Critical Care ACNPs

ArmaniX, MSN, APRN · May 1, 2015

I'm interested in others responses, I am still enjoying bedside nursing but know in a few years (or so I 'think' I know) that I would like to be a NP in the critical care setting. Will be following the post and hope you get some great answers!

Dranger · May 2, 2015

I am an RN but I can provide some feedback on NPs in the ICU. We have a pulm group contracted for our hospital that just started hiring NPs/PAs and their role is mainly night call and coverage. During the day they do some consults but the intensivists still run the show and do most of the procedures besides maybe a-lines or CVCs.

Their schedule isn't the same as the hospitalists who do 7 on 14 off. I think it is a mix of being on an entire week then pulling call for a few days the next.

MallysMama · May 2, 2015

Thanks for the insight! The SICU where I previously worked as an RN didn't have NPs or PAs. My unit now (different state) has 3 NPs and 2 PAs (I think). So I understand it can really vary depending on the state, hospital, and even individual unit. I'm hoping to hear some personal experiences with individual work schedules, and how they balance work and home life.

Advanced Practice Columnist / Guide · May 2, 2015

I've worked as an ACNP in Critical Care since 2005. My schedule has always been three 12-hours shifts a week similar to what it is for many RN's who work in the hospital. For a schedule like this to work in making sure there are NP's covering the unit 24/7, you must have a team of NP's. Currently, we have close to 20 ACNP's on our team and we cover 5 different adult ICU's in a large academic medical center.

Our group is diverse. Our ages are from late 20's to mid 40's and close to half are males. We have NP's who are married with very young kids, NP's who are married but no kids, single with kids and and those who are single with no kids. In my perception (as one of the NP's who are married with no kids), the ones who have kids for sure have childcare arrangements when at work but are still able to have the kind of lifestyle they want outside of work. Many of us travel a lot and we could arrange a schedule in a way that our days off in between work are long to allow for time away without using vacation time. I know some of our married NP's are also active in their life outside of work.

We have a well staffed unit on day shift - an attending, a fellow, one or two NP's in each unit, and usually two residents in each unit. We sometimes have a medical student and an NP student. NP's do everything for their patients including procedures. If the NP's patient needs a central line or an arterial line, the NP assigned to that patient must do it, not the resident. Nights is more "bare bones" staffing - one NP is in charge of an entire unit. A fellow oversees all the adult ICU's and is the back-up. Usually the fellow devotes time to units staffed by a night resident and leaves the NP alone unless they are drowning in work and needs help which does happen sometimes (i.e., NP admits a septic patient from the ED who needs lines, boluses, initiation of pressors, intubation, vent orders).

I think it takes a certain kind of NP to like this line of work. It's definitely not for everyone and we are quite upfront with applicants in telling them that the patients have high acuity and the work can be non-stop at times. However, it is a 24-hour service and the outgoing NP should be able to sign out in time to the incoming NP so that nobody stays over unnecessarily. We don't bring work home when we go home. Occasionally, I would realize I had not written a procedure note for a line I placed and I would at times log on to Epic at home to do that but that's all the extent of work I bring home.

MallysMama · May 3, 2015

Thank you! That was very helpful to hear! Your schedule is exactly what I'm hoping to have someday. I love working 3 12-hour night shifts! I love being busy at work and prefer the fast pace. As an RN I try to choose the complicated patients. So as of right now- the potential work load doesn't scare me. I was just worried about it completely taking over my life! It's helpful to hear that there are schedules that allow for similar time home as nursing does.

Thanks for sharing your experiences!!

Advanced Practice Columnist / Guide · May 3, 2015

Actually, if you prefer to do straight nights in a group like ours, the team will like you. Nights is when you actually do work on your own so you must be well prepared as far as placing lines on your own and managing complicated patients. We do help with orientation and skills training. And when its not busy, you do have a call room to use with a bed to lay down for a bit.

MallysMama · May 3, 2015

That's what I'm hoping for! Now to spend the next 14 months getting as much experience as I can- so that maybe I can be "good enough" to even apply to a job like yours!