Invasive procedures?

  1. Hey everyone. Haven't posted here since I was I baby graduate nurse. Fast forward 4.5 years into my career, I have been a MICU nurse at a level 1 trauma center (4 years), dedicated rapid response nurse with ability to independently order emergent medications and diagnostics (1.5 years), PICC nurse (3 years), and most recently 4 months as a CVICU nurse recovering openhearts, impellas, and balloon pumps. I will graduate as an AG-ACNP in three more semesters. Long story short I love critical care and my goal is to specialize in pulmonology/critical care as an ACNP. I love doing procedures (only PICC lines at this point) and I want to intubate, do chest tubes, bronc, paracentesis, etc. I'm currently in New Mexico (independent practice) but would relocate to find an optimal job.

    So my question.... How many of you are doing invasive procedures? For those that do, what procedures are you doing? How often? Independently or supervised? Can you bill yourself? Big trauma center or rural hospitals? Basically anything you tell me to give me the best chance at landing an intensivist position!

  2. 9 Comments

  3. by   juan de la cruz
    ICU positions with privileges to do procedures isn't that uncommon anymore. I've heard of positions all over on both coasts and in between. Personally, I worked at a 900-bed hospital in the Midwest in a CVICU as an ACNP where we placed central and arterial lines (even PA catheters), and chest tubes. I'm on the West Coast now and work at a university medical center where we also place lines and intubate but do not place chest tubes in all the adult ICU's.
  4. by   Rocknurse
    I'm in my last year of an AGACNP program and did my last clinical placement in an ICU here in the Northeast. As a student I was encouraged to place central lines and arterial lines as part of my placement and the NPs in the unit often intubated and placed chest tubes as well. Its the standard in my state.
  5. by   AnonymousACNPCAG
    Trauma center NP here in the south (restricted practice state) I place chest tubes, central lines, art lines, pretty much anything... my collaborating docs are busy doing actual surgeries so it helps them a lot to have someone like me to help do those things when **** hits the fan lol ;-) love to see others like the adrenaline as much as me
    Last edit by AnonymousACNPCAG on Nov 12, '17 : Reason: typo
  6. by   Dodongo
    The NPs in ICU do central lines, a lines, intubate, etc. The intensivists are around but not always present. The NPs in IR do many procedures without supervision including ports, para/thora, biopsies (liver, renal, etc), LP/myelograms and many more. I have worked for two large hospital systems and the NPs in the units are really autonomous. And PA is still restricted practice.
  7. by   4Pack
    I'm currently studying - I don't think NPs anywhere in the state of Iowa are doing anything invasive - not that I've heard. And certainly not where I currently work, which is a teaching hospital.

    I am going to graduate not knowing how to do any of these things, I am afraid.
  8. by   Pedsnurse0977
    4pack, where do you work? I am in Iowa and NPs do a lot of invasive procedures. I am an NP student as well and do intubations, lines, LPs, and chest tubes.
  9. by   lbonn_MICUNP
    Pulm/Critical Care NP here! I work in a large trauma center in upstate New York (independent practice state). We are a roughly 40-bed MICU service with APPs, residents, and fellows. After our initial "sign-off" on procedures (10 central lines, 5 art lines, etc), we can independently do them. I commonly do central lines, arterial lines, thoracentesis/chest tubes, less commonly intubations, LP, paracentesis but the opportunity does exist.

    Best of luck!
  10. by   MursingMedic
    You guys got me feeling good about my chosen path! I'm 4/10 quarters into my AGNPAC DNP. As a former navy corpsman, paramedic and critical care ER nurse, you're just reaffirming my decision to go into the acute care track versus primary or FNP.

    If only there would be a way to get all the sweet funding opportunities our primary care colleagues get for school and I'd have no worries in the world!
  11. by   ghillbert
    I am in PA. I am a SICU ACNP and do intubation, bronchoscopy, hTee, echo, US, paracentesis, thoracentesis, chest tubes, central lines, PA catheters, dialysis catheters, arterial lines - I do lines independently, and do airways/bronch under "general supervision" (vs proximate or direct supervision). I assist with IABP and ECMO insertion.

    I bill critical care time and bill my own procedures under my NPI, except for insurance companies that don't credential NPs, which are billed under physician NPI.

    There are many places now with critical care residencies/fellowships for APPs, and it is very common for hospitals to hire ACNPs to staff the units 24/7 with either onsite or remote intensivist support.
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