Critical Care NP Question

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Specializes in Critical Care.

Hello,

I am a NP currently working with a hospitalist group. Before working with this hospitalist group I had been working for 2 years with a pulmonary critical care group at a bigger teaching hospital. While I have worked in critical care both as an RN and an NP I still wanted to get some other perspectives on critical care as this is an area that im wanting to start back working in

1. What are some big differences between working as an NP in critical care at a teaching hospital vs. a bigger non-teaching hospital?

2. Are most of you working in a closed unit type setting or more as a consult service for critical care needs?

3. As far as procedures it seems that CVC, Alines, and intubations are fairly standard. What about chest tubes, vas-caths, or maybe in neuro placing EVD catheters, are NP's doing them or Attending's?

4. If you were looking at a new NP critical care job what are some key questions you would ask or things you would look for to make sure you were taking the right job?

Thank you all for your help. Please feel free to answer any or all of the questions.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

1. I've only worked in an academic medical center (part of a medical, nursing, dental, pharmacy, rehab sciences campus) and another large urban teaching hospital that is not directly located within a health sciences campus but has its own residencies, fellowships, and an active research arm and is affiliated with a nearby medical school. I actually don't see a whole lot of difference in the role. The 2 places are in 2 different states so the only difference I experienced was in the culture specific to each location.

2. It's a combination of both closed and consult model as the Critical Care service depending on the specific ICU or the specific admitting hospital service involved.

3. CVC, a lines, intubations are fairly standard. When you say VasCath, is that a temporary non-tunneled HD catheter? we do those and clump them under the CVC label. We don't do tunneled HD caths (IR does those). EVD's are placed by Neurosurgery. I inserted chest tubes and PA catheters at a previous job (the teaching hospital that is not designated as "academic") but that was because it was a CT-ICU where you would expect such skill to be useful.

4. Hmm, I would ask about work hours (some are 12-hr shifts with night commitment vs hired in as straight nights as a new hire). I would ask about how your role is structured (i.e., you split the unit with a physician vs you work together vs you split the unit with residents and the attending oversees, etc.). I would ask about solo NP night coverage vs 24-hr intensivist presence for back up. Lot of questions really but it would depend on what they are offering and I would go from there.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

BTW, I did work per diem (less than 2 yrs) at a community hospital albeit a Level II Trauma Center as a Critical Care NP. It was busy and the NP rounded together with the intensivist with writing notes split between the two (NP does some, intensivist does the rest). Few things I didn't like: wide variation in management depending on the attending, non-adherence to current guidelines sometimes, some attendings seem burnt-out. Things I liked: I was doing procedures, 10-hr shifts with no night commitment (attendings do the nights).

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Specializes in Critical Care.
14 hours ago, ff_king2001 said:

1. What are some big differences between working as an NP in critical care at a teaching hospital vs. a bigger non-teaching hospital?

2. Are most of you working in a closed unit type setting or more as a consult service for critical care needs?

3. As far as procedures it seems that CVC, Alines, and intubations are fairly standard. What about chest tubes, vas-caths, or maybe in neuro placing EVD catheters, are NP's doing them or Attending's?

4. If you were looking at a new NP critical care job what are some key questions you would ask or things you would look for to make sure you were taking the right job?

1. I am part of the surgical critical care team at an academic center, no prior personal experience for comparison. At my prior job in a Trauma 1 teaching hospital the nurse practitioner role seemed more so focused on assessment/plan with little procedural role.

2. We are a closed unit in the sense that no one is placing orders on the patients besides the CC Providers. But we do collaborate with each primary service (surgery, transplant, vascular, thoracic) and develop plans in that sense.

3. We do not intubate nor place tunneled lines. We can place central lines, dialysis catheters, swans, arterial lines. We also are able to place chest tubes, Thora/paracentesis, bronchoscopy. We also are expected to utilize ultrasound for quick cardiac/volume assessment at bedside.

4. Feel important questions pertain to unit culture and role support (are you allowed to be the provider or are you the pack mule). Vacation/time off. CME. Hourly vs Salaried (both have +/-, I’m salaried and pretty mindful of the hours I put in each shift [80 hr pay period with 6 shifts] yet I have coworkers who are pulling 16+hr days and are realistically getting paid very poorly in that stance). Also days vs nights vs rotational.

As a new NP the most important thing for me was to find a job that was going to support me and build me into a great provider. Definitely in a role where I am using my licensure to the fullest extent.

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Specializes in Vascular Neurology and Neurocritical Care.

EVDs can be done by APPs, but usually only Neurocrit or Neurosurgery APPs.

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