ACNP

[ERnurse1257]

I am considering becoming an Acute Care Nurse Practioner. I have read they can do some invasive procedures such as chest tubes, central lines, lp's, etc. I was curious if there was truth to this and if so, how often do they actually get to do these procedures. I would assume most places would want the physician to do these. Anyone with experience or knowledge of this, please help. Thanks!

[Corey Narry, MSN, RN, NP]

NP's in general are able to perform procedures that are considered invasive with proper training. Federal regulations allow NP's to perform procedures that a physician does and actually provide for a mechanism wherein the NP can be reimbursed for these services. However, the extent of how invasive a procedure an NP is allowed to perform depends largely on individual BON regulations as well as individual organizational protocols within hospitals and group medical practices.

Acute Care NP's are best poised in terms of receiving training for the kind of procedures you mentioned because it is the high acuity patients in hospitalized settings who typically require central lines, chest tubes, and LP's. As an ACNP who works in an ICU setting, I have actually placed all kinds of central lines (from PICC's, non-tunneled dialysis catheters, multi lumen CVC's, and Swan-Ganz) and a few chest tube types (thoracostomy tubes, CASP). There are a few changes going on in healthcare that is driving the trend that NP's are now doing invasive procedures such as these.

In academic and other types of teaching hospital settings, one such change is the limitation imposed on the amount of continuous hours residents or house officers can remain in the hospital. Because of these limitations and the fact that residency slots have not increased, NP's (or PA's) have been called upon to supplement the manpower required in maintaining 24-hour coverage of ICU's, ER's and inpatient units in hospitals. Thus, NP's have also been trained to perform invasive procedures typically performed by residents because that is part of providing care to the patients in these settings. Note that attendings in these settings do not typically do these procedures themselves.

The other factor that have given rise to this trend is the shortage of intensivists and other types of specialists particularly in remote regions and rural areas of the US. In these settings, NP's have assumed these skillsets in order to supplement the smaller number of available practicing physicians in meeting the healthcare needs of high acuity patients.

[ERnurse1257]

Thank you so much for the info.. You answered my question and more. I see you work in cardiothoracic surgery as an np. Do you assist the physician directly in surgery or do you do most of the inpatient care?

[Corey Narry, MSN, RN, NP]

Thank you so much for the info.. You answered my question and more. I see you work in cardiothoracic surgery as an np. Do you assist the physician directly in surgery or do you do most of the inpatient care?

I used to work in Cardiothoracic Surgery ICU as an NP. I also have certification in Cardiac Surgery Nursing through AACN. I did not assist with surgeons during heart surgery, I was mainly in the ICU managing post-op open heart and lung surgery patients. But this was the setting where I honed my skills in placing lines including Swan-Ganz and inserting chest tubes.

I now work in a slightly different capacity as part of a group of NP's under the Critical Care service. We cover not just the Cardiothoracic ICU but also the Med-Surg ICU and 2 Neuro/Neurosurgery ICU's. The job description still includes performance of invasive procedures such as intubations and lines but not chest tubes. We have an annual requirement in terms of procedures performed in order to maintain competency as part of our institutional policy.