nurse practitioners as hospitalists/intensivists, etc.

Colleen R. Walsh crwalsh@mindspring.com
Mon, 01 May 2000 15:01:23 -0500


Dr. Gipe:

I wish to correct a mistake in your letter about acute care nurse
practitioners. Acute Care Nurse Practitioners (ACNPs) do not get an extra
15 weeks of schooling. Rather, the ENTIRE curriculum and practicum
(clinical) experiences are geared toward the acute care patient. Many adult
and family nurse practitioners who have been certified for years as nurse
practitioners HAVE taken post masters credits in order to qualify for
sitting for the ACNP boards, but this option is no longer available. 

The American Nurses Credentialing Center (ANCC), the American Nurses
Association's arm for educational standards and testing, no longer is
allowing nurse practitioners who have critical care experience to sit for
the ACNP board certification exam. Persons who wish to sit for the exam
must complete a formal, nationally accredited acute care nurse practitioner
program. This is in order to assure the public that the practitioners
produced can meet certain standards. This, of course, is the same as the
American Board of Medical Specialities who have exams for the multiple
medical specialities that currently exist.

Many of the "skills" that your annotated questionnaire lists ARE skills
that are taught in various ACNP programs, but many ACNP educators,
including myself, believe that teaching generic skills is not in the best
interest of  the student, public, or educational process. We tell our
graduates that if your collaborating physician wishes to have the ACNP
perform skills, then the MD should teach those skills that are pertinent to
the speciality. Also, the state board of Nursing of each state as well as
the hospital that will be credentialing the ACNP have the final word on the
skills that the ACNP are allowed to perform. Just because we are taught
central line placement does not mean that ALL ACNPs will do them in their
practice.

The ACNP movement arose from a perceived need for coverage for acute
in-patients, especially in areas where the HCFA mandated decrease in
Medicare payments to hospitals hit the hardest. It also came about due to
the dramatic decrease in funded positions for residency training programs.
Many of the nation's leading teaching hospitals are hiring ACNPs as
ADJUNCTS, not necessarily replacements, for housestaff.

I hope this helps the members of this list to more fully and accurately
understand the vital role the ACNP has in the health care system.

Colleen Walsh




At 09:21 AM 5/1/2000 -0700, you wrote:
>   in january 2000, JAMA published an article from a program  at Columbia
>University in New York which compared the performance of nurse  practitioners
>(NPs) to primary care physicians in an outpatient setting and  found equal
>outcomes (Mundinger, et al. JAMA 2000;283:59-68).
>
>the  latest trend in training NPs is the "acute care nurse practitioner"
>(ACNP)  track which adds 15 weeks of clinical training and produces ACNPs who
>will  work in the inpatient setting.
>
>   Advanced Practice Nursing (clinical
>nurse specialists, ACNPs, NPs, CRNAs) is  provocative and compelling,
>especially at a time when some intensivists are  trying to fend off
>hospitalists and when we have an oversupply of physicians  and an undersupply
>of nurses. in order to improve collaboration, critical  care physicians need
>to understand how their colleagues in the nursing  profession view
>themselves.
>
>we have been sampling opinions on this  issue via the National Health Care
>& Quality Assn. website (www.nhcqa.org/poll.html).     i am enclosing a
>sample response to the poll questions  by a recent ACNP graduate and would
>appreciate feedback from the list (feel  free to respond to the poll).
>
>are nps able to function as house  physicians = yes nps can function as house
>physicians
>intubation =  intubation yes
>acls = acls yes
>arrythmia = arrhythmia yes
>central line  = central line yes
>thoracostomy = thoracostomy yes
>
>other comments re  Acute Care NPs =
>
>  I am graduating in three weeks from  the ACNP program at the
>  Actually the  program is Trauma/Acute Care/CNS.
>During my shock trauma rotation I placed  chest tubes, central lines
>(sub-clavian and femoral), and a-lines. I was  trained to assess, treat,
>  I also did  an ICU rotation at _____
>hospital in Washington D.C. where I intubated,  placed dialysis catheters,
>  I managed
>  Managed many drips
>  I will be
>  I am doing an extra
>  I will be
>  I will see patients in ICU,
>  My colleagues who graduated last
>semester are getting  certified,(taught and a letter of proficiency sent to
>the SBON by the  teaching doctor,) so they can perform intubations,
>insertions of central  lines and a-lines, and float swanns.
>
>If there is an expectation that you  will be performing a skill frequently,
>and get, say a surgeon at the facility  to teach you how to insert central
>  In school I was in
>clinical every day but class days, and  every third shift was a 30 hour
>on-call shift, I will be expected to take  call for the cardiology group i
>  I would not,  however, in the beginning of my career,
>manage, unstable patients on drips,  without consultation with a physician.
>I will immediately upon getting  hospital privileges, find a surgeon to
>certify my in inserting central lines,  and get one of the cardiologists to
>certify my competence in inserting  swanns.
>
>  By the way, I have a friend who is  managing all inpatient
>for a pulmonary group, all their vents and pulmonary  patients on her shift.
>She has a 2 month continuous supervision period after  her hire, and then she
>will take call like anyone else in the group and  manage on her own with
>consultation encouraged. She is expected to intubate  and insert chest tubes
>   Another friend  manages patients with a
>  Thank
>   I will be interested in the results.
>
>professional field = field:  NP
> bruce gipe, md
>primary critical care medical group, www.pccmg.com
>& quality,  www.cost-quality.com
>& quality assn., www.nhcqa.org
>north hollywood,  california
>818 761 6546
>fax: 818 761 5568
> 
Colleen Walsh, RN, MSN, ONC, CS, ACNP
Faculty, Graduate Nursing
University of Southern Indiana
Evansville, IN
(812)461-5216 work
(270)689-0127 home
crwalsh@mindspring.com
cwalsh@usi.edu