Jefferson celebrates the one year anniversary for a novel, nurse practitioner-run MICU
Recognizing the shortage of intensivists and duty hour constraints on traditional housestaff, the division of pulmonary & critical care at TJU/H implemented a highly novel staffing model for critical care. A geographically designated 8 bed intensive care unit was created to be fully staffed by mid-level providers for 24/7 coverage, with supervision by a fellow and an attending. There is no involvement by house staff in this model. The model includes daily multi-disciplinary bedside rounding, all orders and progress notes being written by the NPs, some/many of the procedures being performed by the NPs. This was a new endeavor at TJUH and required recruitment of 6.5 cFTEs (all graduate trained NPs all of them critical care nurses). These were “newly minted” NPs so the program was initiated in a progressive manner initially, with admissions restricted to daytime hours and as transfers from a parent traditional MICU after initial stabilization. Over time, direct admissions of patients from the ED, floor, and outside hospitals occurred, during day initially and 24/7 subsequently. The acuity of patients increased from inception, after one year paralleling that of the parent house staff-run MICU. The design and implementation of this unit was to be a critical care unit, and not a step-down unit.
An informal evaluation suggests this model is highly successful, with widespread acceptance form families, other nursing staff, referring physicians, hospital administration, and intensivist attendings. The NPs are engaged in family meetings, quality assurance activities, and data collection for quality improvement. Several are engaged as faculty at the nursing school. It is important to note that autonomy and career satisfaction amongst critical care nurses is an important goal for this program, as well as delivering the highest quality critical care.