Questions for NP's working in a hospital setting

[SusanMNNP]

Hello! The group of Nurse Practitioners I work with have been requested to do some research on different aspects of the roll of Nurse Practitioners who work in a hospital setting and the approximate starting salaries in different areas of the country. I would really appreciate any input anyone can provide. Thanks!

1. What city and state do you practice in?

2. What is your specialty?

3. Approximately how many patients are you responsible for on a normal day?

4. What type of shifts are worked by the NP's you practice with?

5. If you work in a specific unit, how many NP's are are covering the unit at a time?

6. Do you provide 24 hour a day NP coverage?

7. If you work in a specific unit, do you have 24 hour a day in house physician coverage?

8. What is the roll of the NP in the institution you work at?

9. If you work in a specialty area, such as Neonatal or Pediatric, do you have any transport responsibilities?

10. What is the approximate starting salary for a NP in your institution?

[Corey Narry, MSN, RN, NP]

I looked at those questions and as I tried to answer each one I realized that merely answering each question doesn't really paint the whole picture of our ICU staffing model.

I'm in Northern California with a group of ACNP's who provide ICU 24/7 coverage to a variety of critical care units (Medical, Surgical, Neuro, Neurosurgery, Cardiac, Cardiac Surgery, Vascular Surgery, Transplant).

Each ICU has 16 beds. We have 12 hour shifts, 3 days a week (basically 36 hours a week). Day shift staffing is robust - there is an attending intensivist, residents on their critical care rotation, ICU fellows, and NP's. Patients are preassigned to providers (residents and NP's) and are followed by the assigned provider.

Nights are less staffed - there is no attending intensivist in-house, only on provider per 16-bed ICU takes night calls, there is an ICU fellow that oversees the on-call resident, the NP's are assigned to a particular ICU and are on their own with the fellow acting as a back-up. NP's (and the other providers) have their own call room for night call.

NP's are privileged and credentialed as providers. They admit patients, write orders, perform procedures (lines, procedural sedation, intubation), respond to adult hospital-wide code blues as part of the code team.

Salary is competitive for the high-cost of living area. Benefits are one of the best in the area as well.

[JUSTanLPN]

What an incredible setup Juan. Very progressive,forward thinking area you live in.

[Corey Narry, MSN, RN, NP]

What an incredible setup Juan. Very progressive,forward thinking area you live in.

Progressive, yes but I think the move towards having NP's (or PA's) in academic institutions was borne out of necessity as well. Traditionally, large academic medical centers have the capability to care for the sickest patients and have multiple ICU's for various specialties. In the past, interns and residents have been in the frontlines under the guidance of fellows and attendings in ICU's in these large centers. The physicians in training were working ungodly hours and never get breaks - it's a baptism of fire.

This practice was linked to a high degree of sleep deprivation and burn-out among physicians in training and many raised patient safety concerns as a result. Medicine has since moved towards friendlier work-hours for residents since 2003 (80-hr work week) and last year interns are no longer allowed to take 24-hr in house calls. Residency slots did not increase so NP's and PA's became the alternative staffing option. This trend has been going on for quite a while now and it luckily coincided with the growth of Acute Care Nurse Practitioner programs.

But going back to being progressive, I do agree that some places are more progressive thinking than others. I think I do work for an institution that takes multi-disciplinary collaboration seriously. This is not only evident in how effective nurse-physician communication is encouraged at the bedside but also in how the APN's value is recognized and incorporated into staffing models. I have seen university hospitals that are affiliated with ACNP programs and yet there is a disconnect between the two entities because there are no true ACNP roles fostered within the hospital.

In our case, it's a win-win for both hospital and school of nursing because our ICU's has become training grounds for the university's ACNP program while still keeping a long-standing relationship with the medical school.