In ACNP school, what should I focus on for clinical rotations

[kramilo04]

Hi guys!

I am currently in a ACNP program and I would like to become a NP in the ICU one day. I want to practice in a state with limited to no restrictions (full practice authority) and possibly a regional medical center or critical access hospital. For this reason, I want to be prepared and competitive when applying. Does anyone have any advice as to how I should guide my clinical rotations to reflect this? (i.e try to get in a lot of procedures such as chest tube insertions, thora/paracentesis, central/a-line, etc....?)

Thanks!

Kris

[Corey Narry, MSN, RN, NP]

I have practiced as an ACNP in an ICU setting for 10 years now. I have only worked in states where a collaborative agreement with an intensivist is required. Having said that, I have been trained and have performed intubations, placements for all types of central lines (including Swan-Ganz), arterial lines, thoracentesis, and chest tube/pigtail placement through the years. I have not performed lumbar punctures and drains, external ventricular drain placements, paracentesis. I have assisted in percutaneous trachesotomies and bedside PEG tube placements.

I will tell you that fresh out of an ACNP program, I only performed central line placements and arterial line placements on a real patient and even that, I did not come out feeling any sort of confidence that I could do these on my own. I happen to start out and continue to work in large urban teaching hospitals with residencies and fellowships and the teaching environment is what allowed me to be supervised initially and later being independent in performing these invasive procedures.

I personally have no experience working as an NP in an independent practice state. However, I have ACNP colleagues whom I used to work with who have moved to states with independent practice but in similar environments as my setting (without naming names, these are academic centers in Portland, Seattle, and Honolulu). They still work alongside intensivists in a collaborative relationship mainly because of the nature of the field and the requirements of hospital credentialing.

I have no experience with critical access hospitals and my understanding is these operate with bare bones physician/NP staffing. It sounds like a great setting for an ACNP trained in procedures and proficient in critical care management. I would say though that finishing an ACNP program alone is not going to get you at a level where you can be independent. If it were me, I would seek employment at an academic medical center ICU, learn the ropes, polish your procedural skills, then seek more independent roles later.