[Nurse practitioners in acute care settings in the United States]

Japan is currently at a historic moment to recognize the significance of the team approach in medicine. There is a mismatch between the supply of physicians and demand for expert care that our patients expect and deserve. The acute care setting including surgery is considering adopting non-physician professionals such as nurse practitioners (NPs) in order to deliver a high quality of care. The NPs in acute care setting have evolved in the United States to meet the medical needs of the society over the last four decades. With the increased complexity of the needs of the patients in Japan, a creative innovation in the care delivery system is required. The use of the NPs in the acute care began in the neonatal intensive care unit in the early 70's as described in the author's previous article. The adult critical care realm embraced the collaborative model starting in the 90's and opened its doors widely as resident duty hours were reduced for the patient safety concerns. This article describes the wide variety of settings in which acute care NPs are found in the US today. The current model of collaborative practice owes its development and success to the committed physicians and nurses who crossed each other's boundaries for the sake of the patients decades ago.