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Advanced practice provider, CICU, Emergency leadership, Nurse practitioner, Pediatric critical care, Team leadership



  1. Florez, Amy R. DNP, APRN, CPNP-AC
  2. Riley, Christine M. MSN, BS, APRN, CPNP-AC
  3. Zender, Jill E. MSN, APRN, CPNP-AC
  4. Cooper, David S. MD, MPH
  5. Henry, Brandon M. MD, PhD
  6. Justice, Lindsey B. DPN, APRN, CPNP-AC


Background: The number of advanced practice providers (APPs) in pediatric critical care has increased dramatically over recent years, leading to increased opportunities to lead resuscitation teams during pediatric emergent events.


Objectives: The aim of this study was to better understand the emergency leadership experience, training, and education that pediatric cardiac intensive care unit APPs receive.


Methods: This study was a cross-sectional descriptive studying using survey responses. The self-administered survey was administered to APP and attending physician members of the Pediatric Cardiac Intensive Care Society. Survey results were analyzed.


Results: One hundred seven pediatric cardiac intensive care unit APPs (n = 53) and attending physicians (n = 54) responded to the survey. Half of APPs felt that attendings allowed APPs to lead emergent events, and 50.9% had never functioned in the team leader role. Most respondents (77.5%) rated their comfort functioning in the role during emergent situations as moderate or lower. Increased APP experience level was associated with a higher number of codes led, increased comfort leading codes, and improved mental model sharing (all Ps < .0001). The number of codes an APP had previously led was associated with increased comfort leading codes (P < .0001) and mental model sharing (P = .0002). One-third of attendings said they allow APPs to lead codes in their unit. Half of attendings who do not allow APPs to function as the team leader would follow formal training.


Discussion: Opportunities for APPs to function as team leaders during emergent events continue to increase. A leadership educational program would be beneficial to pediatric critical care APPs. It may also have the additional benefit of improving physician comfort with APPs leading code events and patient outcomes.