NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Acutely ill patients increasingly dominate the inpatient population, and research has shown that in these settings nurse practitioners provide high quality care, decrease length of stay, and improve patient and family satisfaction. Furthermore, the addition of a nurse practitioner to the health care team improves communication and overall patient care. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Adult-Gerontology Acute Care Nurse Practitioners (AG ACNP) are needed to help assess and manage acutely ill patients within the inpatient/hospital setting and across hospital-to-clinic settings, including the emergency department, intensive care unit, specialty labs, acute and sub-acute care wards, specialty clinics, or any combination of the above.

ORDER A PLAGIARISM-FREE PAPER HERE

The Adult-Gerontology Acute Care Nurse Practitioner can legally diagnose and treat medical conditions. In addition, some AG ACNPs provide direct patient management from admission to discharge in collaboration with the physician and other members of the health care team. AG ACNPs may also continue to monitor the patient as the patient moves into the outpatient setting to ensure successful transition after discharge and complete resolution of transition needs. The structure of the role depends upon the collaborative agreement with physicians and other members of the health care team. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

UCSF's AG ACNP program remains the only one of its kind in Northern California. There are three areas of emphasis: critical care, cardio-pulmonary, and emergency department/trauma. However, the program is flexible enough to enable training within a diversity of hospitalized patient practice settings, such as but not limited to, internal medicine, transplant, cardiology, neurosurgical, oncology, and trauma. A minimum of two years adult acute care nursing experience in the hospital setting is required prior to applying to the program. Applicants are not required to have ICU or Emergency Department (ED) nursing experience, however, prior nursing experience in these settings is preferred if the ED or ICU are settings where the applicant wishes to precept while enrolled in the program. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

The role of the adult-gerontology acute care nurse practitioner is to provide advanced nursing care to adult, older adult and elderly patients with acute, chronic and critical conditions. The term “acute” differentiates acute care nurse practitioners from primary care practitioners. The AG-ACNP must work collaboratively with a host of different health care professionals in order to stabilize and improve the health of patients. Oftentimes, the AG-ACNP will need to collect and evaluate information based on patient history, symptoms, physical findings and/or diagnostic information to choose an appropriate course of action. By constantly and efficiently evaluating the patient’s dynamic condition and reactions to treatment, the AG-ACNP continuously adapts the patient-management plan to fit the specific needs of the patient. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Adult-Gerontology Acute Care Nurse Practitioner Scope of Practice

Adult-Gerontology Acute care nurse practitioners work in many different clinical settings providing advanced nursing care to patients in critical conditions, with chronic or episodic illnesses and/or with acute medical needs. These settings include but are not limited to clinics, physicians’ offices, hospitals, retirement homes, hospices and private practices. Along with performing the tasks of an advanced practice nurse, the AG-ACNP is qualified to provide specific health care functions to acutely and chronically ill patients such as writing prescriptions, interpreting ECG monitoring and assessing patient responses to drugs and other ancillary treatment. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Adult/Gerontology- Acute Care Specialty

Overview

Adult/Gerontology- Acute Care Advanced Practice Nurses (APNs) are Registered Nurses educated at the Master's level with expertise in the care of the adult/gerontology population with high intensity nursing and medical needs, including acute, critical, and complex chronic health conditions. Preparation in the following roles is offered: Adult/Gerontology Acute Care Nurse Practitioner (ACNP) and Acute Care Adult/Gerontology Clinical Nurse Specialist (ACCNS or Adult CNS). Graduate are eligible to sit for certification as Acute Care or Adult NPs or CNSs.

Dual preparation as both a nurse practitioner and a clinical nurse specialist is also available. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Populations of Interest

The population of interest for these programs is adults, from late adolescence through senescence, who have acute, critical and complex chronic health needs. The age and patient status, not the location of the patient, is key; students may care for patients in a variety of settings, including the patient's home, outpatient clinics, medical/surgical wards, critical care units, or emergency/urgent care units. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Nurse Practitioner Role and Preparation

Acute Care Nurse Practitioners provide advanced nursing care across the continuum of healthcare services to meet the specialized physiological and psychological needs of adult/gerontology patients with acute, critical, and complex chronic health conditions. They perform comprehensive health assessments, order and interpret the full spectrum of diagnostic tests and procedures, use differential diagnosis to reach a medical diagnosis, construct and order a plan of care, and evaluate the outcomes of interventions for patients.

Clinical Nurse Specialist Role and Preparation

Adult/Gerontology-Acute Care Clinical Nurse Specialists intervene in the individual patient/family sphere, a nurses-nursing practice sphere, and the organizations-systems sphere to influence patient outcomes. Their activities span 8 dimensions of care: clinical judgment, clinical inquiry, facilitation of learning, collaboration, systems thinking, advocacy/moral agency, caring practices, and response to diversity. Clinical Nurse Specialists perform comprehensive health assessments, interpret diagnostic tests and procedures within their areas of expertise, provide expert consultation to other health care providers, support organizational goals, evaluate application of research to clinical practice within an organizational setting, provide formal and informal multidisciplinary education, and provide leadership, mentoring and guidance to staff nurses. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

ORDER A PLAGIARISM-FREE PAPER HERE

Program Goals

The goal of the UCLA School of Nursing Adult/Gerontology-Acute Care program is to prepare nurses to assume an advanced practice role in the care of adult/gerontology patients with acute illnesses or with exacerbation's of chronic illness and with high-intensity nursing and medical needs. While all students are expected to gain proficiency with care of adult/gerontology patients in acute care general medicine settings, students may also select an area of focus within the adult/gerontology population. Students specializing in oncology may select from a variety of oncology settings.

Education: Master of Science in Nursing

Credentials (depending on role and/or specialty):

  • Eligible for the American Nurses' Credentialing Center's certification exam as a Acute Care Nurse Practitioner, or Adult Nurse Practitioner
  • Eligible for the American Association of Critical Care Nurses certification exam as a Acute Care Nurse Practitioner
  • Eligible for the APN certification exam from the Oncology Nursing Society, as an Advanced Oncology Certified Nurse Practitioner, or Advanced Oncology Certified Clinical Nurse Specialist
  • Eligible for the CCNS exam from the American Association of Critical Care Nurses
  • Eligible for prescriptive authority in all 50 states with restriction as specified by each state   NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Types of Care provided by the Advanced Practice Nurse:

  • Continuous and comprehensive care in a variety of inpatient and outpatient settings
  • Episodic care for acute and critically ill patients
  • Management of chronic conditions or terminal illness
  • Management of long term care or sub-acute/rehabilitation patients
  • Monitoring and case management of medical and cardiac diseases
  • Multidisciplinary and comprehensive care

Key elements of the ACNP include:

  • advanced clinical expertise
  • development of differential diagnoses
  • use of medical diagnostic reasoning to formulate the plan of care
  • order and prescription of pharmacologic and other therapeutic therapy
  • planning and management of patient care across the acute care continuum
  • utilization and performance of invasive and non-invasive interventions
  • evidence-based and research-based clinical practice
  • advocacy or patient agency
  • clinical leadership
  • promotion of health

Key elements of the ACCNS include:

  • advanced clinical expertise
  • comprehensive, holistic wellness and illness assessment
  • design, implementation, and evaluation of innovative individual, aggregate, and/or population-based programs of care
  • identification and measurement of nurse-sensitive patient outcomes
  • multidisciplinary collaboration
  • diagnosis of systems-level problems and development and evaluation of systems-level change strategies
  • evidence-based practice at the patient, nursing, and systems level
  • patient and nursing advocacy
  • clinical and professional leadership

The Acute Care Nurse Practitioner (ACNP) is a registered nurse who has completed an accredited graduate-level educational program that prepares them as a nurse practitioner. This program includes supervised clinical practice to acquire advanced knowledge, skills, and abilities. This education and training qualifies them to independently: (1) perform comprehensive health assessments; (2) order and interpret the full spectrum of diagnostic tests and procedures; (3) use a differential diagnosis to reach a medical diagnosis; and (4) order, provide, and evaluate the outcomes of interventions. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper The purpose of the ACNP is to provide advanced nursing care across the continuum of health care services to meet the specialized physiologic and psychological needs of patients with acute, critical, and/or complex chronic health conditions. This care is continuous and comprehensive and may be provided in any setting where the patient may be found. The ACNP is a licensed independent practitioner and may autonomously provide care. Whenever appropriate, the ACNP considers formal consultation and/or collaboration involving patients, caregivers, nurses, physicians, and other members of the inter professional team.[1]

Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.[1][2] In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.

Acute care services are generally delivered by teams of health care professionals from a range of medical and surgical specialties. Acute care may require a stay in a hospital emergency department, ambulatory surgery center, urgent care center or other short-term stay facility, along with the assistance of diagnostic services, surgery, or follow-up outpatient care in the community.[2] Hospital-based acute inpatient care typically has the goal of discharging patients as soon as they are deemed healthy and stable.[3] Acute care settings include emergency department, intensive care, coronary care, cardiology, neonatal intensive care, and many general areas where the patient could become acutely unwell and require stabilization and transfer to another higher dependency unit for further treatment. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

There are almost a quarter million nurse practitioners (NPs) in the United States. More than 60 percent work as family nurse practitioners (FNPs), but less than 10 percent work as adult-gerontology nurse practitioners (AGNPs). As advanced practice registered nurses (APRNs), both types of NPs must matriculate from a rigorous, graduate-level nurse practitioner program prior to practicing; the most fundamental difference between the two specializations is the patient population they serve.

An FNP serves patients of all ages and backgrounds, from childhood to adolescence and into adulthood. They often work in primary care, making them the central point of contact and the first line of defense for all health issues and questions. FNPs will diagnose and treat illness, promote healthy lifestyles, and guide patients in efforts of disease prevention. All FNPs have at least a master’s of science in nursing (MSN), and some have a doctor of nursing practice (DNP), meaning that they are all experts in providing care for patients of all ages.

On the other hand, an AGNP exclusively works with adult and geriatric patients, beginning at adolescence. They can work in either primary care or acute care. Primary care AGNPs will be the familiar face for long-term patients with routine medical visits, and they typically take a wellness-based and holistic approach to medical care. Acute care AGNPs will manage critical and chronic conditions with a treatment-focused and targeted approach. Whether they work in acute care or primary care, all AGNPs hold either an MSN or DNP degree and have an intimate understanding of the aging process and the unique challenges present in the later stages of life. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

The scope of practice for both FNPs and AGNPs varies by state and facility. In some settings, they may be able to prescribe medication, while in others they may only assist a health professional in performing medical procedures. However, authority for nurse practitioners is increasing.

In all cases, FNPs and AGNPs must undergo repeated professional development and continuing education to maintain competency in their specialization and stay on top of the emerging practices in the areas of nursing and healthcare.

The primary difference between FNPs and AGNPs comes down to the age of the population served, but there are further divergences, both subtle and overt, in their respective educational programs, core competencies, and certifications.

The Doctor of Nursing Practice program is a practice-focused doctoral program in nursing that awards both the Master of Science in Nursing (MSN) degree and the terminal professional degree of Doctor of Nursing Practice (DNP) upon graduation. The DNP prepares expert nurse clinicians and executive leaders for the highest level of practice to improve health outcomes for individuals and populations. Graduates will be employed in primary care settings, hospitals and other acute care settings, public health agencies, and schools of nursing. Graduates are eligible for national certification. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

In today’s advanced practice nursing environment, with the APRN Regulatory Model defining the various APRN roles, this book is a resource for clinical nurse specialists (CNSs) caring for adult patients in the acute care setting. Advanced Practice Nursing of Adults in Acute Care clearly presents the impact of the CNS on patients and families, nursing teams, and health care systems.

The book begins with a historical perspective of advanced practice nursing and the CNS role. The authors define core competencies and discuss the spheres of influence. Chapter 2 covers various concerns commonly seen in the acute care population. The next few chapters address common clinical issues such as pain, palliative and end-of-life care, caring for older adults, and psycho social issues such as violence and substance abuse. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

The last chapters of the book focus on diseases CNSs frequently encounter in the acute care setting. For each disease process, the authors provide background, incidence and prevalence, etiology, psychopathology, associated diagnostics, and management, followed by a presentation of the spheres of influence and related CNS competencies.

Guide to Advanced Practice Adult Gerontology Acute Care Nursing

Adult-gerontology acute care nurse practitioners (AGACNPs) care for adult patients in intensive care settings such as urgent care departments, emergency departments, trauma centers, and intensive care units. AGACNPs’ clinical responsibilities typically include conducting intake assessments, diagnosing critical diseases and conditions, developing short-term and long-term patient care plans, completing procedures and administering treatments to address critical conditions, and advising patients on the management of their illnesses. Adult-gerontology acute care nurse practitioners can also serve as coordinators of care and leaders in the medical setting, managing patients’ care from admission to discharge and guiding nurses and other medical staff. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Unlike primary care nurse practitioners, who typically follow their patients’ health over the course of several years, AGACNPs generally work with patients for a shorter span of time, but interact with patients frequently and work closely with them and their families. AGACNPs work in collaboration with and/or under the supervision of physicians, with the aim of stabilizing their patients’ condition before they are transferred to outpatient care or home.

Advanced adult-gerontology acute care is a demanding field of work due to the complex and critical conditions that AGACNPs are required to address on a daily basis, the fast-paced nature of the inpatient medical settings in which they work, and the emotional strain of working with patients who could succumb to life-threatening illnesses. However, registered nurses who elect to become adult-gerontology acute care nurse practitioners may find the rewarding relationships they form with their patients and colleagues, the intellectual challenge of the daily work, and the ability to work in a more administrative and leadership capacity to improve healthcare systems as very rewarding and motivating aspects of their job. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

AGACNPs must undergo rigorous graduate school and clinical training in order to obtain national certification in their specialty. Prospective adult-gerontology acute care nurse practitioners receive certification through either the American Nurses Credentialing Center (ANCC) or the American Association of Critical Care Nurses (AACN). In order to qualify for the certification exam administered by either the ANCC or the AACN, candidates must have completed a graduate nursing program that has been accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN), and complete a minimum 500 hours of clinical practicum in medical settings that are relevant to adult acute care nursing. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

They must also have graduate training in advanced health assessment, advanced physiology and pathophysiology, and advanced pharmacology. In addition to fulfilling national requirements for APRN certification, AGACNPs must meet and maintain state-specific requirements for licensure/certification. After earning their requisite credentials, adult-gerontology acute care nurse practitioners should maintain their certifications and licenses through continuing education and fulfillment of additional requirements.

The most common setting for adult gerontology acute care nurse practitioners is in the hospital, where they can work within specific critical care units or across multiple departments. Critical care services are structured differently at different hospitals according to the hospital’s size and available resources, as well as state and regional regulations. Typically, however, critical care services in hospitals are comprised of an Emergency Department, Intensive Care Units (ICUs), and Intermediate Care Units (also known as Step Down Units). AGACNPs who work in hospitals can specialize in treating patients who suffer from a specific type of condition, such as cardiovascular, pulmonary, or neurological disease. Other AGACNPs may work across multiple critical care departments, in a general medical or surgical ICU, or in the Emergency Department, where they encounter a wider range of acute injuries and ailments. Below are some examples of medical settings that can employ adult-gerontology acute care nurse practitioners. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Emergency Departments

Emergency departments within hospitals employ AGACNPs to evaluate and triage incoming patients to determine their medical needs, to provide and coordinate direct medical services to ill and injured patients, and to manage patients’ transition to other medical units within the hospital setting. Emergency departments are very fast-paced environments, and health care providers in these settings must prioritize patients facing immediately life threatening injuries and illnesses. The care provided in these settings is short-term and meant to stabilize patients until they can be transitioned to longer-term care. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Intensive Care Units (ICUs)

Intensive Care Units, or ICUs, are medical units within hospitals that have specialized staff to care for seriously ill or injured patients. AGACNPs can work in one or more ICUs in a given hospital, or rotate their time between several hospitals. Depending on the hospital, ICUs can be categorized based on patient population, conditions treated, or a more general criterion, such as medical treatment versus surgical care. Some large tertiary medical centers may have a Pediatric ICU, a Cardiovascular ICU, a Pulmonary ICU, a Neurological ICU, and/or a Psychiatric ICU, to name a few. Small and medium-sized hospitals might have just two ICU divisions–a Medical ICU and a Surgical ICU, or a single Medical/Surgical ICU that serves patients in need of either intensive medical or surgical/post-surgical care. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

AGACNPs who work in ICUs typically work as part of a highly trained team of specialists and advanced practitioners. Dr. Elizabeth Tomaszewski, MSN, DNP, AGACNP-BC is an Adult-Gerontology Nurse Practitioner at Geisinger Health Systems, where she provides critical care services to a wide range of patients suffering from various critical diseases and disorders. “As a nurse practitioner on the critical care medicine service, I see critically ill patients in the intensive care unit with a variety of different medical conditions,” she said, “All of these patients require detailed assessments, complex medical decision-making and life-saving procedures. At times, these patients also require compassionate care at the end of life. […] Our multidisciplinary team includes nurse practitioners, physician assistants, physicians, nurses, respiratory therapists, pharmacists, case management and pastoral care. We all work together to provide comprehensive care to our vulnerable patients.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

ICU staff also work closely with personnel from other departments, such as the Emergency Department and Step Down Units, to ensure patients receive appropriate continuity of care. Below is a more detailed description of the types of ICU environments in which AGACNPs work.

Medical/Surgical ICUs

The Medical/Surgical ICU, also known as the MSICU, is a common work setting for AGACNPs. MSICUs treat patients suffering from a wide array of critical conditions, as well as patients recovering from major surgical procedures. Michelle Edwards, MS, CCRN, AGACNP-BC, is a Critical Care Nurse Practitioner at the Palo Alto VA Hospital, where she cares for veterans struggling with complex and severe illnesses and conditions. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper In an interview with OnlineFNPPrograms.com, she described the role that she and other AGACNPs have on the critical care team at Palo Alto VA Hospital. “As a part of a multi-disciplinary team of interns, residents, fellows, NPs, and attending physicians, pharmacist, RNs, and RTs, we perform daily rounds on all of the patients in the MSICU (Medical/Surgical ICU). We are primary providers of all medical patients and consultants for general surgery, vascular, neurosurgical, and CT surgery patients,” she said.

AGACNPs who work in the Medical/Surgical ICU must be prepared to encounter a wide assortment of critical ailments and post-surgical needs. Kimberly Zilske, MSN, ACNP-BC is an Acute Care Nurse Practitioner specializing in Pulmonary Critical Care at Memorial Hermann Health System, where she cares for patients in the ICU. “I take care of any patient that is admitted into the Medical/Surgical ICU. Some of the patients that are admitted have been diagnosed with Pneumonia, Acute Respiratory Distress Syndrome, Acute Myocardial Infarction, Atrial Fibrillation with Rapid Ventricular Rate, Septic Shock, and Post Cardiac Arrest to name a few,” she explained in an interview with OnlineFNPPrograms.com. Ms. Edwards similarly outlined the many different critical conditions she encounters on a daily basis in her work at the Palo Alto VA Hospital. “[My team and I] manage complex medical patients with neurological disorders (stroke or seizures), pulmonary disorders (COPD exacerbation, ARDS/ALI), cardiovascular disorders (acute decompensated HF and cardiogenic shock requiring vasopressors and/or IABP), renal disorders requiring CRRT/iHD, GI disorders (pancreatitis, U/LGIB), endocrine (DKA, HHNK, thyroid) and sepsis,” she said. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Specialized ICUs

As mentioned previously, some adult-gerontology acute care nurse practitioners focus on a particular area of critical care, and accordingly work in specialized ICUs. John Kenna, MSN, ACNP-BC is an Acute Care Nurse Practitioner in the Neurological ICU at the Medical University of South Carolina (MUSC), which is also a designated Level I Trauma Center. In an interview with OnlineFNPPrograms.com, he explained the types of critical conditions he addresses on a daily basis in collaboration with other specialists on the Neurological ICU team. “We work closely with the Neurosurgeons and Neurologists to manage a variety of neurologic injuries including a variety of Stroke (Ischemic, Hemorrhagic, Subarachnoid Hemorrhage), Traumatic Brain Injury (TBI), Spinal Cord Injury (SCI) and Neuromuscular disorders such as Guillain-Barre Syndrome or Myasthenia Gravis,” he said. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

In addition to her position at Memorial Hermann, Ms. Zilske also works shifts at the University of Texas Health and Science Center at Houston, as a Pulmonary Critical Care Nurse Practitioner in the Transplant ICU and Step Down Unit, and as a consultant in the Critical Care Unit and the Cardiovascular Intensive Care Unit. The multiple medical settings in which she works means that her workweek is often quite varied depending on what services the hospital needs, and what shifts she takes on. “I cover the Transplant ICU and the step down unit for transplant or the Heart and Vascular Institute as a Consultant,” she told OnlineFNPPrograms.com, “If I am assigned to the Transplant ICU, I am responsible for the 10 bed ICU as well as a 20 bed floor that has nephrology, hepatology, and gastroenterology patients. It is also where we send the post op transplant patients. We are responsible for all admits to the floor as well as the ICU. […] If I am assigned to the Heart and Vascular Unit, we are considered consultants for the Critical Care Unit (CCU) and the Cardiovascular Intensive Care Unit (CVICU). We see all patients that we are consulted on with the Pulmonary Fellows, write the notes, and trouble shoot issues overnight.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Intermediate Care/Step Down Units and Hospital Wards

AGACNPs can also work in Intermediate Care Units, where patients in the ICU are transferred when their condition has stabilized. Like ICUs, Step Down Units can be specialized, and provide care for patients suffering from a specific type of disease or condition, or they can be general and treat a wide variety of patients. According to the American Association of Critical Care Nurses, Step Down Units must provide basic and advanced life support services, continuous medical treatment administration, standard procedures for advanced patient monitoring, long term mechanical ventilation, and other services aimed at ensuring patients progress in their recovery and do not experience health complications.

AGACNPs who work in Step Down Units manage patients’ transition from the ICU to the SDU, continually assess the health of medically vulnerable patients, administer treatments as necessary, guide other staff in the care of patients, and coordinate patients’ admission and discharge from the SDU when they have recovered sufficiently. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Hospital Wards are another tier of care below the Step Down Unit, and are where convalescing patients stay before they transition to outpatient care or home. AGACNPs can work in these settings to monitor patients and provide lower-level treatments and primary care services.

Urgent Care Clinics

Urgent care clinics are not based in hospital settings, but are stand-alone clinics staffed with medical personnel who are trained to address acute illnesses and injuries that require immediate treatment, but which are not life threatening or critical, and thus do not require a trip to the ER. The medical team at an urgent care clinic is often comprised of physicians, nurse practitioners, physician assistants, and registered nurses. Conditions treated range from the common cold to the flu, bodily aches and pains, fractures and other sports injuries, strep throat, gynecological and urinary conditions, and laceration repairs. Urgent care staff are also trained to evaluate the severity of a patient’s condition, and to ascertain whether he or she should go to the ER or an ICU. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Primary Care, Palliative Care, and Long-term Care Settings

While adult-gerontology acute care nurse practitioners work mainly in critical care settings such as the ones described previously, they can also work in primary care, long-term care, and/or palliative care settings, depending on their interests and previous work experience. The nature of the patient-provider relationship is quite different between acute and primary medical care; according to the National Organization of Nurse Practitioner Faculties, the role of the Acute Care Nurse Practitioner is a restorative one, aimed at helping patients heal after a severe injury, illness, or exacerbation of an existing condition, whereas the role of the Primary Care Nurse Practitioner is more focused on the lifelong maintenance of health through a long-term relationship and the continuous management of chronic conditions. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Despite these differences, however, the core concepts and many of the fundamental methods of effective nursing care, such as the advanced health assessment, patient consultations, labwork, and treatment of ailments, are the same between both acute and primary care nursing. Oftentimes, acute care nurse practitioners and primary care nurse practitioners treat the same conditions, but at different stages in these conditions’ progression (for example, while an acute care nurse practitioner may treat a patient during a severe asthma attack, a primary care nurse practitioner would help this patient manage his or her condition on a daily basis). These overlaps between acute care and primary care nursing can help acute care nurse practitioners transition to primary care settings if they wish. AGACNPs in primary, long term, and palliative care environments can use their knowledge of critical and terminal illnesses to develop and implement a sound health care plan for their patients, and to understand and meet their needs. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Mary Thiel, MSN, ACNP-BC is an Adult Nurse Practitioner at Premier Health, where she provides primary health care services to patients ages 14 and older. Though she is board certified in adult acute care, she has worked in palliative care, long-term care, and primary care settings for over 10 years since receiving her nurse practitioner certification. In an interview with OnlineFNPPrograms.com, she explained the nature of her work as an Adult Nurse Practitioner for Premier Health Partners. “I function as a primary care provider [at Premier Health Partners],” she said, “The practice only does outpatient, and the physicians have long-term care (LTC) practices. I cover the LTC practice patients when the physicians are on vacation, but do not have any of my own. […] I see essentially anything that walks through the door, such as the usual hypertension, diabetes, heart failure, and arthritis. I also see hepatitis C, breast cancer, substance abuse, and skin diseases of every sort.” Ms. Thiel also noted how her current work in primary care is quite similar to her past work with patients in geriatric and long-term care settings when she worked as a Geriatric Nurse Practitioner for Geriatric Providers, Inc. and as a Nurse Practitioner for UnitedHealth Group, specifically in their EverCare and Optum programs. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

“The nearly 9 years that I worked for Geriatric Providers and Evercare/Optum were all spent in long-term care. […] In practice, the medicine is not different, other than sometimes in its application. Medicine in LTC is more nuanced. Does a 90 year old need to take a statin for hyperlipidemia? Does she need Aricept any longer? There was more risk/benefit analysis to what meds were prescribed, and which should be stopped. There was a lot of end of life planning, especially with Evercare/Optum,” she explained, “The medicine is the same between the settings. The circumstances are different, and the special situations are more variable in LTC. I still treat basic depression and anxiety in adult medicine, but refer out people who need more extensive help or those whom I feel would benefit from counseling.”

Adult-gerontology acute care nurse practitioners’ primary mission is to stabilize patients who are suffering from critical conditions, and to ensure they have the medical support to make as full a recovery as possible. Their core responsibilities can generally be divided into the following categories:

ORDER A PLAGIARISM-FREE PAPER HERE

  • Direct medical services, such as health assessments, treatments, and procedures to address patients’ critical conditions in collaboration with a larger medical staff of physicians, nurses, and medical assistants.
  • Care coordination services, which include organizing the services of other health care providers and medical departments to ensure patients receive appropriate care during their tenure in an intensive care setting. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper
  • Administrative leadership in the hospital setting, which entails working to improve systems of care through program development, trainings, and evaluation of workflows within their hospital.

Below is a more detailed description of the typical responsibilities that adult gerontology acute care nurse practitioners fulfill.

Direct Medical Care

Adult gerontology acute care nurse practitioners complete a wide range of advanced medical tasks, including conducting intake assessments, ordering labs and screenings, performing complex medical procedures, administering (and in certain states, prescribing) medications, and monitoring patients during their stay in the hospital. Their workday is typically quite varied and dynamic, as patients’ complex conditions and health needs often mean AGACNPs must constantly monitor and provide treatments as part of a multidisciplinary team.

In her interview with Online FNP Programs.com, Ms. Edwards described the myriad responsibilities she completes on a daily basis at the Palo Alto VA Hospital. “I manage the day to day needs of all of the patients, including daily progress notes. I perform a comprehensive H&P (medical history and physical assessment) on all new consults and/or admissions, develop differential diagnoses, order labs, diagnostics, therapy and imaging, and consult other services. I respond to codes and e-teams (rapid response teams, or RRTs), determine the diagnosis, and make decisions on the appropriate level of care after resuscitation,” she said.

Mr. Kenna described the importance of the initial and continual assessment of patients upon their admission into a critical care setting. “As a member of the neurosurgical team, we would be responsible for the initial evaluation of the patient’s primary neurologic problem and determine if they needed immediate neurosurgical intervention; if they did, we would provide that,” he said of his time working as an Acute Care Nurse Practitioner at Beth Israel Deaconess Medical Center Division of Neurosurgery. Thorough health assessments are important because they help to ensure that patients are efficiently directed to the care they need. “If [patients did not need immediate intervention], then we would determine the most appropriate setting for them depending on their needs, whether that would be the Intensive Care Unit (ICU), the Step Down Unit, general neurosurgical floor or even home based upon how closely they needed to be monitored,” Mr. Kenna added. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

AGACNPs also play an important role in the administration of intensive treatments and/or the completion of complex medical procedures, often in collaboration with a physician. “We would also assist in the Operating Room and follow-up with patients in clinic. For many of these patients, they require very close neurologic monitoring and that’s where the Neuro ICU team comes into play. This team is dedicated to the ICU and although very focused on the patient’s neurological needs they also take into account all other body systems (ie, respiratory, cardiac, GI, renal etc.),” Mr. Kenna said of his position at Beth Israel Deaconess. His present work as an Acute Care Nurse Practitioner in the Neurological Intensive Care Unit at Rhode Island Hospital is no less varied. “My [current] responsibilities involve rounding on the patients in the ICU and evaluating their condition in order to develop a plan of care for that day,” he said, “We order a variety of tests including blood tests, XRAYs, CT scans, and ultrasounds to name a few,” he said, “We also perform a number of procedures including endotracheal intubations, central line placement, chest tube placement, bedside ultrasound and lumbar punctures.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Dr. Tomaszewski also described in her interview the many procedures she completes, treatments she administers, and palliative care and support she provides patients in collaboration with her colleagues. “As a nurse practitioner on the critical care medicine service, I see critically ill patients in the intensive care unit with a variety of different medical conditions. All of these patients require detailed assessments, complex medical decision-making and life-saving procedures,” she said. “At times, these patients also require compassionate care at the end of life. Some of the conditions I treat include diabetes, respiratory failure, accelerated hypertension, stroke, cardiac arrest, and septic shock. […] Some of the procedures that I may do on a daily basis include endotracheal intubation, central venous catheter placement, arterial catheter placement, temporary hemodialysis access placement, and therapeutic bronchoscopy. I may also be assisting residents and students in learning these same procedures.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Care Coordination

While direct patient care is an integral part of the work that AGACNPs do, equally important is their role as a coordinator of patient care and a leader of staff. Care coordination in acute medicine is defined as the creation and ongoing management of an effective plan of care for patients, from their admission into the hospital to their discharge to outpatient care or their home. Care coordination involves conducting thorough health assessments, meeting with a larger medical team in order to discuss and develop a plan of care, and directing nursing staff, medical assistants, and residents in the completion of tasks around the hospital and the provision of care to patients. Care coordination also involves evaluating patients’ mental, emotional, social, familial, and financial situations and working to connect them with resources such as social services, health insurance, and hospital-based religious support as needed. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Ms. Zilske also described how her work involves balancing patient admissions and discharges with addressing patients’ health issues as they come up during her shifts at Memorial Hermann Hospital. “I am able to manage every patient from admission through discharge; however, since I work the majority of my shifts on nights, I usually initiate their plan of care and trouble shoot other patients’ issues overnight,” she said, “Other roles that I fill are the liaison between the nursing staff and the physicians, an educator, and a patient advocate.”

John Kenna, MSN, ACNP-BC also described his role as a co-coordinator of care as part of a larger team in the Neurological Intensive Care Unit at Rhode Island Hospital. “Members of the team typically include a Neurointensivist, Nurse Practitioner or Physician Assistant, Registered Nurse, Pharmacist, and Nutritionist. Other members may include a Neuro ICU Fellow, Neurology, Neurosurgical, Anesthesia Residents, Pharmacy Resident and students of all backgrounds,” he explained, “We develop a plan as a team of experts, to best meet the needs of our patients and provide them with the best chance to recover from neurologic injury.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Administrative Leadership, Education, and Program Development

In addition to their responsibilities as coordinators and direct deliverers of care, adult gerontology nurse practitioners can also improve the delivery of advanced practice nursing care through updating or streamlining hospital systems of care, developing programs serving both patients and staff, and educating nursing students, medical students, and residents in clinical and academic settings.

Administrative leadership in the hospital setting can be thought of as a more macro-level version of care coordination, in that its primary goal is to ensure that patients receive effective care when they need it. However, while care coordination is still very much close to the patient in that it involves creating individualized care plans, administrative leadership roles that nurse practitioners can take on in the hospital setting seek to make direct medical services and care coordination services easier and more effective on a larger scale, and over the long-term. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Projects and tasks that fall under the term administrative leadership include conducting surveys and other data collection methods in order to determine how well the hospital is serving its patients, making data-informed decisions about the restructuring of certain departments or teams, the purchasing of updated equipment, and the hiring of additional staff; and creating outreach or training programs that meet the needs of patients and staff, respectively. AGACNPs who are interested in administrative leadership can ask their supervisor for opportunities within their work setting. Designated roles in administrative leadership for nurse practitioners can take many forms; examples include Clinical Practice Manager and Education Outreach roles, which some NPs take on to supplement their clinical responsibilities. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

In addition to educating staff and facilitating the improvement of systems of care within their clinical work setting, AGACNPs can also improve the quality of future nursing care by educating nursing students as faculty members of nursing school programs. Mr. Kenna worked as an Assistant Clinical Professor for the University of Rhode Island’s College of Nursing, where he also helped to develop the Acute Care Nurse Practitioner Track in September of 2010 and continues to work closely with the school on the content for their ACNP track. Prior to this role, he worked as the Acute Care Nurse Practitioner Program Coordinator for the Northeastern University Bouvé College of Health Sciences for almost three years.

In his interview with OnlineFNPPrograms.com, he explained how he views part-time faculty instruction of future ACNPs as a way to give back to the nursing community and to help train effective health care providers for the next generation. “I have always enjoyed teaching,” he said, “As nurses we are very trusted and I think still one of the most trusted professions in the US, if not the world. In order to be trusted, you have to know what you’re talking about. I always had fantastic professors and mentors and wanted to share what I learned with others. When offered the opportunity to coordinate the Northeastern ACNP program after graduation I thought it was a chance to do that.”

ORDER A PLAGIARISM-FREE PAPER HERE

Advanced adult-gerontology acute care nursing can be a very rewarding field of work for individuals who enjoy challenging, fast-paced medical environments and forming strong relationships with patients and family members in great need of medical care and support. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

“I think the most rewarding part of working as an ACNP in neurocritical care is the relationships with patients and their families,” Mr. Kenna told OnlineFNPPrograms.com, “Often times neurologic injury is abrupt and sudden and life altering for the patient and their families. We spend a lot of time meeting with patients and families communicating and explaining their diagnosis, plan of care and prognosis. Recovery from neurologic injury is often a very long road and presents a major challenge for patients and families. As providers in the ICU we are a pivotal, but also a very small part of patients’ long road, which may include weeks to months in the ICU or in the hospital and then weeks to months in rehabilitation.” Ms. Thiel similarly cited the bonds she makes with patients and their families, and her ability to guide them through the process of making important medical decisions, to be the most rewarding aspect of her work. “ I think my most rewarding work has been with the families of the terminally ill. Talking with them, listening to them, helping them make the difficult decisions is so powerful,” she said.

The role that AGACNPs play in connecting, supervising, and collaborating with the different groups that comprise a care team–including physicians, registered nurses, and medical assistants–can also be a challenging and rewarding part of the job. “I feel that the most rewarding aspect of working as a nurse practitioner is making a seamless union between nursing and medicine,” Dr. Tomaszewski said in her interview with OnlineFNPPrograms.com, “Nurses can bring different perspectives to medicine, and vice versa. I have learned a lot from my physicians, and hope that they have also learned from me.” As coordinators of care and oftentimes the liaison between physicians and nurses, nurse practitioners often must combine their medical knowledge and clinical skills with emotional intelligence and a sound knowledge of how the different departments and teams within a medical setting work together to optimize patient outcomes; such complex and multidisciplinary responsibilities can offer an intellectual challenge that some people may find engaging and gratifying. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Passing on their knowledge to other medical staff can also be a rewarding aspect of nurse practitioners’ role as an educator and leader in the medical environment. “Another [reward of my job] is teaching someone a topic and seeing the lightbulb go on; and to that fact, having the time to actually teach! As an RN, you do not have time to sit and teach your patients as much as you want to. But as an NP, you have more time to go over conditions, medications, and questions with nurses, patients, students, etc.,” Ms. Zilske said in her interview.

Seeing their patients make concrete improvements in their health through the efforts of a committed care team is also a reward that AGACNPs enjoy on a daily basis. Kimberly Zilske, MSN, ACNP-BC told OnlineFNPPrograms.com, “One of the most rewarding aspects of being an Acute Care Nurse Practitioner is seeing your plan of care work to improve the patient’s condition.” Mr. Kenna also noted that helping patients heal from life-threatening conditions is incredibly gratifying, and has sustained him throughout his years as an acute care nurse practitioner. “[One] of the most rewarding parts of the job is seeing a patient who had a small chance of a meaningful recovery come back and visit the staff. It reinforces that although we see a lot of devastating injuries in a very mentally and emotionally challenging work environment, that there is hope and we need to do our best to provide the best care possible to give them the best chance to recover,” he said. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

With the rewards of the profession also come challenges in the form of emotional pain when a patient does not recover as hoped, feelings of overwork or burnout, and the challenges around making the transition from following orders to creating them in a fast-paced and high-acuity environment. “Albeit years ago, I think that one of the biggest challenges I faced was the transition between nurse and nurse practitioner,” Dr. Tomaszewski said to OnlineFNPPrograms.com, “One goes from being the expert nurse and the resource on the unit, to the sudden realization that you are responsible for medical decisions that could alter someone’s life. As nurses we carry out orders, but as nurse practitioners we are creating the plan of care. I think that many students underestimate the impact that this transition makes.”

With the additional responsibility of being a provider who creates plans of care and gives orders rather than follows them comes additional stress when a patient does not recover or experiences a worsening of his or her condition. “Most patients’ lengths of stay vary in the ICU. Depending on their diagnosis, they may stay anywhere from two to five days. There are others, however, who are very sick that we have had for weeks on end. Working twelve hour shifts, thirteen shifts a month with a patient that has been with us for 4-6 weeks, allows one to get attached at times, which can be difficult, especially when the patient takes a turn for the worse,” Ms. Zilske told OnlineFNPPrograms.com. NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper

Mr. Kenna described the unpredictable nature of acute nursing care, and how the lack of certainty can pose stressors to patients, families, and medical personnel alike. “Some patients are able to make remarkable recoveries and others are not. Prognosticating who will do well and who will not is very challenging and something we are not very good at as a whole in Neurocritical Care,” he noted. Mr. Kenna advised that AGACNPs manage this stress by staying attuned to the needs, desires, and concerns of patients and their families, and to maintain a degree of separation between work and their personal life. “My recommendation for preparing and managing [this challenge] is to always listen, never be too sure of what the future holds and take care of yourself,” he said, “Always listen to your patients and their families. Never be over confident and sure of the outcome, patients will amaze you all the time. Take care of yourself, your family and live life, because you never know what may happen.” NURS 6560 - Advanced Practice Care of Adults in Acute Care Settings II Essay Paper