December 9, 2010

Advanced practice nurses helping to fill critical new role

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Leah Disque, M.S.N., R.N., and Andrew Smith, M.D., confer in the Pediatric Cardiac Intensive Care Unit. (photo by Susan Urmy)

Advanced practice nurses helping to fill critical new role

Leah Disque, M.S.N., R.N., worked as a registered nurse on the Pediatric Critical Care Unit (PCCU) of the Monroe Carell Jr. Children's Hospital at Vanderbilt for six years before going back to school for her master's degree.

Today she is back, caring for critically ill cardiac patients in a new role — one traditionally filled by pediatric residents.

Disque is among four advance practice nurses (APNs), who have been hired to step into physician residents' roles at Children's Hospital. She joins a group of six other advanced nurse practitioners that has been a mainstay of the Pediatric Critical Care Medicine division workforce for several years.

The team is on track to hire one more, bringing the total number of APNs on the unit to 11.

The unit's Advanced Practice Nursing Medical Director, Neal Patel, M.D., and APN manager, Michelle Terrell, M.S.N., have worked together for years to bring more advanced practice nurses into pediatric critical care.

“Last year, it was decided that high acuity cardiac ICU patients would benefit from their own unit. Neal and Michelle had already developed an amazing APN workforce, so to allow greater continuity for the critically ill cardiac patients, APN's were chosen to staff the new cardiac unit,” said Leah Harris, M.D., associate professor of Pediatrics and Vice Chair for Academic Affairs.

“This allows the pediatric residents the opportunity to master the care of children with common medical and surgical diseases in the PCCU.”

During a recent morning rounds on the Pediatric Cardiac Intensive Care Unit (PCICU) at Children's Hospital, Disque and two other APNs reported about the patients in their care. They talked about changes they had made in their patients' care plans and made recommendations to attending physician Andrew Smith, M.D.

“The advanced practice nurses are a vital element of our team,” said Smith, assistant professor of Pediatric Critical Care Medicine and Cardiology. “In addition, some families are here longer than they are on other units, so the APNs also provide a source of continuity and experience that I think is comforting to both families and providers alike.”

“The nurses appreciate that we've been where they are. They trust us, relate to us, and have two-way conversations with us about patients. The physicians have been working with APNs long enough to have established trust and respect, so now the nurse practitioners have a lot of autonomy on this unit,” Disque said.

Harris and others say the success of the program makes the PCICU a model of inter-professional teamwork for other units. Harris said options are especially important in light of recent changes in protocols for residency programs. In July 2010, the Accreditation Council for Graduate Medical Education (ACGME) reduced the number of hours first-year residents could work from 24 to 16 continuous hours.