Maryland.,Carmel A. McComiskey is the director of nurse practitioners and physician assistants, University of Maryland Medical Center, and an assistant professor, University of Maryland School of Nursing.,Brooke Andersen is a nurse practitioner clinical program manager, R. Adams Cowley Shock Trauma Center critical care units, and an adult acute care nurse practitioner, University of Maryland Medical Center
| | - Brooke Andersen
- Shari Simone is a senior nurse practitioner clinical program manager, Women and Children's Services, a pediatric critical care nurse practitioner, University of Maryland Medical Center, Baltimore, Maryland, and an assistant professor, University of Maryland School of Nursing, Baltimore, Maryland.,Carmel A. McComiskey is the director of nurse practitioners and physician assistants, University of Maryland Medical Center, and an assistant professor, University of Maryland School of Nursing.,Brooke Andersen is a nurse practitioner clinical program manager, R. Adams Cowley Shock Trauma Center critical care units, and an adult acute care nurse practitioner, University of Maryland Medical Center
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4
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Preparation and Evolving Role of the Acute Care Nurse Practitioner. Chest 2017; 152:1339-1345. [PMID: 28823758 DOI: 10.1016/j.chest.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/26/2017] [Accepted: 08/07/2017] [Indexed: 11/21/2022] Open
Abstract
Acute care nurse practitioners (ACNPs) are increasingly being employed as members of critical care teams, an outcome driven by increasing demand for intensive care services, a mandated reduction in house officer hours, and evidence supporting the ability of ACNPs to provide high-quality care as collaborative members of critical care teams. Integration of adult ACNPs into critical care teams is most likely to be successful when practitioners have appropriate training, supervision, and mentoring to facilitate their ability to practice efficiently and effectively. Accomplishing this goal requires understanding the educational preparation and skill set potential hires bring to the position as well as the development of an orientation program designed to integrate the practitioner into the critical care team. Pediatric ACNPs are also commonly employed in critical care settings; however, this commentary focuses on the adult ACNP role.
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Gilliland J, Donnellan A, Justice L, Moake L, Mauney J, Steadman P, Drajpuch D, Tucker D, Storey J, Roth SJ, Koch J, Checchia P, Cooper DS, Staveski SL. Establishment of Pediatric Cardiac Intensive Care Advanced Practice Provider Services. World J Pediatr Congenit Heart Surg 2016; 7:72-80. [PMID: 26714997 DOI: 10.1177/2150135115611356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The addition of advanced practice providers (APPs; nurse practitioners and physician assistants) to a pediatric cardiac intensive care unit (PCICU) team is a health care innovation that addresses medical provider shortages while allowing PCICUs to deliver high-quality, cost-effective patient care. APPs, through their consistent clinical presence, effective communication, and facilitation of interdisciplinary collaboration, provide a sustainable solution for the highly specialized needs of PCICU patients. In addition, APPs provide leadership, patient and staff education, facilitate implementation of evidence-based practice and quality improvement initiatives, and the performance of clinical research in the PCICU. This article reviews mechanisms for developing, implementing, and sustaining advance practice services in PCICUs.
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Affiliation(s)
| | - Amy Donnellan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lindsey Justice
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lindy Moake
- Heart Center, Children's Medical Center Dallas, Dallas, TX, USA
| | - Jennifer Mauney
- Section of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Page Steadman
- Division of Cardiothoracic Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David Drajpuch
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dawn Tucker
- Ward Family Heart Center, Children's Mercy Hospital and Clinics, Kansas City, MO, USA
| | - Jean Storey
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephen J Roth
- Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Josh Koch
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Paul Checchia
- Section of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - David S Cooper
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sandra L Staveski
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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American Academy of Nursing: Improving health and health care systems with advanced practice registered nurse practice in acute and critical care settings. Nurs Outlook 2015; 62:366-70. [PMID: 25353040 DOI: 10.1016/j.outlook.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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