sarah crowe, mn, rn, cncc(c) - caccn.ca adv pract partners transforming... · critical care...
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Sarah Crowe, MN, RN, CNCC(C) Clinical Nurse Specialist Critical Care
Wendy Bowles, MN, NP F, CCN(C) Nurse Practitioner Lead, Regional Department Head
Fraser Health Authority, B.C.
For more information please contact: [email protected] 1 of 18
A costly area, critical care needs to look at new ways to provide high quality care
Although new to BC, there is strong evidence to
support improved patient care and reduction of costs in critical care with the addition of an NP to the interdisciplinary team
A case was made to the senior leadership team;
followed by an advanced practice nursing (APN) partnership to bring the idea of NPs in ICU from inspiration to implementation
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A partnership between the Critical Care Clinical Nurse Specialist (CNS) and the Nurse Practitioner (NP) Lead for Fraser Health was formed
Each APN brought unique perspectives to the
project After identifying the vision for the program, the
PEPPA framework was used to create a 1 year fellowship program to support & guide implementation of NPs into ICU
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Incorporate NP expertise into an interdisciplinary Critical Care team within
Fraser Health; starting at Abbotsford Regional Hospital
Create a sustainable NP fellowship program
to support integration of NPs into Critical Care
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NP
1. Define population & current
state 2. Identify stakeholders
& participants
3. Determine the need for a new model
of care
4. Identify priorities &
goals
5. Define the new model of
care & the NP role
6. Plan implementation
strategies
7. Initiate
8. Evaluate
9. Long term
monitoring
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Critical care patients are cared for by physician led interdisciplinary teams that include nurses, respiratory therapists, and other allied health professionals
Some sites have residents who also rotate through
Admission to critical care and patient care is determined by
the ICU physician
Physicians rotate through the ICU leading to multiple handovers & change
1. Define Population & Current
State
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To improve patient access, consistency of care, and address a service gap, key stakeholders were engaged early in the planning.
Stakeholders: Critical Care Leadership including Executive Directors, Directors,
Managers, CNS, and NP Lead
Physicians
NPs
Critical Care Nurses
Health Authority Professional Practice
Patients and families
2. Identify stakeholders
& participants
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Critical care is a costly area facing resource and provider shortages
Across Canada & in other countries Critical Care NPs are part of the care teams
Evidence supports improved care, reduced costs, and decreased complication rates with the integration of an NP into critical care Including: Reduction in UTIs, VAP, skin
breakdown; and improved compliance with care bundles / guidelines
3. Determine the need for a new model
of care
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Addition of an NP to the Critical Care interdisciplinary team will enable:
Early diagnosis and establishment of treatment plan based on best practice standards
Create capacity / access to critical care
Demonstrate improved patient care and cost – effectiveness
Develop an innovative and desirable new role for NPs in B.C.
4. Identify priorities &
goals
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Incorporate 2 NPs into the ARH ICU team to enhance and provide consistent coverage
Majority of NPs in B.C. are primary health / family practice trained; to support integration a 1 year fellowship program was created with the appointment of a physician mentor and protected education time
5. Define the new model of
care & the NP role
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Partnership with CNS & NP Lead to create an educational program to ensure support and proper integration of the new NPs
Fellowship was created using CNA, CRNBC, CACCN and AACN critical care guidelines as a framework
Collaboration with other specialty NPs and Harborview Critical Care NP Leader to ensure content was comprehensive and appropriate
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Included: Overall goals Principles Evaluation Mentors and mentees roles and expectations Technical Skills Development & Competency Systems Overview: Basic knowledge and
skills required of Critical Care NP
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Once the fellowship program was completed, advertisement and hiring of 2 NPs occurred
During the hiring process re-engagement of the health authority and the specific hospital site was done, including:
Communication campaigns; including physician communication
ICU staff engagement through unit
huddles, staff meetings and a survey
6. Plan implementation
strategies
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Gradual implementation plan allowing time for integration and knowledge assimilation
First 6 months of the fellowship program
provide protected time for structured learning with physician mentor
Last 6 months of the fellowship program
provide time for consolidation and focused training as required
7. Initiate
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NP self assessment & identification of learning needs
BC ICU Database to monitor pre and post implementation length of stay, complication rates, compliance with care standards, etc…
Staff satisfaction surveys
8.Evaluate
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Fellowship program has been operating for 6 months
Positive feedback from staff & NPs Continue to monitor ICU statistics for
evaluation and opportunities for improvement
Advocating to utilize fellowship program to incorporate NPs into other sites within Fraser Health
9. Long Term
Monitoring
For more information please contact: [email protected] 16 of 18
Becker, D., Kaplow, R., Muenzen, P.M., & Hartigan, C. (2006). Activities performed by acute and critical care advanced practice nurses: American Association of Critical Care Nurses study of practice. American Journal of Critical Care, 15(2), 130-148.
Crowe, S. (2014). A role for nurse practitioners in the ICU: advocating for change. Dynamics, 25(3), 26 – 29.
DiCenso, A., Martin-Misener, R., Bryant – Lukosius, D., Bourgeault, I., Kirkpatrick, K., Donald, F., … Charbonneau-Smith, R. (2010). Advanced practice nursing in Canada: overview of a decision support synthesis. Nursing Leadership, 23, 15 - 34.
Fry, M. (2011). Literature review of the impact of nurse practitioners in critical care services. Nursing in Critical Care, 16(2), 58 - 66.
Hoffman, L.A., Tasota, F.J., Zullo, T.G., Scharfenberg, C., & Donahoe, M.P. (2005). Outcomes of care managed by an acute care nurse practitioner / attending physician team in a subacute medical intensive care unit. American Journal of Critical Care, 14, 121 – 130.
Kapu, A.N., Thomson – Smith, C., & Jones, P. (2012). NPs in the ICU: the Vanderbilt initiative. The Nurse Practitioner, 37(8), 46 - 52
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For any questions or comments please contact: Sarah Crowe, RN, MN, CNCC(C)
Clinical Nurse Specialist Critical Care Fraser Health
For more information please contact: [email protected] 18 of 18