Critical Care Advanced Nursing Practice
As noted by the Canadian Nurses Association (CNA) in Advanced Nursing Practice: A National Framework (2000, 2002), trends in the delivery of health care are providing opportunities for nurses to create new positions and expand current roles. Among these trends are advanced nursing practice (ANP) positions in the field of critical care. Historically, ANP has been defined in somewhat differing and contradictory terms. It is critical that there be no confusion for consumers, other health care-professionals, health-care administrators, and health-care policymakers about critical care advanced nursing practice (CC-ANP). Therefore, the Canadian Association of Critical Care Nurses (CACCN) believes that a national definition of CC-ANP and clarity regarding how it is enacted in various critical care settings is crucial to the continued development of ANP and to the nursing profession itself. To ensure consistency and continuity, the position taken by CACCN regarding CC-ANP and the roles contained therein has been built on the landmark papers from CNA (2000, 2002) and the joint working group of the American Nurses Association and the American Association of Critical Care Nurses (1995).
CC-ANP is an umbrella term. It describes an advanced level of nursing practice that maximizes the use of in-depth nursing knowledge and skill in meeting the complex health care needs of clients (individuals, families, groups, and communities) within the specialized clinical area of critical care nursing. The nurse employed in a CC-ANP role has expertise in a specialized practice grounded in knowledge from nursing theory and other theoretical foundations, experience, and research associated with the field of critical care. Nurses engaged in CC-ANP hold formal education and experience beyond those of the beginning domains of practice and CACCN endorses that all critical care advanced practice nurses hold a graduate degree in nursing (or the equivalent) and have expertise in their critical care nursing specialty. CC-ANP includes five interrelated components: advanced practice, education, research, consultation, and leadership. Although there are variations in the implementation of the components, this implementation always includes the practice component. The practice component means engaging in practice and/or planning care for complex situations or complex client needs in acute, actual and/or potential life-threatening illnesses. The critical care advanced practice nurse is autonomous, but works in partnership with clients and other health care professionals. Integrated within the practice of each component are expert skills related to communication, collaboration, and ethical decision-making, for moving through the transition of change.
CC-ANP positions for which CACCN has developed position statements include the critical care clinical nurse specialist (CC-CNS) and the critical care nurse practitioner (CC-NP). CACCN does not endorse any one particular CC-ANP job description. Generally, job descriptions should be aligned with the characteristics and core competencies of advanced nursing practice as defined by CNA within their Advanced Nursing Practice Framework. Despite a similar conceptual foundation, job descriptions within organizations will differ depending on the area of specialization and the organizational structure (e.g. reporting structure, workload, patient population needs, etc). CACCN acknowledges that the critical care advanced practice nurse must work in accordance with the policies and procedures of the employing facility in association with the regulations and standards of practice provided by the provincial and territorial regulatory bodies. CACCN cannot predict the full range of roles and functions of a practice in critical care that continues to evolve. Ultimately, the responsibility and accountability for attaining and maintaining the professional standards and continuing competency development rests with the individual nurse.
Practice Environment
CC-ANP may occur in such settings as neonatal, pediatric, adult, medical, surgical, trauma, cardiac, and neurologic critical care units located within secondary, tertiary or quaternary level facilities. CC-ANP may also be provided to critically ill patients while on transport. CC-ANP may span the geographic settings of the home, ambulatory care sites, the hospital ward, and the intensive care unit.
Patient Population
Critical care patient populations for whom the critical care advanced practice nurse may care include neonates, children and youth, adults, and the aged. It will include patients who require short-term health care interventions that are restorative, rehabilitative, or maintenance. The patient's problems may be the result of new, chronic, or terminal illness. CC-ANP may include end-of-life care.
References
Ackerman, M. H., Norsen, L., Martin, B., Wiedrich, J., & Kitzman, H. J. (1996). Development of a model of advanced practice. American Journal of Critical Care, 5 (1), 68-73.
Canadian Nurses Association. (1997). Out in front - advanced nursing practice. Nursing Now, No. 2, 1-4.
Canadian Nurses Association. (2000). Advanced nursing practice – a national framework. Ottawa: Author.
Canadian Nurses Association. (2002). Advanced nursing practice – a national framework (2nd ed). Ottawa: Author.