Integrating New NPs into the ICU

Integrating New NPs into the ICU

When Nurse Practitioners (NPs) begin to work at the R. Adams Crowley Shock Trauma Center in the University of Maryland Medical Center, they are given training that helps integrate them into the ICU. Brooke Andersen, ACGNP-BC, Clinical Program Manager for Shock Trauma and Advanced Practice Provider for the Critical Care group, wrote about this topic for Critical Care Nurse. She took the time to answer our questions about how this process works and why it is important.

What follows is an edited version of the interview.

As opposed to having them begin working directly in the ICU, what kind of preparation is done beforehand? Why is this necessary?

All newly hired NPs attend a 2-day hospital orientation and a 1-day Advanced Practice Provider orientation that includes content on regulatory requirements, computer training, access to systems, and supplies needed for the job. Each NP receives a structured orientation manual and details regarding the orientation plan.

This standardized onboarding phase assists the NPs in completing the necessary requirements to begin work in the ICU and has minimized delays in credentialing and other regulatory requirements while streamlining the process.

What kind of training do they receive before starting in ICU? Why?

We do not provide training before starting in the ICU. The new NPs receive education in conjunction with their clinical training. They participate in weekly 1-day standardized didactic education and bimonthly procedural workshops or simulation sessions throughout the orientation. The weekly sessions provide time off the unit and opportunities for the NPs to obtain knowledge and technical skills while gaining confidence and competency in the critical care setting.

Education sessions include over 30 critical care core topics. The procedural skills lab provides the necessary training for NPs to become credentialed in ICU advanced skills. High-fidelity clinical simulations are failure-to-rescue and rapid-response scenarios that provide training in critical high-stress situations with debriefing.

How has this helped them be better at their jobs when they begin in the ICU? Why? How does this training and integration help the patients?

The weekly education allows the NPs time to network with other critical care providers and develop a support system. Our program evaluation has shown that novice NPs do not feel adequately prepared to work in an ICU immediately after graduation, but at the completion of orientation, they are confident and competent.

This training helps the patients by ensuring that the NPs have had standardized training that promotes success in achieving competency in necessary critical care knowledge and technical skills.

Is this just done for the ICU or other departments as well? Why?

A structured orientation is provided for newly NPs throughout the organization, but is tailored to the specialty areas. The critical care orientation that we have described is specific to the critical care units and has been shown to meet the necessary NP competencies needed in all the ICUs. These competencies are based on the AACN Scope and Standards for adult and pediatric ACNPs.

What else do you think is important for nurses to know about how new NPs are integrated into the ICU?

Newly hired NPs require a depth of knowledge and skills to successfully transition into their new roles. A comprehensive training program that includes standardized educational activities, clinical training, and thoughtful matching of preceptors with new NPs are key elements. Mentorship is especially critical during the orientation period to ensure new NPs receive support and guidance in their learning while fostering independence and autonomy as competencies are achieved—and ultimately builds confidence.

Nurses Respond After AMA Launches ‘Turf War’ Over Direct Patient Access

Nurses Respond After AMA Launches ‘Turf War’ Over Direct Patient Access

Following opposition efforts from the American Medical Association (AMA) on new policies that allow advanced practice registered nurses (APRNs) to practice independently of physician supervision, many nursing groups have expressed upset over the ‘turf war’ between nursing and doctor groups. There are four types of APRN roles: nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse midwife.

According to, “AMA opposes ‘the continual, nationwide efforts to grant independent practice…to non-physician practitioners’ including advanced practice registered nurses (APRNs).” AMA, the nation’s largest doctor group, voted at a policy meeting last week in a move designed to combat a national strategy to allow APRNs more direct access to patients.

This new national lobbying strategy from the AMA has been spurred by many states and branches of federal government moving to allow APRNs more direct access to patients without physician supervision. Just last year, the Department of Veterans Affairs granted APRNs direct access to veterans in a landmark decision.

The American Nurses Association (ANA) has accused the AMA of perpetuating “the dangerous and erroneous narrative that APRNs are trying to ‘act’ as physicians and are unqualified to provide timely, effective and efficient care,” as reported by

[APRNs] practice advanced nursing, not medicine, in which they regularly consult, collaborate and refer as necessary to ensure that the patient receives appropriate diagnosis and treatment. For AMA to imply that APRNs are incapable of providing excellent care or that their care puts the patient at risk is blatantly dishonest. The future of health care calls on health care professionals to work together as a team to meet the growing demand for health care services. 

Pamela Cipriano

President, ANA

Nurse groups like ANA and the American Association of Nurse Practitioners (AANP) have spoken out about the benefits of new state and federal laws that allow direct access as an effort to speed up care to patients. It is part of a larger nationwide move toward value-based care which has also been recognized by government and private insurers who emphasize getting treatment in the right place at the right time, meaning care is often given upfront in a primary care setting where nurses are on the front lines.

To learn more about this ‘turf war’ between doctor and nursing groups debating which health care providers should have direct access to patients, visit here.

Talk to Nursing School Admission Officers Online on 11/29

Talk to Nursing School Admission Officers Online on 11/29

DailyNurse wants to help you plan the next step in your nursing career! Our online open houses will help you plan your next step and guide you through the nursing school application process. These events also serve as an easy and effective way to connect with admission officers from the comfort of your home, school, or office.


Chat with nursing school admission officers on Wednesday, November 29th (12pm-3pm EST)

Next week, aspiring nursing students interested in a BSN or MSN degree will have an opportunity to meet with admission officers from Herzing University. Herzing has opened applications for the following programs:

  1. RN-BSN
  2. RN-MSN
  3. MSN-Family Nurse Practitioner
  4. MSN-Nurse Educator w. emphasis in Staff Development
  5. MSN-Nurse Educator w. emphasis in Faculty Development
  6. Post Master Certificates
  7. MBA w. Concentration in Healthcare Management

Whether you are new to nursing or want to further your career with an advanced degree, Herzing offers program options as well as support teams to help you succeed. Register now to chat online from any device, and connect with admissions officers for 1-on-1 chats next week.


The Nurse-Practitioner Abroad: Working as an NP Internationally

The Nurse-Practitioner Abroad: Working as an NP Internationally

This story was originally published by The Professional Nurse blog, a trusted and reliable source for nursing career advice, news, and academic resources.

Ever since the advent of the Nurse Licensure Compact, working as a registered nurse in half of the states in the United States has become almost seamless. The multistate license is particularly helpful for nurses who work as travelers and for nurses who live near state borders. The evolving APRN Compact will similarly provide for nurses in advanced practice as long as they continue to work in the United States.

As someone who lives in the Metropolitan DC area, I see friends and neighbors move from country to country as readily as many people seem to go to the grocery store. The area is, naturally, home to a large number of government and international agency employees. I started to wonder, how would I continue to work as a nurse-practitioner if my family needed to relocate overseas? I found my options limited. Few countries recognize the role of an advanced practice nurse (APN).

Registered nurses in the United States enjoy a broad scope of practice compared to nurses in much of the rest of the world. The concept of advance practice nursing? Virtually unheard of outside North America and Europe. In only a handful of countries would it be possible for me to continue working legitimately as an advanced practice nurse. Once I had met local requirements, that is.

Setting aside visa, work permit, and language-proficiency requirements, let’s look at what it would take to work as an APN in some of these places.

The APN role in Canada has come a long way during the past 15 to 20 years. It is similar to the APN role in the United States. Canada recognizes nurse-practitioners as autonomous providers. An APN license requires both graduate-level education and clinical experience. The process for foreign-trained APNs to qualify for licensure in Canada varies among Canadian provinces. In general, you would need to have your NP educational program approved, apply (a multi-step process) for and pass the appropriate NP exam, supply copies of your various licenses and pay fees in excess of $2,000.

Once you leave North America, your options for practicing as an APN are limited. In Nigeria, for example, where decades of wars, conflicts and political instability reduced medical manpower, the APN role has started to evolve. Nigeria recognizes only the advanced practices of midwives and certified registered nurse anesthetists. Licensure in those specialties requires application, verification of your state nursing license, a statement of good standing from your state board of nursing, official transcripts from the nursing school(s) you attended, approval of your educational program, taking and passing Nigeria’s licensing exams, and the completion of three months of orientation.

In Israel, where advanced practice nursing is still in its infancy, one must be a citizen or resident of Israel to qualify for nursing licensure. The process of obtaining licensure in Israel is not unlike the process in Canada and Nigeria – it requires paperwork, testing (including simulation testing) and fees. In fact, these requirements are fairly standard.

What is not standard is the scope of advanced practice nursing. In places like Nigeria and Israel, advanced practice nursing is restricted to certain specialties. In Finland, nurses work in advanced practice roles but do so without any standardization in education and without an advanced practice license. Thailand recognizes APNs, but the APN role is not well defined. One third of APNs in Thailand work in places where doctors are not present and often end up providing care beyond their legal scope.

Obtaining a license as an APN in another country will require planning and patience. The process can take as few as six months or as long as two years. Many countries do not recognize educational programs that are completed online. You should expect compensation to be much less than you would earn in the United States.

If the overseas licensing process is overly daunting, you might want to consider other career possibilities. You may not be able to work the way you do in the US, but you may be able to teach, do research or hold management positions in health care – all without going through the laborious licensing process. International healthcare jobs are plentiful owing to USAID, the US State Department, the CIA, the United Nations, and the World Health Organization and will generally not require a foreign license. International job listings can also be found at and

Report: Nurse Education Demo Project Good for Primary Care

Report: Nurse Education Demo Project Good for Primary Care

This story was originally published by MedPage Today, a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals and provider of free CME.

An increase in government funding for clinical training opportunities for advanced practice registered nursing (APRN) is a feasible and affordable way to grow the primary care workforce, according to a Report to Congress on the Centers for Medicare and Medicaid Services (CMS) Graduate Nurse Education Demonstration.

The $200 million initiative was started in 2012 to determine if Medicare funding for graduate clinical education for APRNs, similar to residency training for physicians, could help meet meet the health needs of the U.S. population.

“There is a shortage of primary care providers in this country and the education of more APRNs can be part of the solution to increasing access to care,” Barbara A. Todd, DNP, director of Graduate Nurse Education (GNE) Demonstration at the Hospital University of Pennsylvania in Philadelphia, told MedPage Today.

CMS awarded funding for clinical training programs to five hospitals, which then partnered with accredited schools of nursing and non-hospital community-based care settings to deliver primary, preventive, and transitional care to Medicare beneficiaries.

The five hospitals are Duke University Hospital in Durham, North Carolina; Hospital of the University of Pennsylvania, Memorial Hermann-Texas Medical Center in Houston, Rush University Medical Center in Chicago, and HonorHealth Scottsdale Osborn Medical Center in Arizona.

Lori Hull-Grommesh, director of demonstration at Memorial Hermann-Texas Medical Center, commented on program results in the Texas Gulf Coast area, noting that 95% of APRN graduates are employed in the community setting and are helping meet critical access needs. She said she believes that national funding would allow these results to be replicated in other states.

Linda H. Aiken, PhD, coordinator of the GNE Demonstration Consortium of University of Pennsylvania, agreed. “If permanent Medicare funding were available for the clinical training of advanced practice nurses in all states, the national shortage of primary care could be solved and Americans would be able to get timely healthcare where ever they live.”

The report stated that demonstration schools had significantly greater APRN enrollment and graduation growth than comparison schools. It also touched on financial incentives: clinical training for an APRN came to a total of $30,000 compared with $150,000 for just 1 year of community-based residency training for primary care physicians.

Although the GNE demonstration is slated to conclude at the end of June 2018, the five hospitals are currently collaborating with major national stakeholders in order to promote permanent funding to roll out the program nationally.

“All five sites are working together to promote efforts for ongoing funding, along with major stakeholders AARP and [American Association of Critical-Care Nurses], who were instrumental from the beginning,” explained Hull-Grommesh. This is being done through publications, meetings, presentations and discussions with our legislators, she added.

Aiken noted that various types of healthcare organizations, including physician practices and retail clinics, are hiring nurse practitioners in larger numbers and supporting efforts like the demonstration to increase the supply for advanced practice nurses. Also, healthcare settings are working to recruit more advanced practice nurses, especially for their valuable role in ending the opioid epidemic and addressing unmet mental healthcare needs, she pointed out.

What Nurse Practitioners Can Do in the Opioid Crisis

What Nurse Practitioners Can Do in the Opioid Crisis

The impetus to address—and combat—the opioid epidemic that is plaguing our country has never been more urgent. Overdose rates have more than quadrupled since 1999, making opioid overdoses now the leading cause of death in Americans under 50. For every person who obtains opioids on the streets, there are many more who abuse prescription drugs that are prescribed to them.

Nurse practitioners (NPs), in primary care and in specialties, can help break this cycle. Nurse practitioners are on the frontline in patient care and have the skill and authority to intervene. As a provider, I have seen firsthand how pain medication can help patients regain control of their lives, when prescribed and taken correctly. I have also seen people become so dependent on these medications that they will do almost anything to get access to them. Part of my role at Columbia University School of Nursing is to oversee the school’s faculty practice, ColumbiaDoctors Primary Care Nurse Practitioner Group, which offers combined primary care and mental health services in New York City.

At the practice, we handle opioid prescriptions with a three-prong approach: comprehensive history and assessment, opioid patient-prescriber agreements, and educating our faculty NPs to engage in Medication-Assisted Treatment, particularly the authority to now prescribe Buprenorphine, an opioid medication used to treat addiction.

Nurse practitioners bring an evidence-based and culturally-competent approach to primary care. I connect with my patients and am able to understand a patient’s needs by eliminating barriers to care. This includes a comfortable environment that allows for ample time to interact with the patients and is focused on building the patient-provider relationship. When it comes to pain management especially, we want patients to feel comfortable sharing the root causes of their problems, so that we can provide the most appropriate course of treatment.

If we feel the problem stems from a multitude of factors, we may refer them to our mental health nurse practitioner, or other specialists before prescribing opioid prescriptions. By taking the time to assess the problem, we aim to ensure that opioid medication is methodically prescribed—and not our first course of treatment.

We know that this alone is not enough, which is why we also ask our patients to sign an opioid patient-prescriber agreement. This helps us to ask for accountability from both the patient as well as the prescriber.

Beyond just promising to take medications at the dose and frequency prescribed, our patients must agree to come in for a random “pill count” whenever asked. They must always bring the original pill bottle with unused pills in to every appointment, and we will even ask for consent for random drug screenings.

The purpose of these precautions is to remind our patients that this treatment modality will be taken away from them at any time if they cannot adhere to our safe practices. It also reminds our prescribers to keep a watchful eye to ensure the patient’s treatment does not become habit forming.

For those who come to us already addicted to opioids, NPs can now legally prescribe Buprenorphine, an opioid medication used to treat addiction, thanks to the Comprehensive Addiction and Recovery Act (CARA), passed just last year. This allows patients to come to us when they need help, and allows us to devise a plan of action from the convenience of our primary care practice. Patients appreciate being able to be treated in the familiar surroundings of our practice, and in the care of an NP who knows their complete health history.

Last year, the opioid epidemic claimed 64,000 American lives. Today, there are more than two hundred thousand nurse practitioners in the country who are prepared to help. Perhaps, this is one of our greatest assets. We offer access to quality and patient-centric care, especially in underserved and underinsured communities across the United States. As we recognize Nurse Practitioner Week, November 12-18, it is important to remember our role in combating this escalating health crisis.