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Position statement: nurse practitioner in critical care.

Definition

The nurse practitioner in critical care (NP-cc) is a registered nurse in an advanced nursing practice (ANP) position with a minimum of a master's in nursing and additional educational preparation from an accredited acute care or critical care NP program and who has clinical expertise in a critical care nursing subspecialty. The NP-cc has advanced knowledge, skill and training in health assessment, physiology, pathophysiology, pharmacology, diagnostic reasoning, clinical decision-making, therapeutic interventions, family nursing, and ethical decision-making. The NP-cc has the authority through an enhanced legislated scope of nursing practice to diagnose, order and interpret diagnostic tests, prescribe and perform restricted procedures (CNA, 2009).

Qualifications

* Registered nurse

* Minimum of master's degree in nursing

* Current critical care expertise

* Current appropriate life support certificate(s) (e.g., ACLS, PALS, N-ERP)

* Licensure as appropriate for jurisdiction

* CNA's specialty certification in critical care or equivalent to critical care subspecialty (recommended)

Scope of practice

The NP-cc is expected to practise in each of the following ANP core competencies: clinical, consultation and collaboration, leadership, and research (CNA, 2008). These competencies incorporate the previously identified five interrelated domains of practice: clinical, education, research, consultation and leadership (CACCN, 2002). These competencies are not separate and distinct, but are woven into the everyday functioning of the NP-cc role. The NP-cc applies these competencies across three spheres of influence: the patient (and family); nursing, both the individual and the profession; and organizational systems. Integrated within the practice of each competency are expert skills related to communication, collaboration, and ethical decision-making, as well as effectively moving through the transition of change.

The NP-cc devotes the majority of time to direct patient/family clinical care, which includes complex monitoring and therapies and high-intensity interventions within the full range of high-acuity and technologically complex care. The NP-cc integrates the skills and knowledge from nursing and medicine within a broad framework of advanced nursing practice. The NP-cc functions both autonomously and in collaboration with physicians and other health professionals to: (a) stabilize and manage, in a comprehensive manner, the complex, multisystem, life-threatening illnesses of an assigned number of acute and chronic critically ill patients (and their families); (b) minimize complications; (c) restore maximal health potential; (d) provide holistic nursing care to the patient and family; (e) implement strategies to minimize or prevent the problems for which these patients are at risk; and (f) facilitate and coordinate quality end-of-life care when curative goals cannot be achieved.

The NP-cc shares specialized knowledge with other members of the interdisciplinary team to achieve treatment goals and provide continuity of care. The NP-cc acts as a resource person, preceptor and mentor for nurses, students and other professionals. The NP-cc advances the education of nurses and clinical partners through publications and presentations. As a clinical expert within the critical care specialty, the NPcc partners with nursing colleagues to facilitate the patients' and/or families' learning and promote an environment that maximizes their understanding, participation, and control in their health.

The NP-cc shares specialized knowledge and provides consultation to patients, nurses, other health professionals (both internal and external to the organization), health care facilities/institutions, organizations (local, national, and international), and policy-makers. The NP-cc consults with others to improve patient care, and to deal with complex and challenging situations faced in the critical care setting.

The NP-cc enhances excellence in critical care nursing by critically appraising research findings and implementing strategies to translate them into practice to improve patient care. The NP-cc has knowledge in research methodology, identifies, conducts, and collaborates in the development of nursing and/or interdisciplinary critical care research and quality improvement projects.

The NP-cc provides professional leadership in the development of standards, policies, procedures, and outcome measures related to critical care and the development of NP-cc advanced practice. The NP-cc plans, implements, and evaluates changes in clinical practice. The NP-cc provides clinical leadership by acting as a resource, facilitator, coordinator, role model, and advocate. The NP-cc's leadership responsibilities should enhance the clinical focus of the role.

CACCN believes that time, opportunity and other supports are needed for the NP-cc to engage in the full scope of the role. The integration of the core competencies will continuously evolve depending on the critical care subspecialty in which the NPcc is involved, that is, the predictability and complexity of the patients/families cared for by the NP-cc in the critical care setting, the needs of the nursing staff, as well as the education and experiential learning of the nurse in the NP-cc role.

Approved by the CACCN Board of Directors Date: January 19, 2011

REFERENCES

Canadian Association of Critical Care Nurses. (2002). Critical Care Advanced Nursing Practice: CACCN Position Statement. London, ON: Author.

Canadian Nurses Association. (2008). Advanced nursing practice: A national framework (3rd ed.). Ottawa: Author.

BIBLIOGRAPHY

American Association of Critical Care Nurses. (2006). Scope and standards of practice for acute care nurse practitioners. Aliso Viejo, CA: Authors.

Association of Registered Nurses of Newfoundland and Labrador. (2000). Competencies for: Nurse practitioner specialist. St. John's: Author.

Association of Registered Nurses of Newfoundland and Labrador. (2008, April). The professional framework for nurse practitioner practice in Newfoundland and Labrador. St. John's: Author.

Association of Registered Nurses of Newfoundland and Labrador. (2007, February). Advanced practice--The nurse practitioner. St. John's: Author.

Association of Registered Nurses of Prince Edward Island. (2007, March). Standards of practice for nurse practitioners. Charlottetown: Author.

Canadian Nurses Association. (2000). Advanced nursing practice: A national framework. Ottawa: Author.

Canadian Nurses Association. (2002). Advanced nursing practice: A national framework (2nd ed.). Ottawa: Author.

Canadian Nurses Association. (2003, June). Position statement: The nurse practitioner. Ottawa: Author.

Canadian Nurses Association. (2006). Canadian nurse practitioner initiative: Implementation and evaluation toolkit for nurse practitioners in Canada.

Ottawa: Author. Retrieved from www. apnnursingchair.mcmaster.ca/resources_ links.html

Canadian Nurses Association. (2007, November). Advanced nursing practice position statement. Ottawa: Author.

Canadian Nurses Association. (2010, May). Canadian Nurse Practitioner Core Competency Framework. Ottawa: Author.

College & Association of Registered Nurses of Alberta. (2005, September). Nurse practitioner competences. Edmonton: Author.

College & Association of Registered Nurses of Alberta. (2009). Nurse practitioners and nurse practitioner streams of practice. Retrieved from http://nurses.ab.ca

College of Nurses of Ontario. (2009). Nurse practitioners. Toronto: Author.

College of Registered Nurses of British Columbia. (2003, July). Competencies required for nurse practitioners in British Columbia. Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, June). Scope of practice for nurse practitioners (adult). Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, June). Scope of practice for nurse practitioners (pediatric). Vancouver: Author.

College of Registered Nurses of British Columbia. (2010, July). Nurse practitioner streams of practice. Vancouver: Author.

College of Registered Nurses of Manitoba. (2005, May). Competencies for the registered nurse (extended practice), RN(EP) register. Winnipeg: Author.

College of Registered Nurses of Manitoba. (2009, May). Standards of practice for registered nurses on the extended class register. Winnipeg: Author.

College of Registered Nurses of Manitoba. (2009, May). What is an RN(EP) or NP? Winnipeg: Author.

College of Registered Nurses of Nova Scotia. (2009, April). Nurse practitioner competencies. Halifax: Author.

College of Registered Nurses of Nova Scotia. (2009, April). Standards of practice for nurse practitioners. Halifax: Author.

Saskatchewan Registered Nurses Association. (2003, October). Registered nurse practitioner standards and core competencies. Regina: Author.

Saskatchewan Registered Nurses Association. (2004, April). Registered nurse practitioner scope of practice and the law. Regina: Author.
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Publication:Dynamics
Geographic Code:1CANA
Date:Mar 22, 2011
Words:1214
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