NP role in the Neuro ICU

allnurses Guide · Dec 26, 2014

I did a lot of NP clinicals in a trauma ICU - the NPs who work there do H&P's, progress notes, put lines in (central lines, arterial lines, dialysis caths), intubation etc... pretty much the same as the fellows. They do have a rotating physician intensivist who comes to supervise intubations.

allennp · Dec 26, 2014

I work in a academic trauma (level1) center with lots of residents/interns/ fellows. The system uses NP's more than PA's for the benefit of our independence and billing ability. Pretty much no NP's in the ICU's in my center, the interns and residents are always hungry for procedures. I help out on a few cases there but they have no interest in needing me for procedures.

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a close friend of mine works in a SICU at our sister center, as the primary NP for the ICU, she does little to no procedures (though she has been traned and such for them) as they are all coming out of the OR with lines intact, and again the interns and residents salivate at the chance of a procedure, again they are trying to get there checklists done on skill sets. She does manage though quite a few acute cases and keeps the interns from bungling the sick ones up to much. Any PGY 1 can learn to put in a central line, a line, or intubate a patient. What they can not do is manage a pt through a course of care and anticipate, manage, and plan the course. As I no longer have to work weekends, nights, hoildays as i did in the ED as a NP and now make my own schedule and am afforded Attending respect and privileges otherwise I have left my procedure oriented life behind. I am growing old and settling in as part of a team...... :-)

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Advanced Practice Columnist / Guide · Dec 26, 2014

I work as a part of a team of ACNP's in an Adult Critical Care Medicine service at an academic medical center. We cover Med-Surg, Cardiac/Cardiac Surgery, and Neuro/Neurosurgery ICU's in the medical center. In the Neuro/Neurosurgery ICU, our role is more of a consult service. We co-manage Neurology or Neurosurgery patients specifically offering services in the areas of line placement (all kinds of central and arterial lines), sedation and pain management, and intubation and ventilator management. We have critical care fellows and residents as well but NP's do all these procedures without competition from residents because there are shifts when only NP's are covering those units. Our rule is that the provider who is assigned to the patient gets to do the management and all procedures involved.

Our medical center campus is not the designated Level I Trauma Center for the system. However, our Neuro/Neurosurgery ICU's have a heavy expertise in all types of bleeds (SAH, IPH, SDH, AVM's), brain tumors, and exotic neurologic manifestations/mysteries. The primary Neurosurgery teams have NP's who work for them and round in the ICU in addition to floors and clinic. The only procedure the NP's in that team perform in the ICU are EVD removals (they are placed by residents). However, the NP's are highly involved in patient management. They are proficient in reading brain imaging and are great resources for the nurses in terms of neurologic findings and what they mean in terms of brain pathology.

The larger Neurology service has many residency and fellowship programs (including Neuro Interventional Radiology, Neurovascular and Neurocritical Care Fellowship) and they do not have NP's in their team who round in the hospital.

suprmedic · Jan 13, 2015

Just a quick response.... I am a new grad NP that is part of a 8 "person" team that consists of 7 NP's and a PA in neurocritical care unit. I work at a large tertiary care center with a level 1 trauma, full neurosurgical coverage, Neuro IR etc. We manage the neurology and neurosurg patients while they are in the ICU. Our role is that we see 3-6 patients a day and are responsible for assessing, ordering, writing the progress note and chiefing each patient to the attending MD whom makes changes if they feel the need.

In general mid level providers are having an expansion in neurocritical care nation wide and- so far- has been a challenging yet rewarding position.

kayceeACNP · Jan 19, 2015

I actually am an ACNP in a Neuro ICU in a large academic center. We have 5 NPs on our team (working on getting up to 8). We, along with the senior residents who join us monthly from Neurology and Anesthesia are responsible for the 24/7 in-house call coverage of our unit. Meaning, sometimes we are on days and take part in academic rounds and note writing with the entire team or we are the night person and cover the unit for overnights. On days we divide the patients based on the number of people that are on and we all have patients we are the primary provider for. We write the daily note and we bill for our services in critical care time. We are a primary service that admits our patients, those with primary neuro injury (status epilepticus, neuromuscular patients requiring intubation or other critical care needs, ICHs, and ischemic strokes). We also act as a critical care consult service to the neurosurgeons and manage pressors, ventilation, and other critical care needs for those patients, the things that make you an intensivist (FASTHUGSBID) :) hehe. We do procedures (and bill for them). We work very closely with neurosurgery, neurology, and stroke neurology teams, depending on the patient. We are the first contact for issues on patients admitted on the unit as we are the call person that is there and someone from our team is there 24/7. Hope this is helpful.

-KC

ShifraSaraRice · Jan 21, 2015

how do people get into specialties such as neuro ICU or cardiac ICU? do they do them before, during or after schooling?

Advanced Practice Columnist / Guide · Jan 21, 2015

how do people get into specialties such as neuro ICU or cardiac ICU? do they do them before, during or after schooling?

You would have to apply for an opening should you find one. Few things will help you become a great candidate for such roles: working in a critical care setting as a nurse, going to an Acute Care NP program and having critical care rotations, and networking with intensivists and ICU NP's.

kayceeACNP · Jan 21, 2015

how do people get into specialties such as neuro ICU or cardiac ICU? do they do them before, during or after schooling?

I didn't work in a Neuro ICU as an RN but always in an ICU. I actually worked in the Medicine/Transplant ICU at the same hospital I am at now. I agree with jaun de la cruz that networking and experience are very important. A good critical care background will make you a better candidate, additionally more and more hospitals are requiring an ACNP for their inpatient positions, especially in critical care. Additionally, if you can get rotations in these settings as a student that's a good foot in the door. As I said, I didn't work in the Neuro ICU as a nurse but I knew the medical director of the unit through the hemodynamics committee at the hospital and he knew I was in school so it was a nice step in the door. So, I would highly recommend joining committees and taking those opportunities to network as Juan said.