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Abstract |
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 Top Abstract BackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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• Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners.
• Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners.
• Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment.
• Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.
This article presents the study’s findings about advanced practice nurses working with acute and critically ill patients. In this report, we describe and discuss the activities performed by advanced practice nurses, the spheres of influence upon which they direct their practice, and the percentage of time they devote to specific problems related to patients’ care. Items on an experience inventory were validated and rated relative to their uniqueness to acute and critical care.
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Background |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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In a 1997 study, subject matter experts developed 5-point rating scales to behaviorally anchor the midpoint and endpoints of a continuum describing each characteristic of patients and nurses as outlined in the AACN Synergy Model for Patient Care (described in the next section). The 5-point rating scales for the characteristics of patients were developed to include descriptors for the most compromised patients (level 1) and the least compromised patients (level 5), as well as for midpoint patients (level 3). Similarly, each rating scale for characteristics of nurses included descriptors reflecting novice (level 1), competent (level 3), and expert (level 5) performance by a critical care nurse providing direct care to a patient—consistent with the pattern of skill acquisition described by Benner.2
In 1998, Professional Examination Service undertook a study to delineate the practice of acute and critical care CNSs in terms of the 8 competencies of nurses of the Synergy Model. Expansion of the Synergy Model to reflect CNS practice involved the identification of activities performed by CNSs. These activities were labeled level 7 competencies.3,4 No study, to date, had been done to delineate the roles and responsibilities of the nurse practitioner within the context of the Synergy Model.
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The AACN Synergy Model for Patient Care |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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The central concept of the AACN Synergy Model for Patient Care is that the needs or characteristics of patients and patients’ families influence and drive the characteristics or competencies of nurses.6 Synergy results when the needs and characteristics of a patient, clinical unit, or system are matched with a nurse’s competencies. Further, when patient characteristics match nurse characteristics, patients’ outcomes are optimized.7
Each patient brings a unique set of characteristics to the healthcare situation. Among the many characteristics, 8 are consistently associated with patients who are experiencing critical events: resiliency, vulnerability, stability, complexity, resource availability, participation in care, participation in decision making, and predictability (Table 1
). These characteristics underlie the needs of the patients.5,8 Each characteristic exists on a continuum from low (level 1) to high (level 5) (Table 2).
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The Synergy Model was initially based on 5 assumptions9:
These basic assumptions provided the guide for identification of characteristics of patients and competencies of nurses in the model.5,8
In February 2002, a practice analysis task force was created by the AACN Certification Corporation. The group consisted of advanced practice nurses from across the United States who worked in a variety of practice settings. The task force expanded the assumptions of the Synergy Model to include 4 more assumptions5,10:
Outcomes are considered patients’ conditions measured along a continuum.6 Six major quality indicators were identified: (1) satisfaction of patients and their families, (2) rate of adverse incidents, (3) complication rate, (4) adherence to the discharge plan, (5) mortality rate, and (6) each patient’s length of stay.
The Synergy Model was congruent with outcomes derived from 3 sources: patients, nurses, and the healthcare system (see Figure). Outcomes derived from the patient include functional changes, behavioral changes, trust, satisfaction, comfort, and quality of life. Outcomes derived from nursing competencies include physiological changes, the presence or absence of complications, and the extent to which treatment goals were reached. Outcome data derived from the healthcare system include readmission rates, length of stay, and cost utilization per case.5,6,8
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Advanced Practice Nursing |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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More than 2 decades ago, the initial delineation of CNS practice was based on job specifications or roles. These roles included direct care and independent practice, research, and consultation.12 A few years later, the published subroles and competencies of the CNS were modified to include clinical practice and direct care of patients, consultation, education, research, collaboration, and clinical leadership.7,13
Consistent with the National Association of Clinical Nurse Specialists Statement on Clinical Nurse Specialist Practice and Education,14 the roles of a CNS are currently described on the basis of 3 spheres of influence: (1) patients and patients’ families, (2) nurse-to-nurse, and (3) system.4,14,15
The multifaceted role of a CNS who cares for acute and critically ill patients and their families, working within an organization and with nursing staff, can also be described according to the Synergy Model. The model aligns not only the 8 characteristics of patients and the 8 competencies of nurses but also the role of the CNS in relation to the 3 spheres of influence.16 CNSs manage, support, and coordinate the care of acutely and critically ill patients with episodic illness or acute exacerbation of chronic illness7 while addressing both system and staff interaction. In Standards of Practice and Professional Performance for the Acute and Critical Care Clinical Nurse Specialist,17 AACN delineates several activities of CNSs in relation to each of the competencies inherent in the Synergy Model and the 3 spheres of influence.
ACNP is a second advanced practice role that has existed for approximately 12 years. In the early 1990s, the nursing profession recognized that the needs of patients were not being adequately met.18 It became evident that nurse practitioners had a scope of practice that could be maximized to meet both the medical and nursing needs of these vulnerable acutely ill patients.19,20 The American Nurses Association and the AACN formed a task force of experts to delineate the scope of practice for adult ACNPs. According to the document defining the scope,21 "the purpose of the ACNP is to provide advanced nursing care across the continuum of acute care services to patients who are acutely and critically ill." ACNPs focus on the stabilization of acute medical problems, prevention and management of complications, comprehensive management of injury and/or illness, and restoration to maximal levels of health within an interdisciplinary and collaborative healthcare team.21
Since development of the ACNP scope and standards and the subsequent offering of a national certification examination by the American Nurses Credentialing Center (ANCC) starting in 1996, Kleinpell has surveyed those ACNPs who sought certification to determine practice habits, practice environments, and emerging roles.22–26 Since 1997, Kleinpell’s reporting of longitudinal survey results has served as a means of keeping practitioners, educators, administrators, and colleagues informed of changes in the role. At the inception of the role, it was thought that ACNPs would work primarily in intensive care units (ICUs). Results of Kleinpell’s most recent survey26 indicate that most ACNPs do work in ICUs; however, nearly 50% of the respondents reported a practice environment other than the traditional ICU or urgent/acute care practice setting. Although the practice setting may vary among ACNPs, the main focus of their practice remains direct management of patients’ care, with 85% to 88% of time reportedly spent on this responsibility.26
Recognizing the need for consensus on the core competencies of ACNPs, the National Organization of Nurse Practitioner Faculties convened a national panel of ACNPs to identify ACNP competencies. The panel described entry-level competencies for graduates of master’s and post-master’s ACNP programs.27 The panel’s report describes for educators, practitioners, and the public the unique philosophy of ACNPs and the needs of the populations served. Further, the descriptions of the competencies include the role components of ACNPs within the 7 core domains outlined in the section on domains and core competencies of nurse practitioner practice of the same document.27
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Research Design and Method |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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Specific aims of the study were to obtain criticality and frequency ratings for each of 65 advanced practice activities, as determined by the practice analysis task force; compare the spheres of influence of the individual activities when performed by either the CNS or ACNP; compare the percentage of time that CNSs and ACNPs devote to specific problems related to patients’ care; and obtain frequency ratings for the items on the experience inventory that are unique to critical care.
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Development of a Comprehensive Description of Critical Care Nursing Practice |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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A task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. Examination of advanced practice nursing was part of a larger study of the continuum of critical care practice (new-to-critical care competencies, updated levels 1, 3, and 5 of the Synergy Model as described earlier); only the results related to advance practice nurses are reported in this article. The task force comprised 15 experts representing practitioners and educators, and it included CCRNs, CCNSs, and ACNPs who served neonatal, pediatric, and adult patients. Committee members were drawn from rural, suburban, and urban practice settings across the United States.
The task force met 4 times during the course of the project. The focus was on developing a comprehensive delineation of practice in acute and critical care. At each meeting, time was spent both in full-group discussions and in small-group work. Two nurse staff members from the AACN Certification Corporation attended all meetings of the task force. Staff from Professional Examination Service, the corporation’s testing company at the time, facilitated all of the meetings.
Sampling Plan
A sampling plan was designed to permit comparison of the populations of patients and the techniques and tools of advanced practice nurses and to allow validation of the competencies required for advanced level practice in acute and critical care nursing. The CNS sample consisted of all holders of the CCNS credential (N = 332) plus 168 holders of the CCRN credential who indicated that they were working as CNSs. The ACNP sample consisted of 500 ACNPs selected randomly from the population of currently certified ACNPs. A total of 75% of this combined CNS/ACNP pool received the Survey of Advanced Practice in Acute and Critical Care Nursing, and 25% of the pool received the Survey of Patient Care Problems in Acute and Critical Care.
Measures
The Survey of Advanced Practice in Acute and Critical Care Nursing was designed to collect data that would validate advanced practice activities, the 8 competencies of nurses, and the experience inventory. For each of the 65 advanced practice activities (Table 4), organized according to the 8 competencies of nurses of the Synergy Model, 3 rating scales were used:
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Frequency: How frequently did you perform the activity during the past year in your role as an advanced practitioner?
Sphere(s) of influence: Toward which sphere(s) of influence did you direct the activity during the past year? (Respondents were able to select all that apply.)
Complementary Data Collection Initiatives
Three additional data collection initiatives were conducted to complement and extend the work of the practice analysis task force: focus panels, critical incident telephone interviews, and independent reviews.
Focus Panels. A focus panel of CNSs (n = 12) and another of ACNPs (n=18) were conducted in May and June 2002. Each focus panel lasted 2 hours and was facilitated by a moderator from Professional Examination Service. All panels consisted of a mix of guided discussion and document reviews. In addition to responding to and discussing open-ended questions, each group was asked to review materials developed by the task force. The primary task of the CNS and ACNP groups was to define the competencies required of advanced practice nurses in acute and critical care.
Critical Incident Telephone Interviews. Each member of the task force was asked to nominate ACNPs and CNSs who would be willing to participate in a telephone interview. Nomination parameters included emphasis on creating a diverse pool of interviewees with experience working with different populations of patients (neonatal, pediatric, and adult) and nurses working in diverse geographical areas. Interviewees were contacted by e-mail and telephone to establish a time for the interview and were sent materials to review. All interviewees received the list of problems related to patients’ care that was used in the CCNS examination program and were asked to review the list appropriate to the age of the patients with whom they worked. CNSs and ACNPs received the advanced practice competencies.
A total of 21 interviews were conducted in June 2002. Each interviews was conducted by telephone and lasted from 25 to 50 minutes. A protocol was created to guide the interviews.
Independent Reviews Subject matter experts independently reviewed the various aspects of the practice delineation. In September 2002, materials for independent review were mailed. The advanced practice competency list was disseminated to 9 CNSs and 8 ACNPs. The advanced practice competencies were returned by 3 CNSs and 4 ACNPs.
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Results |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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Characteristics of the Sample
Nearly all ACNP respondents (95%) indicated that they worked in the role of a nurse practitioner; 85% of these respondents reported that their primary position was as an ACNP. The CNS respondents held more varied positions. Although 72% of the CNS respondents worked as a CNS, another 9% worked as nurse educators, and 3% to 4% each worked as first-line managers, middle managers, and nurse researchers. Of the CNS respondents, 68% said that the CNS role was their primary position; another 11% reported that their primary role was as a staff nurse.
The most typical employment setting for both CNS respondents and ACNP respondents was community nonprofit hospitals; 50% of CNS respondents and 26% of ACNP respondents worked in that setting. About one fourth of both groups worked at a university medical center. Ten percent of the ACNP respondents worked in private industry, whereas no CNS respondents worked in that setting. Finally, ACNP respondents were more likely than CNS respondents to work in a for-profit community hospital and in "other" settings.
The type of unit(s) worked in as the primary employment setting of CNS respondents and ACNP respondents was obtained. CNS respondents were more than twice as likely as ACNP respondents to work in a medical ICU, neuro/neurosurgical ICU, progressive care unit, surgical ICU, or trauma unit. ACNP respondents were more than twice as likely as CNS respondents to work in catheterization laboratories, burn units, medical cardiology unit, outpatient clinics, private practice, subacute care and "other" units (Table 5). In addition, ACNPs primarily cared for patients who were adults (60%) and geriatric (22%). For CNS respondents, 72% of the patients cared for were adults and 15% were geriatric.
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For the highest degree earned by respondents, 74% of the CNS respondents indicated they had earned a master’s degree as a CNS; 8%, an unspecified master’s degree; and 7%, a doctorate. No more than 3% indicated any other advanced degree earned. Of the ACNP respondents, 65% indicated that they had earned a master’s as an ACNP; 14% earned 2 master’s 1 as a CNS and 1 as an ACNP, and 14% were educated as ACNPs in a post-master’s certificate program. No more than 3% of the respondents indicated earning any other advanced degree.
Table 6 indicates the states or territories where CNS and ACNP respondents practice. The CNS respondents worked in 33 different jurisdictions. California contributed the largest percentage of CNS respondents (12%). Another 5 states (Illinois, Minnesota, Missouri, New Jersey, and Texas), contributed 6% each, and Ohio contributed 5%. The ACNP respondents worked in 27 different jurisdictions. A total of 8% each worked in Illinois and Texas, 6% worked in Maryland, and 5% each worked in Arkansas, New York, Pennsylvania, South Carolina, Tennessee, and Virginia. Sixteen jurisdictions were not represented by either cohort.
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. Respondents were asked to rate the criticality and frequency of each activity. Criticality describes how critical the activity is to optimizing the outcomes for acute and critically ill patients. The mean criticality rating for each nurse characteristic for CNS and ACNP respondents was obtained. The criticality ratings for the CNS respondents indicated that the 8 characteristics of nurses are generally moderately to highly critical to optimizing outcomes for acute and critically ill patients. With only a single exception, the criticality ratings of the ACNP respondents were slightly lower than those of the CNS respondents. For collaboration, both the CNS and the ACNP respondents rated the characteristic as moderately to highly critical.
The advanced practice activities that the CNS respondents rated highest on the criticality scale were associated with the characteristics of clinical judgment and clinical inquiry. The advanced practice activities that ACNP respondents rated highest on the criticality rating scale were associated with clinical judgment and reflected the primary role of ACNPs in directly providing care to patients (Tables 7 and 8).
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). Of the 8 activities, 7 are in the area of clinical judgment.
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Spheres of Influence
The Survey of Patient Care Problems in Acute and Critical Care Nursing Practice was conducted to collect data that would validate the 65 advanced clinical activities identified by the practice analysis task force. Each respondent was asked to assign a sphere of influence (individual patient, populations of patients, nursing staff, or others) to each of the activities as it related to the respondents’ practice.
The mean percentage of practice time that respondents directed toward the spheres of influence was determined (Table 10). For both CNSs and ACNPs, many of the activities were directed toward more than a single sphere of influence. The largest difference in responses from the CNS and ACNP respondents was the difference in the time each spent with individual patients. Consistent with the diversity of roles of CNSs, these respondents were more likely to direct their time to nursing personnel (36%), populations of patients (21%), and other disciplines, organizations, or systems (17%). As expected, and reflecting the direct care role of ACNPs, these respondents direct 74% of their practice toward individual patients, whereas the CNS respondents directed only 26% of their practice time to individual patients. ACNP respondents directed relatively equal amounts of time to the other spheres of influence.
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At least 20% of the CNS cohort indicated each of 6 primary employment settings: combined ICU/coronary care unit (29%), medical ICU (28%), telemetry unit (23%), cardiovascular/surgical ICU (23%), step-down unit (20%), and surgical ICU (20%). Three employment settings were indicated by more than 20% of ACNP respondents: step-down unit (27%), medical cardiology unit (22%), and telemetry unit (22%).
CNS respondents reported that the acuity levels of the majority of their patients were critical; however, about one fourth of their patients require acute care, and about 6% require subacute care. Conversely, for the ACNP respondents, the acuity levels of their patients were almost equally distributed among the 3 acuity levels.
Table 11 lists the problems related to patients’ care organized by systems. The percentages of time that CNS and ACNP respondents devoted to such problems in each system was calculated. Table 12 lists those problems for which the percentages of time allocated to the problem differed by 5% or more between ACNPs and CNSs. CNSs most often provided care for patients with life-threatening coagulopathies, acute renal failure, diabetic ketoacidosis, chronic renal failure, and septic shock. ACNP respondents reported caring most often for patients with acute hypoglycemia, life-threatening coagulopathies, stroke, chronic lung disease, gastroesophageal reflux, acute renal failure, chronic renal failure, and septic shock. Four problems required large amounts of time for both CNSs and ACNPs: acute and chronic renal failure, life-threatening coagulopathies, and septic shock.
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). Respondents were asked this question: During the past year, how frequently did you provide direct bedside care to patients receiving this intervention, test, procedure, medication, and/or monitoring device?
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Mean frequency ratings for the CNS and ACNP survey participants were calculated and compared. Generally, the frequency ratings of CNS and ACNP respondents were similar for the advanced practice activities. The percentage of respondents who rated each item as unique to critical care was also included. Six items were rated by more than 90% of the participants as unique to critical care: hemodynamic monitoring and/or pulmonary artery monitoring (92%); cardiac assist devices (92%); pulmonary artery monitoring (96%); invasive determination of cardiac output and cardiac input (93%); direct monitoring of the right atrium, left atrium, or pulmonary artery (94%); and monitoring of intracranial pressure (93%). Respondents confirmed that all of the items on the inventory were experienced by both the ACNPs and CNSs caring for patients with critical and acute illness.
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Discussion |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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A practice analysis task force set out to define the activities performed by ACNPs and to confirm that the activities performed by CNSs remained as previously defined. In addition, frequency ratings for the activities of advanced practice nurses, an experience inventory, and problems related to patients’ care were obtained from the study respondents.
As the term ACNP denotes, care provided by these practitioners occurs in areas where acute or critical care is provided. Indeed, respondents reported that the care provided by these practitioners occurred in areas outside of traditional critical care units, such as cardiac catheterization laboratories, burn units, private practice, outpatient clinics, and medical cardiology areas. In Kleinpell’s most recent study,26 similar practice areas were identified; however, the findings are in contrast to the care provided by CNSs in our study, which was provided primarily in ICUs and reflected the study sample.
A debate about combining the CNS and ACNP role has ensued since 1986. Analysis of master’s degree programs to prepare advanced practice nurses has shown the same basic core curriculum for ACNPs and CNSs, with the exception that ACNP curricula emphasize history taking, physical assessment, and pharmacology.29
Moloney-Harmon4 described the practice of the CNS by using the 8 competencies of nurses of the Synergy Model. Interventions were delineated on the basis of the 3 spheres of influence: patients and patients’ families, nurse-nurse, and system. As noted, CNS practice had historically been delineated on the basis of roles, including clinician, educator, researcher, and consultant.12 Nurse practitioner practice has also been defined by using the same roles.30 However, in the study we report here, the majority of ACNP time was spent in the role of clinician, directing practice toward the individual patient sphere of influence. This finding is consistent with Kleinpell’s finding that 85% to 88% of ACNPs’ time is spent directly providing care to patients.26 CNS respondents reported directing their practice fairly evenly across all 4 spheres of influence asked about in the survey.
In 2003, the ANCC conducted a role delineation study31 of nurse practitioners in 7 different specialties: acute care, adult, family, gerontology, pediatric, adult psychiatric, and mental health. In that study,31 data were collected on the roles and responsibilities of nurse practitioners working in each of these specialties. Response rates ranged among specialties from 17% to 51.4%.
Similar to the findings in our study, the majority of the respondents in the ANCC study were women (93%). A total of 43% of the respondents were between the ages 41 and 50 years, a finding that parallels the ACNP respondents in our study, 76% of whom indicated that they were 35 to 54 years old.
The ANCC assessed frequency (how often an activity was performed, ranging from never to daily or approximately every other day), performance expectation (when the ACNP was expected to perform this activity on the job, ranging from never to within the first 6 months as an ACNP), and consequence (what degree of harm would come to a patient if the activity were performed incorrectly, ranging from little to severe harm). Criticality data were calculated on the basis of these 3 variables, a different method than was used in our study.
The respondents in our study were asked to rate the 65 advanced practice activities on how critical each activity is to optimizing the outcomes of acute and critically ill patients. The CNSs rated 8 activities in the nurse characteristics of clinical judgment and clinical inquiry as most critical, and the ACNPs rated 8 activities in the nurse characteristic of clinical judgment as most critical. Again, this focus on clinical judgment corresponds to the main focus of patients’ care. The 8 activities rated highest in frequency by the ACNPs (Table 8) were also reported to be performed by the ACNPs in the Kleinpell study.26
Only a single activity was performed less than once a month by both ACNPs and CNSs: performing invasive procedures (eg, placement of pulmonary artery catheters, central venous catheters, arterial catheters; thoracentesis; lumbar punctures). Although CNSs are generally not thought of as performing invasive procedures, 2% of the CNS respondents reported performing an invasive activity less than once a month. ACNPs are often thought of as spending a majority of their time performing invasive procedures; however, we found this idea to be untrue. Kleinpell26 also found that ACNPs do not spend most of their time performing invasive procedures.
Nurse practitioner respondents in the ANCC study who worked as ACNPs or adult nurse practitioners reported spending 73% and 76%, respectively, of the time with direct care of patients. This finding is consistent with the findings of our study, in which ACNPs reported spending most of their time with activities associated with clinical judgment. ACNPs and adult nurse practitioners in the ANCC study spent 12% and 13% of their time, respectively, with management, supervision, and administrative issues, and they spent 10% and 11%, respectively, teaching. Both groups spent 7% of their time with research activities and 11% performing consultation with staff. However, in the ANCC study, data for acute care, adult, family, gerontological, pediatric, adult and family psychiatric, and mental health nurse practitioners were evaluated and reported collectively; hence, ANCC data cannot be directly compared with the data from our study of ACNPs.
The problems related to patients’ care identified by the participants in the current study reflect the settings in which care is provided by advanced practice nurses in acute and critical care. Both CNSs and ACNPs reported focusing much of their attention on problems such as life-threatening coagulopathies, acute and chronic renal failure, and sepsis or problems stemming from infectious diseases. CNSs focus more of their time than their ACNP counterparts do on diabetic ketoacidosis, immunosuppression, and ingestions of toxic agents. ACNPs focus more of their time on problems such as stroke, acute hypoglycemia, and gastroesophageal reflux disease. Interestingly, the last 3 problems have a component of chronicity, a characteristic that either may indicate that the care provided by ACNPs goes beyond the acute episode or may reflect the recidivism of acute care patients. No comparison data are available.
Study respondents were asked to rate how frequently each item was performed in their practice. Six items were rated at greater than 90% by the participants as unique to critical care. Of the 6 items, 4 involved hemodynamic monitoring. All of the items on the inventory were reported to be unique to critical care by the respondents. Many of these items were also reported to be performed by ACNPs in the Kleinpell study.26
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Limitations |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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AACN Certification Corporation recognizes the effect of the dynamic healthcare environment on critical care nursing practice. Although high-acuity patients are still cared for in intensive care settings, many patients traditionally cared for in those areas may now be admitted to or cared for in other units. The corporation acknowledges that critical care nursing is not limited to the walls of traditional intensive care settings, and so the CCNS certification examination program certifies clinical nurse specialists in acute and critical care. Study participants were asked where they were employed, but more importantly, the study concentrated on the types of patients being cared for by CNSs and ACNPs, and the competencies needed by those advanced practice nurses to provide that care, regardless of the clinical setting in which the nurses practiced.
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Summary |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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ACKNOWLEDGMENTS |
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To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints{at}aacn.org.
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REFERENCES |
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TopAbstractBackgroundThe AACN Synergy Model...Advanced Practice NursingResearch Design and MethodDevelopment of a Comprehensive...ResultsDiscussionLimitationsSummaryReferences |
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