CC Nurse Practitioner

 

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Definition

The nurse practitioner in critical care (NP-cc) is a registered nurse in an advanced nursing practice (ANP) position with a minimum of a masters in nursing and additional educational preparation from an accredited acute-care or critical care NP program and who has clinical expertise in a critical care nursing subspecialty. The NP-cc has advanced knowledge, skill and training in health assessment, physiology, pathophysiology, pharmacology, diagnostic reasoning, clinical decision-making, therapeutic interventions, family nursing, and ethical decision-making. The NP-cc has the authority through an enhanced legislated scope of nursing practice to diagnose, order and interpret diagnostic tests, prescribe and perform restricted procedures (CNA, 2009). 

Qualifications

  • Registered Nurse
  • Minimum of Masters degree in nursing
  • Current critical care expertise
  • Current appropriate life support certificate(s) [e.g., ACLS, PALS, N-ERP]
  • Licensure as appropriate for jurisdiction
  • CNA's specialty certification in critical care or equivalent to critical care subspecialty (recommended)

Scope of Practice

The NP-cc is expected to practice in each of the following ANP core competencies: clinical, consultation and collaboration, leadership, and research (CNA, 2008). These competencies incorporate the previously identified five interrelated domains of practice: clinical, education, research, consultation and leadership (CACCN, 2002). These competencies are not separate and distinct but are woven into the everyday functioning of the NP-cc role. The NP-cc applies these competencies across three spheres of influence: the patient (and family); nursing, both the individual and the profession; and organizational systems. Integrated within the practice of each competency are expert skills related to communication, collaboration, and ethical decision-making, as well as effectively moving through the transition of change. 

The NP-cc devotes the majority of time to direct patient/family clinical care, which includes complex monitoring and therapies and high-intensity interventions within the full range of high-acuity and technologically complex care. The NP-cc integrates the skills and knowledge from nursing and medicine within a broad framework of advanced nursing practice. The NP-cc functions both autonomously and in collaboration with physicians and other health professionals to: (a) stabilize and manage, in a comprehensive manner, the complex, multi-system, life-threatening illnesses of an assigned number of acute and chronic critically-ill patients (and their families); (b) minimize complications; (c) restore maximal health potential; (d) provide holistic nursing care to the patient and family; (e) implement strategies to minimize or prevent the problems for which these patients are at risk; and (f) facilitate and coordinate quality end-of-life care when curative goals cannot be achieved. 

The NP-cc shares specialized knowledge with other members of the interdisciplinary team to achieve treatment goals and provide continuity of care. The NP-cc acts as a resource person, preceptor and mentor for nurses, students and other professionals. The NP-cc advances the education of nurses and clinical partners through publications and presentations. As a clinical expert within the critical care specialty, the NP-cc 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.

The NP-cc shares specialized knowledge and provides consultation to patients, nurses, other health professionals (both internal and external to the organization), healthcare facilities/institutions, organizations (local, national, and international), and policy makers. The NP-cc consults with others to improve patient care, and to deal with complex and challenging situations faced in the critical care setting.

The NP-cc enhances excellence in critical care nursing by critically appraising research findings and implementing strategies to translate them into practice to improve patient care. The NP-cc 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 NP-cc provides professional leadership in the development of standards, policies, procedures, and outcome measures related to critical care and the development of NP-cc advanced practice. The NP-cc plans, implements, and evaluates changes in clinical practice. The NP-cc provides clinical leadership by acting as a resource, facilitator, coordinator, role model, and advocate. The NP-cc’s leadership responsibilities should enhance the clinical focus of the role.

CACCN believes that time, opportunity and other supports are needed for the NP-cc to engage in the full scope of the role. The integration of the core competencies will continuously evolve depending on the critical care subspecialty in which the NP-cc is involved, that is, the predictability and complexity of the patients/families cared for by the NP-cc in the critical care setting, the needs of the nursing staff, as well as the education and experiential learning of the nurse in the NP-cc role.

Approved by the CACCN Board of Directors
Date January 19, 2011

References

Canadian Association of Critical Care Nurses (2002). Critical Care Advanced Nursing Practice: CACCN Position Statement. London, ON: Authors.

Canadian Nurses Association. (2008). Advanced nursing practice: A national framework (3rd ed). Ottawa: Author.

Canadian Nurses Association. (2009, November). Position statement: The nurse practitioner. Ottawa: Author. 

Bibliography

American Association of Critical Care Nurses. (2006). Scope and standards of practice for acute care nurse practitioners. Aliso Viejo, CA: Authors.

Association of Registered Nurses of Newfoundland and Labrador. (2000). Competencies for: nurse practitioner - specialist. St. John's: Author.

Association of Registered Nurses of Newfoundland and Labrador. (2008, April). The professional framework for nurse practitioner practice in Newfoundland and Labrador. St. John’s: Author.

Association of Registered Nurses of Newfoundland and Labrador. (2007, February). Advanced practice – the nurse practitioner. St. John’s: Author.

Association of Registered Nurses of Prince Edward Island. (2007, March). Standards of practice for nurse practitioners. Charlottetown: Author.

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.

Canadian Nurses Association. (2003, June). Position statement: The nurse practitioner. Ottawa: Author. 

Canadian Nurses Association. (2006). Canadian nurse practitioner initiative: Implementation and evaluation toolkit for nurse practitioners in Canada. Ottawa: Author. Retrieved from http://www.apnnursingchair.mcmaster.ca/resources_links.html

Canadian Nurses Association. (2007, November). Advanced nursing practice position statement. Ottawa: Author.

Canadian Nurses Association. (2010, May). Canadian Nurse Practitioner Core Competency Framework. Ottawa: Author.

College & Association of Registered Nurses of Alberta. (2005, September). Nurse practitioner competences. Edmonton: Author.

College & Association of Registered Nurses of Alberta. (2009). Nurse practitioners and nurse practitioner streams of practice. Retrieved from http://nurses.ab.ca

College of Nurses of Ontario. (2009). Nurse practitioners. Toronto: Author.

College of Registered Nurses of British Columbia. (2003, July). Competencies required for nurse practitioners in British Columbia. Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, June). Scope of practice for nurse practitioners (adult). Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, June). Scope of practice for nurse practitioners (pediatric). Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, July). Nurse practitioner streams of practice. Vancouver: Author.

College of Registered Nurses of Manitoba. (2005, May). Competencies for the registered nurse (extended practice), RN(EP) Register. Winnipeg: Author.

College of Registered Nurses of Manitoba. (2009, May). Standards of practice for registered nurses on the extended class register. Winnipeg: Author.

College of Registered Nurses of Manitoba. (2009, May). What is an RN(EP) or NP? Winnipeg: Author.

College of Registered Nurses of Nova Scotia. (2009, April). Nurse practitioner competencies. Halifax: Author.

College of Registered Nurses of Nova Scotia. (2009, April). Standards of practice for nurse practitioners. Halifax: Author.

Saskatchewan Registered Nurses Association. (2003, October). Registered nurse practitioner standards and core competencies. Regina: Author.

Saskatchewan Registered Nurses Association. (2004, April). Registered nurse practitioner scope of practice and the law. Regina: Author.