Acute Care Nurse Practitioner

An 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. 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 interprofessional team. An 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. 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 interprofessional team. The scope of practice for a nurse practitioner includes the range of skills, procedures, and processes for which the individual has been educated, trained, and credentialed to perform. Scope of practice for nurse practitioners is defined at four levels: 1) professional, 2) state, 3) institutional, and 4) self-determined. At the professional level, nursing organizations such as the AACN and the ANCC regulate nursing certification and publish guidelines for the scope and standards of practice for ACNP’s. At the state level, nurse practice acts and administrative rules and regulations define requirements for licensure. Because of rapid changes in health care technologies, state nurse practice acts rarely define specific tasks that a nurse practitioner may conduct. Many state nurse practice acts still do not define scope of practice based on board certification or educational preparation. In states that require collaborative practice agreements, these documents frame the scope of practice for entry-level ACNP’s. Collaborative practice agreements may also include language about future expansion of scope of practice based on continuing education and field experience. ACNP’s with collaborative practice agreements review them often to ensure that they confer the authority to practice at the full extent of education and training. At the institutional level, ACNP scope of practice is outlined in a nurse practitioner privilege form. This document lists core privileges that apply to all nurse practitioners in a facility as well as special privileges that represent the individual ACNP’s education and training. The privilege form specifies which practices can be performed autonomously and which practices require physician supervision. For certain practices (e.g. intubation, chest tube insertion) the privilege form may also specify how many supervised procedures must be performed before the ACNP may practice autonomously. The specific privileges granted to an ACNP vary by practice setting and the practice specialties of collaborating physicians. Finally, ACNP’s utilize self-determination when determining whether a given task is within a scope of practice. Self-determination requires not only an evaluation of personal competencies, but also an awareness of the capacities of other members of the healthcare team. The education to become an ACNP involves several steps. First, one must hold current licensure as a Registered Nurse (RN) and meet the application criteria for an accredited master's, post-graduate or doctoral acute care nurse practitioner program. This program will prepare the Registered Nurse as an advanced practitioner. The National Organization of Nurse Practitioner Faculties list 9 core competencies that are gained from graduate education. These competencies include areas of: Within these competencies, graduate level courses in pathophysiology, pharmacology and physical assessment are completed. Clinical experience is then gained. A minimum of 500 faculty-supervised clinical hours in the role of acute care nurse practitioner is gained. Once graduated from the program, Advanced Practice Registered Nurses may apply for Board Certification (BC) as an ACNP. ACNP's have several options to become nationally board certified. The American Association of Critical-Care Nurses (AACN) offers the Acute Care Nurse Practitioner-Adult/Gero (ACNPC-AG) certification. Eligible candidates must pass an exam, possess a valid RN license and have a graduate-level nursing degree from an accredited acute care advanced practice nursing program. The American Nurses Credentialing Center offers the Adult-Gerentology Acute Care Nurse Practitioner - Board Certified (AGACNP-BC) credential. This credentialing exam replaces the ACNP-BC exam, in order to better align with the APRN Consensus Model, which promotes a more uniform model of nurse practitioner licensing, accreditation, certification, and education. Both credentials will continue to be used, but candidates who apply after 2015 will sit for the AGACNP-BC exam only. Candidates must possess a valid RN license and have a graduate level nursing degree from an accredited program which includes at least 500 clinical hours and specific content in pathophysiology, pharmacology, health assessment, health promotion and maintenance, and diagnosis and disease management. Many state boards of nursing require that nurse practitioners are certified by a national certifying body. In multiple studies, care provided in the critical care setting by Nurse Practitioners and Physician Assistants has been equal to or superior to that provided by resident physicians and fellows. Patients cared for by acute care nurse practitioners in a neurosurgical setting during a period of six months were found to have shorter ICU lengths of stay, lower rates of urinary tract infections and less skin breakdown when compared to routine medical management In addition, a systematic review found that patients managed by the acute care nurse practitioners were hospitalized 2,306 fewer days than the baseline population cared for by fellows, resulting in $2,467,328 in cost savings. The core competencies and knowledge base for the pediatric or adult-gerontology acute ACNP originate from the full spectrum of needs of high-acuity patients along the wellness-to-illness continuum. The ACNP provides individualized patient care based on the patient's age, gender, mental status, race, culture, individuality, ethnicity, spiritual beliefs, lifestyle, sexual orientation, socioeconomic status, disability, and family configuration. The type of care provided by the ACNP is determined by the needs of the patient and may include restorative, curative, rehabilitative, palliative, or supportive end-of-life care. The profile of an ACNP may include episodic management of a patient in a clinical speciality unit, following a caseload of patients during a hospitalization, or caring for patients across the acute care spectrum (hospitalization to home). ACNP short-term patient care goals include stabilization of acute or life-threatening conditions, minimizing or preventing complications, and promoting physical and mental well-being. Long-term goals consist of restoring maximum health potential, evaluating risk factors, and managing co-morbid conditions. In order to achieve these goals of patient care, the ACNP utilizes the following key components: