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.