Calling all ICU/Critical Care NPs!

Advanced Practice Columnist / Guide · Feb 16, 2016

The only ICU NP teams I know of use the 72-hour bi-weekly schedule for every NP similar to many bedside RN's. This would entail 3 or even up to 5 twelve-hour shifts a week with a stipulation that if the NP did 5 shifts one week, they would only work one more shift on the second week. Typically, days and night shifts involve a rotating schedule between all the NP's but some places grant perks to seniority with less to no night shift commitment. Night shift NP's must have a call room to use on slow times during the night.

In order to keep NP's happy, I found that self-scheduling ahead of time and working with each other to create a schedule that is fair to everyone and allows members to take the time off as they wish works great. You would need a creative scheduler who can make it work. It is also important to ensure that overtime pay, shift differentials, holiday pay, and on call pay is added as part of the benefits (even in situations where the NP is considered salaried).

As you mentioned, consistency can suffer in this particular model. It is important to have a good system for printable electronic sign-out that includes patient one liners, events, medications, culture results/antibiotic history, and lines/tubes/airway to minimize the time it takes for verbal hand-offs or sign-outs. Everyone must commit to keep that electronic sign-out updated.

core0 · Feb 17, 2016

Hey all, I've been working as an intensivist ACNP for several years now and have just moved to a new facility to help with building their advanced practice presence in the critical care units (NPs as well as PAs).
Here is where I need your help: please reply with your current staffing model/typical shift rotation, and how/why you came to that conclusion. Would love feedback about what works (and what doesn't) so we can work to make this new team a successful one from the start. In my previous position, we worked 7 on/7 off, 7p-7a. It's great for the continuity of care, however it is simply not sustainable for most people who wish to have the mythical thing called work-life balance.
Thanks in advance for any feedback!

We have 9 ICUs in three hospitals. Around 90 PAs and NPs. We work 13.5 hour shifts (6a to 730p) with an hour overlap on each end for sign out. We are salaried so we don't get overtime. We pay extra shift premium if you work extra shifts. There is also a premium for nights and weekends. When we first started this, we looked at the literature and the only thing worse than working nights is working rotating shifts. For this reason we hire for nights or days. Nights has a built in pay premium so they don't get a separate premium for nights.

Basically for our 20 bed ICU with partial resident coverage we schedule 2 people M-F on Days and 2 People M-F on nights with single coverage on weekends. This means if we have vacation we go down to single coverage or someone works extra to cover. We have 4 day positions and four night positions. This means people work one weekend per month, which we have found is a limiting factor. We are adding a part time (2/3) FTE so we can have double coverage on weekend days. If we can find a WEO night time person we would probably add that position.

After some experimenting we've found that 6 patients per provider is reasonable coverage for days and 10-12 at night. For our non resident ICUs we have more PAs or NPs (4 or so for a 20 bed ICU). For our small 12 bed ICUs the attending is expected to do notes if there is only one provider.

Before you reinvent the wheel I would look at the SCCM workforce page:

SCCM | Workforce

allnurses Guide · Feb 18, 2016

Our hospital has several ICUs staffed by APPs, particularly out of hours. They work either 2 x 15hr shifts (4p-7a) and 1 x 10hr day shift (7-5), or they can do 1 x 24hr shift and 1 x 16hr shift. Most do the former. On the day shift they can attend required meetings, classes, meet with supervisors etc. Overnight they have a resident intensivist who is available for consultation.

babyNP., APRN · Feb 19, 2016

I work in the NICU where we do three 12 hour shifts a week (with 4 hours of paid professional time per week). We are assigned to a "team" of patients with two NPs per team. Two practitioners are assigned to each side of the team and they work opposite each other. A fifth person is added to the overall team to fill in any holes. Works pretty well, we occasionally have to cross-cover a different team.

There is one person per team for the night shift, but this isn't assigned; it's just whoever comes in first and wants a particular team.

We also have an electronic sign-out tool that is updated daily that we print out for night shift.