Faculty Practice: APN - team coverage in an ICU

I was approached to begin a new program at the local university hospital in an open admission Intensive Care unit.  The program began with 2 FT APN’s, and one PT APN, that would cover the daytime hours, 7 days a week, for 13.5 hours a day.  The night shift was then endorsed to a physician intensivist group.  A major emphasis on the development of an APN-run team was to decrease length of stay, decrease days on mechanical ventilation, decrease HAI, and generally improve the care for the patients.  Since the program inception,  there has been decrease in LOS and days on mechanical ventilation. HAI were very low to begin with, so a decrease in this in a short period of time has not been demonstrated.                 Our program is funded as a half time release from my teaching duties with the hospital responsible for the monetary cost of the release time.  The team coordinates care for up to 10 ICU patients;  do admissions, transfers, family meetings and general coordination of care, including orders and procedures.  I also collaborate with the other resident teams in the MICU, with respect to  teaching procedures and assisting with management issues.  I also participate in the evidenced based policy development and research in the ICU with the nurses. 

              Patient and family response to the role of the APN has been well received due to the availability of a consistent team. 

              Students in the AG-ACNP program rotate with the APN’s in the ICU, learning firsthand the role transition, management and invasive procedures.  During this past year,  more than half of the AG-ACNP have rotated in this  MICU unit.

              Barriers can be seen in in the reception of the APN team by some physicians.  Many physicians were not trained with AG-ACNP, and were not aware or comfortable  with the management style of the APN. 

              The program has had its successes.  All staff members, including the private physicians and staff nurses, pharmacists are very enthusiastic about working with the APN team.