Nurse Practitioners who work in Acute Care, please respond..

I'm an adult health CNS in a state where NP and CNS have the same nurse practice act. I work prn as a mid-level in a community hospital ER. Typical day: colds, flu, lots of pelvice exams, minor lacerations (no more than 3cm and not on the face per credentialling at the hospital), an ABG or two if an arrest comes in, more pelvics (often I'm the only female provider), minor stuff.

This said, this is a community hospital where there just aren't a lot of procedures done in the ER.

To work in the ERs in my area, yes, you need both an adult as well as a peds certificate. I'm doing my peds CNS clinicals now...have been an adult CNS for about 3.5 years.

I am an ACNP and have been working in critical care since 2005. I currently work in a 16-bed Adult Cardiothoracic Surgery ICU in a large medical center and have also started picking up shifts at a community hospital owned by the same health system in a 12-bed Combined Adult Med-Surg ICU. I would have to honestly say that the ACNP program I attended have been a good fit for my role. ICU's have always been set-up with an age-specific population in mind, thus, I have not been pressured to return to school to add a pediatric component to my training. The ER, obviously, is a different ballgame where the NP may be required to see both adults and children. I have not worked as an NP in the ER myself although I did so as a staff RN, so I would defer discussion of that to those NP's who do work in that setting.

My ICU role in both ICU's I work in is pretty much like a House Officer slash ICU Fellow. We do work closely with an intensivist but have autonomy to order anything the patient needs (except for physical restraints which I find odd - unfortunately, this seems to be a regulatory policy). Our early mornings are spent doing AM rounds with the ICU team. This team consists of the Intensivist, NP, RN, Respiratory Therapist, Pharmacist, Dietitian, Discharge Planner when I am working in the Med-Surg ICU. In the CTSICU, the team consists of the exact same professionals with the addition of the Cardiac Surgeon. Depending on which ICU I am working in, rounds involve team agreement on typical critical care plans for each patient. This may include stuff like ensuring patients are on vent bundles, determining whether sepsis endpoints are being met, which patients can be transferred out, which patient's antibiotic coverage needs to be de-escalated, social issues, which vented patients are doing well enough to plan to extubate, things of that sort. There is always a teaching component on rounds which I love.

We document our progress notes, ICU admission H&P, discharge summaries, transfer orders, and procedure notes. Speaking of procedures, all the NP's were trained to do procedures and this is an expectation for all NP's who are hired. The hospital system provided us with resources and invaluable opportunities to learn and practice line placement including central venous lines and arterial lines. We received training in and have recently started inserting triple lumens using bedside ultrasound guidance which has made accuracy better and complications less. In the CTSICU, the NP's can insert chest tubes but I have performed thoracenteses in both ICU's. We are also learning to use bedside ultrasound technology more often and have been applying the technology in helping diagnose for pleural effusions, stroke volume variations, and even simple echocardiography to determine heart function.

I find that there are indeed ICU NP roles similar to mine in large academic medical centers in major cities. I am in the process of moving out west and have accepted a position to work in a similar role in a large university-based hospital on the West Coast.

In the PICU at my hospital, the NPs are basically responsible for EVERYTHING. THe NPs are first call on all of the non-cardiac pts. We are currently responsible for PICCs, intubations, CVLs of all types, chest tubes, arterial lines, lumbar punctures, suturing, etc. A typical day consists of xray rounds @ 0900 followed by bedside rounds and then patient mgmnt for the next 24hr. We are teamed with an intensivist for the shift. Very busy. Lots of ECMO, HFOV, CRRT, etc. Good Luck!