Nurse Practitioners in the PICU

Pediatric Critical Care Columnist · Jan 17, 2009

I worked with a nurse practitioner in my previous unit, both while she was achieving her NP status and after. She specialized her Master's program specifically to pediatric critical care at a time when the NP educational program was in its infancy. Her roles in the unit are similar to that of the PICU fellows I encounter in my current unit. She consults on and admits patients, writes medication, diagnostic and treatment orders independently, intubates, places lines, does complex dressings and so on. She is often involved with the long-stay patients as a case coordinator. I know she loves her job. We occasionally get referrals from her; my current unit is their cardiovascular referral centre.

My current unit has a clinical nurse specialist who does not have the same authority as an NP. We had an NP for a while, who also completed a specialized pediatric NP program. But her roles were different; she was involved with CQI, wound care practices and that sort of thing. She left that position and is now the regional coordinator for CQI and our children's hospital's wound care specialist. She has been away from the bedside for many years and has no real grasp of the realities of bedside nursing in the PICU so some of her edicts are a bit difficult to follow.

PICNICRN, BSN, RN · Jan 19, 2009

The unit where I work currently does not utilize CCPNPs however.... I worked for a HUGE midwest children's hospital for years and we used them there and they were WONDERFUL! The PICU had 2 PNPs that functioned most like fellows- rounds, orders, procedures, troubleshooting ect. Then, the CV surgeons had 2 NNPs that would communicate from the OR to the PICU RN and the pts parents on the progress in the OR- the were great because we knew exactly what was going on with the kiddo before they hit the unit. They also covered the unit while the CV surgeons were in the OR.

I really miss them! Trusted them more than the residents!

gal220RN, BSN, RN · Jan 22, 2009

After many years working as a bedside nurse, I entertained the idea of going back to school for my peds critical care PNP. I have worked in units where they are utilized aggressively in patient care, with responsibilities equal to a Fellow. However, what I have come to realize is I love taking care of patients. I love the close interaction and bond with kids and families- something that can not be achieved as a PNP or MD.

The reality is that many nurses are searching desperately for respect and value- and the way many of them think they are achieving it is by leaving the bedside for graduate school. While I have great admiration for those who are looking for more education, I encourage my fellow peds critical care nurses to embrace the invaluable place they take in health care. You are important- no matter how many letters follow the abbreviation RN.

PhilaBSNstudent · Jan 23, 2009

I really appreciate the information that everyone has offered. I figured the role was similar to a resident but I wasn't exactly sure. I was just curious about the program because the director of the CCPNP program came into one of my classes recently when she was asked to substitute as an exam proctor because my professor had a family emergency. She introduced herself before we took the exam and I wish we could have heard more but of course she didn't talk much because we needed to focus on the test.

My school is very competitive and there is a huge push from professors and the administration for students to eventually be APRN's or other careers seen as leaders in the health field. I do think there is a little too much of the attitude gal220RN mentioned - feeling the need to eventually validate yourself through pursuing a higher level of education. Like she said, I know that some of the advanced level practitioners are probably missing out on some of the fulfilling patient interaction that I was looking forward to having eventually as a nurse. My dad is an anesthesiologist so I do feel some push from him to become a CRNA, which I do find to be a very interesting career, but I'm not sure it suits my personality. I was hoping an acute care NP might be more of the in between a bedside nurse in an ICU and CRNA - it allows you more independence and requires a lot of critical thinking skills, but the NP would have more interaction with patients that I think I would enjoy. Obviously I have time to make these decisions later about what I want to do. For now I am going to concentrate on finishing school. I am hoping to job shadow one of the PNP's who works in the trauma unit at the children's hospital so that would be exciting and hopefully give me more insight for the future about what I might enjoy.

Sorry if that was a lot of random thought spilling. I've just been thinking a lot lately about future career options...

PhilaBSNstudent · Jan 23, 2009

I was just rethinking what I wrote. I didn't mean to come across elitist or anything by saying I was considering an advanced practice degree. I very much respect beside nursing :heartbeat and intend to do that for some time. I just was trying to explain the pressures that are around me to eventually become an APRN.

tryingtohaveitall · Jan 28, 2009

I have been a beside PICU nurse for 19 + years and am currently working on my acute care PNP degree. I don't see it as the need to fulfill myself more, but rather, (this is going to sound terrible) there are some times that I feel I could be of more use on a broader scale than being limited to one or two patients. When I'm in charge or the transport nurse for the day, I float around the unit and will often notice things going on with someone's patient that need to be addressed.