Mapping the advanced practice nursing in emergency and intensive care units: A scoping review

Advanced Practice Nurses (APNs), including Nurse Practitioners and Clinical Nurse Specialists, contribute significantly to quality, efficiency, and leadership in emergency departments (EDs) and intensive care units (ICUs). However, role variability, inconsistent regulation, and limited post-pandemic evidence remain challenges.

To synthesize recent global evidence on APN roles, competencies, outcomes, and implementation challenges in EDs and ICUs, and identify strategies for effective integration.

A scoping review, following Arksey and O'Malley's framework and PRISMA-ScR guidelines, searched six databases. Eligible sources focused on APNs in EDs or ICUs. Two reviewers independently screened, extracted, and synthesized data descriptively and thematically.

Twenty-five studies were included, showing APNs' main competences as advanced clinical reasoning, procedural skills, leadership, and evidence-based practice. Challenges involved role ambiguity, regulatory gaps, and limited autonomy. Post-COVID-19 developments expanded APN responsibilities but exposed workforce and educational gaps. Solutions proposed included standardized competencies, policy reform, postgraduate education, and interprofessional collaboration.

APNs enhance outcomes and efficiency in EDs and ICUs, but variability in role definitions limits impact. The current body of evidence surrounding APN practice in ICUs and EDs is primarily based on studies with low levels of evidence. Future implementation should be accompanied by rigorous evaluations to generate robust statistical evidence that supports the transferability of APN-led models.