ICU Nurse Practitioners

ArmaniX, MSN, APRN · Aug 23, 2019

5 years bedside ICU in trauma 1 hospital. Charge, precept, additionally floated and covered rapid response for many shifts.

I did this while in school. My transition has been smooth.

DesertSky, BSN · Aug 24, 2019

On 8/22/2019 at 8:48 PM, ArmaniX said:
5 years bedside ICU in trauma 1 hospital. Charge, precept, additionally floated and covered rapid response for many shifts.
I did this while in school. My transition has been smooth.

ArmaniX - that's good to hear as a current AG-ACNP student! I currently have 6 years of high acuity ICU and ER experience as well as my CCRN. By the time I graduate, I will have over 7 years. It's always interesting to hear about people's transition from RN to Acute Care NP as well as how much experience they had at the bedside.

Did you have any difficulty finding an Acute Care NP position?

Thanks for your time.

Advanced Practice Columnist / Guide · Aug 24, 2019

There are many ICU NP groups across the country now. Many are actually surprisingly thriving in academic medical centers despite what one would assume in terms of competition with physician trainees. There are also some in non-teaching hospitals. I've worked as an ICU NP since 2005 and I've met many colleagues in other hospitals and other parts of the country since.

For our group, we tend to prefer experienced ICU NP's but that can be hard to recruit. New grads are hired if they have significant high acuity ICU experience preferably in a similar academic setting as ours. It doesn't matter if it's MICU, SICU, Cardiac or Neuro - we will place you in the appropriate ICU based on your nursing background.

We have hired new AGACNP grads who had between 5 to more than 10 years experience as ICU nurses. Our system does reference checks extensively so it helps to have good references from managers and/or physicians.

We have an ANCC accredited Critical Care fellowship. Few of the grads have chosen to work with us.

DesertSky, BSN · Aug 24, 2019

14 hours ago, juan de la cruz said:
There are many ICU NP groups across the country now. Many are actually surprisingly thriving in academic medical centers despite what one would assume in terms of competition with physician trainees. There are also some in non-teaching hospitals. I've worked as an ICU NP since 2005 and I've met many colleagues in other hospitals and other parts of the country since.
For our group, we tend to prefer experienced ICU NP's but that can be hard to recruit. New grads are hired if they have significant high acuity ICU experience preferably in a similar academic setting as ours. It doesn't matter if it's MICU, SICU, Cardiac or Neuro - we will place you in the appropriate ICU based on your nursing background.
We have hired new AGACNP grads who had between 5 to more than 10 years experience as ICU nurses. Our system does reference checks extensively so it helps to have good references from managers and/or physicians.
We have an ANCC accredited Critical Care fellowship. Few of the grads have chosen to work with us.

How long is the critical care fellowship at your organizaton? Does the fellowship rotate students through multiple specialties or focus on a specific unit? Thanks in advance!

Advanced Practice Columnist / Guide · Aug 24, 2019

3 hours ago, DesertSky said:
How long is the critical care fellowship at your organizaton? Does the fellowship rotate students through multiple specialties or focus on a specific unit? Thanks in advance!

It's a year long. It's a combined Critical Care and Surgical Specialties. I can discuss details in PM.

core0 · Aug 25, 2019

On 8/22/2019 at 6:07 PM, otterpop1989 said:
Hello,
I am about to start an AGAC-NP program, and I hope to become an ICU NP. I'm trying to get a feel for how NP's who currently work in the ICU setting arrived at their position. Did you work in ICU throughout school? Did you enter one of the few ICU NP fellowships currently available? Any thoughts or comments are welcome, thank you!

We have 150 APPs across 4 hospitals and around 15 ICUs. We get hires from 2 pathways.

1. APP residency. We have 3-4 slots every six months (6-8 per year). The residency is a year long and includes ICU rotations as well as OR for intubation, ID, and nephrology. There are also optional rotations in interventional pulmonology, CV surgery, transplant medicine and palliative care. The residency requires a contract to work at the institution for one year (penalty if you don't accept a job offer). There is a bonus for first year graduates that about equals the amount of money you miss due to the lower residency salary.

2. Direct hires - orientation is highly variable but generally 3-6 months (trying to standardize). It generally includes only the ICU you are hired for. We have been experimenting with putting new grads from our community ICU in a 6 month mini residency (n=1).

We have started to publish our results (hopefully at SCCM next year). Previously published research show residents are quicker to optimal billing compared to OJT. New research addresses both confidence and medical knowledge comparing 6 vs 12 month residencies as well as OJT vs Residency.

DesertSky, BSN · Aug 25, 2019

23 hours ago, juan de la cruz said:
It's a year long. It's a combined Critical Care and Surgical Specialties. I can discuss details in PM.

Thank you! PM sent.

DesertSky, BSN · Aug 25, 2019

20 hours ago, core0 said:
We have 150 APPs across 4 hospitals and around 15 ICUs. We get hires from 2 pathways.
1. APP residency. We have 3-4 slots every six months (6-8 per year). The residency is a year long and includes ICU rotations as well as OR for intubation, ID, and nephrology. There are also optional rotations in interventional pulmonology, CV surgery, transplant medicine and palliative care. The residency requires a contract to work at the institution for one year (penalty if you don't accept a job offer). There is a bonus for first year graduates that about equals the amount of money you miss due to the lower residency salary.
2. Direct hires - orientation is highly variable but generally 3-6 months (trying to standardize). It generally includes only the ICU you are hired for. We have been experimenting with putting new grads from our community ICU in a 6 month mini residency (n=1).

We have started to publish our results (hopefully at SCCM next year). Previously published research show residents are quicker to optimal billing compared to OJT. New research addresses both confidence and medical knowledge comparing 6 vs 12 month residencies as well as OJT vs Residency.

Wow, it sounds like your organization has a great residency program! I would love to hear where if you don't mind sharing with me.

It will be interesting to see the research regarding how NP's who completed a residency fare compared to those that do not. Perhaps that data will encourage more organization to offer NP residencies and validate that they are financially beneficial for the organization as well as beneficial for new NP's entry to practice in terms of boosting knowledge and confidence.

core0 · Aug 27, 2019

On 8/25/2019 at 5:48 PM, DesertSky said:
Wow, it sounds like your organization has a great residency program! I would love to hear where if you don't mind sharing with me.
It will be interesting to see the research regarding how NP's who completed a residency fare compared to those that do not. Perhaps that data will encourage more organization to offer NP residencies and validate that they are financially beneficial for the organization as well as beneficial for new NP's entry to practice in terms of boosting knowledge and confidence.

What we have published so far is that residency trained APPs reach full productivity (as measured by billing) 3 month sooner than non residency trained APPs. The issue with financial benefit is a trickier one. The cost of a residency is tremendous (north of $500,000 for us). The benefits are hard to quantify, but when you have 150 APPs (most likely expanding to near 180 in the next few years) having a guaranteed pipeline of well trained providers is invaluable. It also goes to mission. As an academic medical center training providers is part of the mission.

jmaynp, MSN, NP · Sep 15, 2019

I had 13 years as a bedside ICU RN, this was across all adult specialties including years of travel nursing as well as brief stents in the peri-op and home health fields. I've been a critical care NP for 6 yrs now and its been a pretty good transition for myself as well. I originally was thinking about a residency/fellowship but I was fortunate to find a job where I could OJT in a supportive environment. I do think a residency is good as you can never go wrong being more prepared. In my experience and in helping train new grad hires it really depends on your learning style, as far as are you extremely self motivated and going to seek out the information aggressively or do you need more direction and structure for learning guidance?

Rocknurse, MSN, APRN, NP · Sep 30, 2019

I've been a nurse for 30 years, with more than half of that in ICUs at various facilities. I also have a CCRN certification. I was offered a job in a cardiac ICU of a major teaching hospital before I graduated and it was too good an offer to turn down. I suspect it was because I had 5 years experience in a cardiac ICU so they deemed me a perfect fit. My school is the major school in my state and hosted a hiring event and invited HR reps from all the large hospitals. I was shown interest at that event and had several phone calls within a few days of attending. That is how I found my job.