Critical Care Nurse Practitioner
Definition
The Critical Care Nurse Practitioner (CC-NP) is an advanced practice nurse with additional educational preparation from an accredited NP program and has clinical expertise in critical care nursing. The CC-NP practices in such specialized critical care settings as neonatal, pediatric, adult, medical, surgical, trauma, cardiovascular, and neurosurgical located within secondary, tertiary, or quaternary level facilities. The CC-NP may also provide clinical care to critically ill patients while on transport. The CC-NP integrates the skills and knowledge from nursing and medicine within a broad framework of advanced nursing practice. The CC-NP functions both autonomously and in collaboration with physicians and other health care providers to manage, in a comprehensive manner, the complex, multi-system, life-threatening health care needs of an assigned number of acute and chronic critically ill patients (and their families). The goals of the CC-NP are to stabilize patients with episodes of acute and life-threatening illnesses, minimize complications, restore maximal health potential, and provide holistic nursing care to the patient and family in order to implement strategies to minimize or prevent the problems for which the acute care populations are at risk. When curative goals cannot be achieved, the goal of the CC-NP may be to assist patients to achieve a peaceful death. Additional expectations for the CC-NP role include consultation, leadership, education, and research.
Qualifications
The CC-NP is a registered nurse who is prepared at the graduate level (minimum of a master's degree in nursing preferred or equivalent graduate degree with advanced clinical skills and training in advanced health assessment, physiology, advanced pathophysiology, pharmacology, diagnostic reasoning, clinical decision making, advanced therapeutics, family nursing, ethical decision making) and who has completed an approved acute/critical care nurse practitioner course. The CC-NP possesses current clinical expertise in their critical care specialty and has attained the appropriate Canadian Nurses Association specialty certification(s). The CC-NP has proven leadership, communication, critical thinking, and collaborative skills.
Scope of Practice
There are five interrelated components of the CC-NP role: practitioner, educator, consultant, researcher, and leader. These components are not separate and distinct but are woven into the everyday functioning of the CC-NP role. The balance of these components will vary depending on the setting in which the nurse is employed and the needs of the patients cared for in that setting. However, given the nature of CC-NP role, the majority of the CC-NP's time is in the practice component of the role.
As an advanced practitioner working within the auspices of approved medical directives and a practice agreement with physician partners, the CC-NP devotes the majority of time to direct patient/family care, which includes complex monitoring and therapies and high-intensity interventions within the full range of high-acuity and technologically complex care. The CC-NP carries a caseload of patients, and manages the patient and families' care during the patient's stay in the critical care setting in conjunction with clinical partners (e.g. bedside nurses and physicians). The CC-NP identifies and communicates nursing and medical diagnoses; prescribes and initiates medications from an approved formulary; and initiates, performs and interprets a broad range of investigations, diagnostic procedures, and treatments from a defined list. The CC-NP demonstrates an in-depth understanding of pathophysiology as it relates to the patient's disease process; strong verbal presentation and defense skills; proficiency in the analysis and synthesis of data; and the use of complex skills and interventions such as history taking, physical examination skills, pattern recognition and the ability to generate a working diagnosis. Assessments, planning, and provision of this care are guided by strong theoretical underpinnings and evidence-based knowledge.
In the educator component, the CC-NP shares specialized knowledge with other members of the interdisciplinary team to achieve treatment goals and provide continuity of care. The CC-NP also acts as a resource person, preceptor, and mentor for nurses, students and other professionals. The CC-NP advances the education of nurses and clinical partners through publications and presentations. As a clinical expert within the critical care specialty, the CC-NP partners with nursing colleagues to facilitate the patients' and/or families' learning and promote an environment that maximizes their understanding, participation, and control in their health.
As a consultant, the CC-NP shares specialized knowledge and provides consultation to clients, nurses, other health care professionals (both internal and external to the organization), health care facilities/institutions, organizations (local, national, and international), and policy makers. The CC-NP consults with others to improve client care, and to deal with complex and challenging situations faced in the critical care setting.
The research component strengthens the link between clinical practice and research. The CC-NP has knowledge in research methodology, identifies, conducts, and collaborates in the development of nursing and/or interdisciplinary critical care research and quality improvement projects. The CC-NP enhances excellence in critical care nursing by critically appraising research findings and implementing strategies to translate them into practice to improve patient care in the critical care setting.
As a leader, the CC-NP provides professional leadership in the development of standards, policies, procedures, and outcome measures related to the specialty area and the development of CC-NP advanced practice. The CC-NP plans, implements, and evaluates changes in clinical practice. The CC-NP provides clinical leadership by acting as a resource, facilitator, coordinator, role model, and advocate. The CC-NP's leadership responsibilities should enhance the clinical focus of the role.
References
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Joint Work Group of ANA/AACN. (1995). Standards of clinical practice and scope of practice for the acute care nurse practitioner. Washington, DC: American Nurses Association.
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