New Roles for Nurse Practitioners Bring Opportunities and Challenges
Kerry Decker, MSN, RN, NP, co-Director of the UCSF Surgical and Critical Care Nurse Practitioner Fellowship, recently discussed the challenges NPs face in assimilating into high-acuity environments such as neurosurgery, intensive care units (ICUs) and transplant service in "Science of Caring", a UCSF School of Nursing's publication. Also interviewed for the article was Sheila Antrum, RN, BSN, MHSA, President UCSF Medical Center, Senior Vice President, Adult Services UCSF Health, and Chief Nursing Officer, UCSF Medical Center.
Decker underscored the importance of programs like the Surgical and Critical Care Nurse Practitioner Fellowship in providing the mentorship and clinical experience needed for NPs to truly "hit the ground running" as they enter these rarefied environments.
One of the challenges in filling these vacancies, however, is the need to find NPs with the practical skills and experience to manage complex patients with special needs on units like neurosurgery, the intensive care units (ICUs) and transplant services. While NPs get a minimum of 500 clinical hours during training, these hours are spread across a variety of areas, which may not adequately prepare them to work in highly specialized and complicated services when they are just out of training. “Six or seven years ago, when the acuity wasn’t as high, it worked,” says Antrum. “But it won’t work in today’s world. You’re going to burn people out.”
The transplant service is an example, says Decker. Physicians were eager to hire NPs, but they felt NPs coming out of school didn’t have the specialized knowledge and skills they needed, and it took too long to get them up to speed in the fast-paced, high-acuity environment. “There was high turnover,” Decker says. “NPs would get discouraged entering these roles with an enormous learning curve, and other providers would be frustrated with the time it took for them to get up to speed. You have to be given the support to acquire the knowledge to take care of these critically ill patients.”
These challenges led to UCSF Medical Center and UCSF School of Nursing to collaborate on developing innovative solutions.
Six years ago, Antrum and a group of 15 advanced health practitioners formed a board that, among other activities, developed a process to help identify and promote NPs with demonstrated clinical expertise and the skills to thrive in an academic environment. Candidates are assessed according to rigorous criteria and interviews. Those selected, designated nurse practitioner 3 (NP 3), are considered capable of managing a higher level of clinical, research and teaching responsibility.
Decker, who was among the first cohort of NP-3 designees, has become a champion for increasing clinical training opportunities for recent NP graduates. In 2014, with Thomas Farley, an NP in the UCSF Medical Center ICU and a clinical instructor in the School’s Adult-Gerontology Acute Care Nurse Practitioner Program, she co-created the UCSF Surgical and Critical Care Nurse Practitioner Fellowship. The fellowship allows a graduate of an accredited acute care geriatric NP program to rotate through surgery and critical care services, providing direct patient care while receiving additional didactics in each area. It also provides opportunities to take extra courses, such as an ultrasound workshop, to help them build skills specific to acute and critical care work.
Over the fellowship year, says Decker, fellows receive about 2,000 additional training hours beyond what they received in school. While that’s incredibly valuable, perhaps the key piece of the fellowship, she adds, is the close mentorship fellows get with an NP on each service rotation. “The idea is that you aren’t thrown in where you don’t have support. You gradually increase your knowledge and patient load, and sample different services to see what patient population you might enjoy working with long-term,” she says.
About the UCSF Surgical and Critical Care Nurse Practitioner Fellowship
The UCSF Surgical and Critical Care Nurse Practitioner Fellowship is a joint non-accredited program of the Departments of Surgery and Anesthesia, and UCSF Medical Center. The fellowship co-Directors are Kerry Decker, MSN, RN, NP and Thomas Farley, RN, NP, ACNP-BC. The fellowship program is designed to expand upon the knowledge and skills acquired during graduate nursing training. It prepares licensed and certified AG-ACNPs to provide care for adults in critical care and surgery settings through focused clinical rotations, and emphasizes advanced assessment, planning, negotiation and collaboration skills. The fellowship program leverages the resources within the UCSF system to prepare novice AG-ACNPs to excel in a tertiary medical center.
Kathleen Balizan, ACNP, upon graduation in 2015 as the first alumni of the program, has joined the kidney transplant service at UCSF. Archie Garino, the current SCCNP fellow, appears alongside Decker on the floor of the liver transplant service in the linked article.