Implementation of an interprofessional staffing model: Utilizing nurse practitioners and the eICU

There is a growing demand for intensive care unit (ICU) providers at the time of physician shortages, increased provider burnout, and attrition. Evidence supports safe utilization of nurse practitioners (NPs) and physician assistants (PAs) in the ICU.

An ICU team using intensivists (medical doctors) and doctors of osteopathic medicine, NPs, and PAs experiencing staffing challenges because of staff shortages and increased clinical responsibilities.

An evidence-based pre-post quality improvement project.

Utilization of NPs and PAs overnight instead of intensivists in a community medical/surgical ICU with electronic ICU support. Primary measures were mortality, procedural complications, central line-associated bloodstream infection, and catheter-associated urinary tract infections preimplementation and postimplementation. Secondary measure was qualitative data on facilitators and barriers to implementation.

Catheter-associated urinary tract infection rates preimplementation and postimplementation were zero. Central line-associated bloodstream infection rates decreased from one pre to zero post. Procedural complication rate decreased by 0.4% ( p = .687). The survey had an 80% response rate, with >90% answering that implementation positively affected quality and communication. Communication, collaboration, focus on quality care, and increased accessibility were identified as facilitators. Role understanding, acceptance, and communication with other services were identified as barriers.

A collaborative model of care using NPs and PAs overnight in a community ICU is a feasible, safe, and effective staffing solution. The hybrid model provided additional support for NPs, PAs, and nursing staff, which helped with transition and overall satisfaction. Further research on NP and PA implementation in a hybrid model is needed on a national, multisite scale.