Nurse practitioners and physician assistants in the intensive care unit: An evidence-based review

Abstract

Although existing research supports the use of nurse practitioners and physician assistants in acute and critical care settings, a low level of evidence was found with only two randomized control trials assessing the impact of nurse practitioner care. Further research that explores the impact of nurse practitioners and physician assistants in the intensive care unit setting on patient outcomes, including financial aspects of care is needed. In addition, information on successful multidisciplinary models of care is needed to promote optimal use of nurse practitioners and physician assistants in acute and critical care settings.

Nonphysician providers in hospital medicine: Not so fast

“…3 Ford and Britting, 1 in their article, cite several studies [4][5][6] as evidence that a MLP model of care either improved outcomes or provided cost benefits. Each of these studies has important limitations that are worth examining.…”

Lost in translation: The acute care nurse practitioners’ use of evidence based practice: A qualitative study

“…In a study utilizing nurse practitioner educators, numerous barriers were reported to EBP use, such as resource availability (time/money), oppositional clinical mind set, research training based on research production not utilization, lack of access to data, and lack of mentorship [18] . These factors serve to inhibit maximal implementation of EBP, as well as practice based changes [19,20] . To date, it is not known if ACNP experience the same barriers as other nurses, or to what degree their practice is evidenced based.…”

Provider to Patient Ratios for Nurse Practitioners and Physician Assistants in Critical Care Units

“…In intensive and acute care units, general roles and responsibilities of NPs and PAs include assessing patients, obtaining patients' history and doing physical examinations, making rounds with the multidisciplinary team, and, for NPs and PAs who have credentials and privileges, performing invasive procedures (eg, suturing, placing central and arterial catheters), and assisting in surgery under the supervision of a physician. 4,6,7 Other roles include serving as first responders for institutional rapid response teams and cardiac arrest teams, doing evaluation and triage for patients outside the ICU, acting as a preceptor for medical and nursing students, providing support and education to the clinical nursing staff, and communicating with patients and patients' families. 8,9 Although the roles and practice of NPs and PAs in the ICU and other hospital-based practices have been studied, [10][11][12][13][14] aside from several investigations 8,15,16 done in single institutions, published information on provider to patient ratios for NPs and PAs is limited.…”