I assume that you're in an adult ICU based on your specialization- I work in NICU which is very different patient population
but I'll share what we do if that's helpful. NNPs were the first in-patient intensivist NPs practicing. I first worked at an academic center (children's hospital) where we did anything and everything up to ECMO, immediate post-ops, cooling, dialysis, oscillators, etc etc and now work at a community Level III where we have vents, oscillators, and occasionally some vasoactive drips, and then obviously covering the delivery room where we run codes on occasion. I'll number them below (#1 for the academic center, #2 for the community site)
How many APPs does your unit have?
1. The group was ~50 or so NNPs with 10 on (11 ideally with one as a float) each day, 5-6 on each night
2. The group has ~30 or so NNPs covering multiple community sites and one academic center; my community site has 1 NNP on each day/night along with a neo that is on during the day.
What is their schedule?
1. Three 12 hour shifts (days or nights) per week, 4 hours paid professional time
2. Three 12 hour shifts (days/nights) per week or three 24 hr shifts in a 2 week period, 2 hours call time, 2 hours professional time. Folks can do either or a mixture of both
How do you organize your coverage?
1. Self-scheduling. Used to have someone on call for each shift for a sick call, but we got rid of it as we weren't being paid for it. Now if someone is sick or there is a hole in the schedule, you can work and get paid a premium, set at $72/hr
2. Similar, although the premium for an extra shift is $100/hr
How many patients do you see and chart/bill for?
1. My caseload was 6-8 patients- but they were generally all very complex with multiple co-morbidities. They would often have 15+ diagnoses. Did not bill as our attendings did that, although their note was at least partially based off our note for the day.
2. Generally 12-20, but the bulk of them are "feeder growers," not a true ICU patient. In this job, I bill for any deliveries that I attend and admits that come in after the neo goes home in the afternoon.
Who do they report to?
1. Attending neonatologist
2. Attending neonatologist
How did you integrate new hires?
- NNPs have been around for a few decades (I believe since the 80's if not earlier)
1. Orientation as a new grad for me was 4 months
2. Not sure about this job, as I came in with experience and didn't need an extensive orientation
Does your intesivist APP group cover hospital codes?
1. Only in the NICU
2. NICU, delivery room, and occasionally the ED will call us if they have a baby down there
Does your MD intensivist work in-house overnight/weekends or on call?
1. Full set of neos during week days, one on each night, and about half as much on weekend days.
2. Neo will stay overnight if the unit is crazy but is otherwise on-call for any problems and/or if the NNP needs additional help. Weekends are treated the same as weekdays, but the neo goes home a bit earlier usually if there aren't many anticipated changes.
Hope this helps!