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  • Vanderbuilt Starts Acute Care Nurse Practitioner Intensivist Fellowship



    Vanderbilt University Medical Center has developed a pilot Acute Care Nurse Practitioner (ACNP) Intensivist Fellowship program run jointly by Vanderbilt University School of Nursing and the Department of Anesthesiology-Division of Critical Care Medicine.


    “Much like physicians prepare for their subspecialty with a fellowship, the new ACNP fellowship provides an opportunity for master’s-prepared nurses to further refine skills and knowledge in experiential learning environments,” said Josh Squiers, MSN, ACNP-BC, who co-directs the fellowship with Nathan Ashby, M.D., assistant professor of Anesthesiology.


    Specifically, the program combines an Intensive Care Unit-focused fellowship with VUSN’s Doctor of Nursing Practice (DNP) program, resulting in an advanced critical care curriculum at the doctoral level.


    “Our DNP program is about preparing practice scholars as leaders in bringing evidence-based knowledge into practice,” said Donna McArthur, Ph.D., director of the DNP program.


    “The intensivist fellows practice on multidisciplinary teams, develop competencies in performing advanced procedures and skills, participate in research initiatives within the intensive care units … and when they have successfully completed the program, they are clinical scholars who will have a profound impact on patient outcomes.”


    “My role is to try and provide participants with very concentrated, face-to-face learning. The student looks at the patient from different angles and forms a plan working with multiple disciplines,” said Ashby, ACNP Fellowship co-director.


    “It’s about making connections to see how this pathology affects patients in multiple different ways, from several different angles.”


    Both Squiers and Ashby believe the culture at VUMC, one of the largest employers of nurse practitioners in the country, makes this pilot possible.


    “The patient demand in Intensive Care Units is more than what any one group can fill. Nurse practitioners are one component of how you fill that need. If you are going to put them in that position, you need to give them the best training possible,” Ashby said.


    There are several practice models for nurse practitioners in the ICUs throughout the Medical Center.


    Some integrate nurse practitioners and residents, some are non-teaching services that handle less critically ill patients and others are the team like in the Cardiac Surgery ICU.


    The pilot program plans to enroll up to four more students in August 2012.
    Comments 16 Comments
    1. lvl1micuRN's Avatar
      lvl1micuRN -
      And what kind of jobs are these DNP's going to be fulfilling once out of school?
      In the MICU at my primary training site, the charge nurse/daytime manager is an ACNP that functions as an RN with managerial duties, he doesn't order labs, tests, or manage fluids/meds for the patients.
      I couldn't imagine going to train to be a provider and go back to the function of a staff RN or a manager.
    1. stanman1968's Avatar
      stanman1968 -
      yes and the wise folk at SDN are PISS"ED.
    1. FST6's Avatar
      FST6 -
      Why? I'm sure these ACNP intensivists will be regulated by MDs. I doubt their role will be much more independent than a PA.
    1. MmacFN's Avatar
      MmacFN -
      A tun of places are feeling the crunch with resident hours being restricted and expected to be more so in the future so they wont have the cheap labor. The answer is ICU NPs.



      Quote Originally Posted by lvl1micuRN View Post
      And what kind of jobs are these DNP's going to be fulfilling once out of school?
      In the MICU at my primary training site, the charge nurse/daytime manager is an ACNP that functions as an RN with managerial duties, he doesn't order labs, tests, or manage fluids/meds for the patients.
      I couldn't imagine going to train to be a provider and go back to the function of a staff RN or a manager.
    1. MmacFN's Avatar
      MmacFN -
      They sure are.

      I love how they are now saying people should hire PAs as opposed to NPs. It is clear they know nothing about PA education which is 100% OTJ. They wont come with ANY ICU understanding or background but the few weeks they might (or may not) spend there in clinical.

      The former ICU RN plus NP plus 1 year fellowship in CCM is obviously more suited for the job but they cant see past the ego.

      Quote Originally Posted by stanman1968 View Post
      yes and the wise folk at SDN are PISS"ED.
    1. MmacFN's Avatar
      MmacFN -
      Yes, for now. Then when it has been proven these ACNPs do as good a job in the ICU you will see it proliferate to rural ICUs as autonomous providers and eventually more autonomy will follow in community facilities.

      Quote Originally Posted by FST6 View Post
      Why? I'm sure these ACNP intensivists will be regulated by MDs. I doubt their role will be much more independent than a PA.
    1. beard's Avatar
      beard -
      Quote Originally Posted by ADMIN View Post
      Was just accepted to this program, from talking to the nurses going through it, it's super cool. Also, the way Vanderbilt utilizes NP's is amazing. I hope that the team approach with the NP being the main liaison becomes more prominent as time goes on...

      Decisions, decisions...
    1. unconscious's Avatar
      unconscious -
      Interesting that on avg., PAs are getting about 4K more per year salary than NPs.

      The problem here is that if NPs displace MDAs out of the critical care/intensivist venue they'll just want to come back to the OR...I actually think critical care/intensivist iOS a good role for MDAs...

      Jay
    1. pilot424's Avatar
      pilot424 -
      Vanderbilt.
    1. Esper's Avatar
      Esper -
      Quote Originally Posted by MmacFN View Post
      They sure are.

      I love how they are now saying people should hire PAs as opposed to NPs. It is clear they know nothing about PA education which is 100% OTJ. They wont come with ANY ICU understanding or background but the few weeks they might (or may not) spend there in clinical.

      The former ICU RN plus NP plus 1 year fellowship in CCM is obviously more suited for the job but they cant see past the ego.
      False. Not only do many (dare I say most) PA programs require experience, but vanderbilt in particular is a "go from nothing to NP in two years" school. Very bad choice of school if you want to play that card. Only 3 semesters and no nursing experience and you too can be an NP. Had three of them working on my unit. Rough start but they do fine now.

      I'm not saying ALL PAs have great experience, but my future class is about 25% former medics and navy corpsman. Not to mention the amount of nurses (probably not many), EMT-p (many), and RTs (lots).

      PAs have dozens of CCM residencies (optional for now). NPs have 2-3 including a shared one with PAs. Now PAs have a qualifying exam (optional unless a residency or job requires it) to demonstrate minimum knowledge in a specialty.

      Before you start talking about being an assistant, a name change BACK to the original name of Physician Associate is coming in the next five years.

      Let's not pretend one is better than the other because of politics. Both have their flaws in different ways. The only one that has the right prereqs and amount of training to both be a full service provider from day one and be cost effective is CRNA. You should go over to clinician one forum where PAs and NPs get along just dandy and work together to better both professions.
    1. Esper's Avatar
      Esper -
      My other post seemed to not get posted. oh well.

      Short version:

      Vanderbilt has a two year nothing to NP program and a 3 semester RN with no experience necessary to NP. Don't play the "all nurses have experience" card.

      PAs have dozens of residencies in CCM. Go to appap.org to see just the ones that have been certified.

      Lots of PAs have experience. My future class is 25% medics and navy corpsman. That is just one profession, plenty other from RN, EMT and RT. Then there is myself. Obviously and outlier but does exist.

      Before you talk about being an assistant, that name will be changed back to the original Physician Associate in 5 years. After that I suspect people will start arguing for collaborative practice agreements. Won't happen in all states, but as I've come to find out in some states the medical board and PA board are separate.

      Lastly, let not pretend a PA or NP is better than one another. Both have their flaws and only CRNAs can say they have the prereqs and right amount of training to be a full service provider and be cost effective.

      You should go to clinician one forum and see how they get along just dandy and work to better each other. No prePA or preNP allowed so little bickering goes on.
    1. Esper's Avatar
      Esper -
      PAs make more on average because they are in more specialties, especially CT surgery, which pays better.

      Vanderbilt is a bad school to mention in the same breadth has NPs having experience. They have a two year "go from nothing to NP" and a 3 semester RN with no experience to NP. We had three of them on our unit. So it is very common.

      On PA experience, they have dozens of CCM residencies and you can see them at appap.org. Many of these programs are guaranteed to provide you with the skills to practice in a solo setting with only electronic communication back up. Secondly, most programs require at least some experience, if not a lot of experience like MEDEX in Washington that requires 4000 hours. Go to the physicianassistantforum.com and here the people whine about not being able to get in because they have no experience but great grades. My future class is 25% medics and navy corpsman, not including the number of RNs, RTs, and EMTs. I'll admit I think 20% of the class has no experience, or at least not significant experience.

      Before you talk about being an assistant, that name will be changed in the next 5 years back to the original name, Physician Associate. I also hear rumblings of people wanting collaborative practice agreements, which I imagine will come first in states where the PA board and MD board are separate (which is way more than I imagined).

      Lastly, let's not pretend that NP or PA is better. Both have their flaws. Only CRNA can claim to be a full service provider on graduation day and more cost effective compared with MDs. You should go to clinician one forum and see all the NPs and that get along just dandy and work to better each other through collaboration.
    1. Esper's Avatar
      Esper -
      Tried to post three times. Let's try one more.

      It is not wise to mention the OTJ of PAs and the experience of NPs when also speaking of Vanderbilt. They have a 2 year "Nothing to NP" and a 3 semester "RN who just graduated with no experience to NP" program. I know it is pretty common as well since 3 of them with no prior experience worked on my unit. Vanderbilt is not the only program like this, it's not even uncommon.

      PA education is not 100% OTJ and it is laughable you would suggest that. There are a dozen CCM residencies for PAs. You can look at them at appap.org, many of which guarantee being able to function in a solo environment after graduation. Also, many (if not most) PA programs require at least some experience. Some are even designed for second career healthcare professionals, such as MEDEX in washington that requires 4000 hours of documented experience. My own program has 25% of the class made up of medics and corpsman. At least 40% are RNs, RTs, and EMT-Ps. ~20-25% are people with insignificant (in either scale or role) experience. Go to physicianassistantforum.com and see the number of people whining because they can't get in without experience, then see how those without RN, RT, or EMT are belittled.

      Before you talk about being an assistant, that name will be changed in the next 5 years back to the original name, Physician Associate. I also hear some rumbling about getting collaborative practice agreements instead of this "supervision" agreements. This has already happened in Washington where they have "Sponsoring" physicians instead of "supervising". Now you might say "well you are under the medical board so you can't have that..." I recently found out that MANY states have separate boards for PAs and MD/DO. "But NP's can own their own practice." I also study the statistics of this and just as many NPs and PAs own their own business. I know of 3 personally that own a FM clinic, a pain management clinic, and a headache specialist clinic. No physician around, ever.

      Lastly, let's not pretend that NP or PA is better. They both have their flaws in different ways. The only one that can say they have the prereqs and education to be a full service provider on day one of graduation and still be economically viable is CRNA, not including the mills of course. It's not like AAs and CRNAs, where the former was created in direct opposition. Also, PAs function nothing like AAs. Physicians don't have to be in the same country, much less the same building, for a PA to practice. Chart review isn't done until way after the fact. That's if it's even required, which it isn't in numerous states. All that may be required is a meeting every so often (30 mins per 6months in NC).

      You should go over to clinician one forum and see the NPs and PAs getting along just dandy and are collaborating for the betterment of each other. People who have gotten over the political/turf war/competition, and actually do what's best for patients.






      Jay,
      PAs make more on average because they are in more specialties, especially surgery, which pays more. You'll find the pay is pretty much the same when breaking down area and specialty.
    1. Esper's Avatar
      Esper -
      I have tried numerous times to post, but it keeps deleting it.

      Short version:
      It is laughable that PA training is 100% OTJ. They have dozens of residencies and the majority of my class has HCE, despite no requirement. Most schools require at least some.

      Vanderbilt is no better with it 2 year "nothing to NP" and 3 semester "RN with no experience to NP." It is very common, I had three on my unit.

      NP and PA are not better than one another, both have flaws. Only a CRNA has the training/experience to be an independent provider from day one, as of now.

      Don't bash PA. They aren't trying to limit the practice of another and they weren't created as tool to be used in direct opposition like AAs.

      They are changing the name to Physician Associate so they will no longer be an "assistant." Many are starting to talk about collaborative practice agreements.

      Go to clinician one forum to see NP and PAs get along dandy and collaborate for the betterment of each other and the patient. Few there are worried over turf and politics. There are plenty of jobs and specialties to go around.
    1. Esper's Avatar
      Esper -
      Quote Originally Posted by unconscious View Post
      Interesting that on avg., PAs are getting about 4K more per year salary than NPs.

      The problem here is that if NPs displace MDAs out of the critical care/intensivist venue they'll just want to come back to the OR...I actually think critical care/intensivist iOS a good role for MDAs...

      Jay
      Jay, there are more PAs in specialties, especially surgery, which accounts for the difference. In the same specialty, they are very much the same.

      I have tried numerous times to post, but it keeps deleting it.

      Short version:
      It is laughable that PA training is 100% OTJ. They have dozens of residencies and the majority of my class has HCE, despite no requirement. Most schools require at least some.

      Vanderbilt is no better with it 2 year "nothing to NP" and 3 semester "RN with no experience to NP." It is very common, I had three on my unit.

      NP and PA are not better than one another, both have flaws. Only a CRNA has the training/experience to be an independent provider from day one, as of now.

      Don't bash PA. They aren't trying to limit the practice of another and they weren't created as tool to be used in direct opposition like AAs.

      They are changing the name to Physician Associate so they will no longer be an "assistant." Many are starting to talk about collaborative practice agreements.

      Go to clinician one forum to see NP and PAs get along dandy and collaborate for the betterment of each other and the patient. Few there are worried over turf and politics. There are plenty of jobs and specialties to go around.
    1. beard's Avatar
      beard -
      Interesting enough I just got accepted to this program. It is one of the only ACNP programs I've seriously considered going through.
      From talking to current students, and working with some of the graduates, I can say that Vandy utilizes NPs in a way that I had not seen up until working there. They are my contact for orders, voicing concerns, overall management. I can only hope that this becomes the status quo at more facilities/schools. As is it working amazingly at Vandy...
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