1. Morse, Kate J. RN, CCRN, CRNP, MSN

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If you're an expert critical care nurse who's looking for a new challenge and you don't wish to leave the ICU, what are your options? The varied and numerous roles for advanced practice nurses, especially nurse practitioners (NP), almost make it difficult to choose. Yet one fact remains certain: Watching your practice evolve into an advanced practice role is exciting and challenging.

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Those aiming for the next level may want to consider the role of the acute care nurse practitioner (ACNP). The ACNP provides advanced nursing care to complex, acute, and critically ill patients. This encompasses exacerbations of chronic illness, episodic illness, palliative, and end-of-life care. Because the ACNP isn't limited to a role in the ICU, he or she may care for patients throughout the institution.


In the critical care arena, the advanced practice nurse's role has expanded greatly. Nurse practitioners are providing excellent care in collaboration with their physician and nursing colleagues. The ACNP may be employed by a specific medical practice and have a narrower focus, or he or she may work under an intensivist model, with responsibility for all the patients in the ICU, along with global hospital tasks.


The competencies for the entry-level ACNP were outlined comprehensively in 2004 by the National Panel for Acute Care Nurse Practitioner Competencies (the National Organization of Nurse Practitioner Faculties).1Acute Care Nurse Practitioner Competencies is an excellent tool for nurses looking to understand the general role of the ACNP. For those already in the role, this tool acts as a blueprint for practice.


Remember, the ACNP can serve as the link between the nursing and medical models. Our knowledge of both is a valuable asset. This unique insight can lead to improved communication between team members. Additionally, the professional role of the ACNP includes mentoring and teaching bedside nurses. Our physician colleagues may not perceive this as an important function because it is nonbillable time. However, one of our responsibilities is to educate and interpret our role for others.


The Society of Critical Care Medicine has recognized the important contribution that mid-level providers make to the outcome of patients.2 Included in the criteria for Leapfrog compliance is the availability of a mid-level provider within 5 minutes and a board-certified critical care physician within 30 minutes. The presence of mid-level providers, physician assistants, or nurse practitioners can and does make a difference in patient outcomes.


One unresolved ACNP-related issue is billing practices. Currently, the ACNP may be a hidden provider in the eyes of some insurance companies. This will be a barrier to practice, as we not only have to show our worth in quality of care outcomes, but also in financial outcomes.


The role of an NP in critical care requires patience, enthusiasm for the work, and attention to detail-all of which is a perfect fit for the expert critical care nurse.


Kate J. Morse, RN, CCRN, CRNP, MSN


Editor-in-Chief, Director of Nurse Practitioners Chester County Hospital West Chester, Pa.




1. National Panel for Acute Care Nurse Practitioner Competencies. Acute Care Nurse Practitioner Competencies. Available at: Accessed March 30, 2007. [Context Link]


2. Haupt MT, Bekes CE, Brille RJ, et al. Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med. 2003;31(11):2677-2683. [Context Link]