161: IMPLEMENTATION OF A SURGICAL CRITICAL CARE NURSE PRACTITIONER SERVICE.

Abstract

Ensuring nurse practitioner staffing is sufficient to meet patient care needs is an on-going difficulty in large intensive care units with high patient turnover rates. With the added pressures of improved patient flow, it is imperative that staff workflows are not hindered by a lack of coverage. Given an increase in the capacity of our Surgical Intensive Care Unit (SICU) along with increased duty hour restrictions for house staff, we elected to add an Acute Care Nurse Practitioner (ACNP) component to our physician coverage model.

This project sought to assess staff perceptions of workflow and available staffing on a 25-bed SICU in an urban, academic medical center prior to the addition of the ACNP component in order to create the best model.Prior perception was that the busiest time on the unit was during the evening hours. As a surgical ICU, most post-operative patients are received on the unit in the late afternoon/early evening.

An anonymous, voluntary, online survey was opened to staff (66 nurses, 26 physicians). The survey focused on staff perceptions about unit needs, adequacy of current resident coverage on each shift, and perceptions regarding patient care improvements with the addition of an ACNP.

Respondents included 43 nurses (65%) and 14 physicians (54%). The majority of respondents (58%) indicated 3-11p was the busiest time on the unit. Some respondents (14%) reported 11a-3p was busiest. Nearly 35% believed the current staffing to be inadequate to meet needs during busy times and 82.5% believed the addition of the ACNP would help “address issues as they come up”. A majority (59%) reported the addition of an ACNP 11a-11p would improve shift to shift communication. This finding is particularly important given 42% of respondents believed shift to shift communication was “less than adequate”.

Unit administration concluded the addition of an 11a-11p ACNP would improve patient care and multidisciplinary, shift to shift communication during the busiest time on the unit.