Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

Abstract

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

Practice Analysis: Adult-Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist

“…The limited number of ACNP and CNS respondents to the 2006 practice analysis led to results that reflected only the subset of certified ACNPs and CNSs who completed the survey. 4,5 For the 2011 6,7 and 2016 10,16 practice analysis survey results, the convenience sample and the respondents' voluntary participation may have introduced selection bias, which is typical of practice analysis studies conducted for professional credentialing examinations.…”

“…The AACN Certification Corporation previously conducted 2 practice analyses of the ACNP and CNS roles. The 2006 study 4,5 continued the process from the practice analysis that began in 1990. The 2011 study 6,7 for AGACNPs and AGCNSs was the first e21 survey initiated after the Consensus Model had been adopted that provided information on new APRN roles and populations, including the CNS role spanning wellness through acute care.…”

Acute Care Nurse Practitioner: An Advanced Practice Role for RN First Assistants

“…A survey of 158 CNSs and 77 ACNPs supports the scope of practice described for each role. The ACNP respondents indicated that individual patient care accounted for 74% of their practice time, whereas the CNS respondents indicated that 26% of their practice time was spent on individual patient care 6 …”

Time use of advanced practice nurses in hospitals: A cross‐sectional study

“…Several studies have examined the professional time use of CNSs (Darmody, , ; Kilpatrick et al, ; Leary et al, ; Mayo et al, ; Norton, Sigsworth, Heywood, & Oke, ; Oddsdóttir & Sveinsdottir, ; Ream et al, ; Wickham, ), NPs (Johnson, Brennan, Musil, & Fitzpatrick, ; Kleinpell & Goolsby, ; Martin‐Misener et al, ; Rosenfeld, McEvoy, & Glassman, ; Woo, Zhou, Lim, & Tam, ), or both (Becker, Kaplow, Muenzen, & Hartigan, ; Lincoln, ). These studies investigated the time investment of APNs using self‐reporting methods, such as diaries (Ream et al, ; Norton et al, ; Oddsdóttir & Sveinsdottir, ), instruments to register the frequency of activities (Becker et al, ; Leary et al, ; Martin‐Misener et al, ; Wickham, ), or the estimated proportion of time spent on APN roles (Darmody, ; Johnson et al, ; Kilpatrick et al, ; Kleinpell et al, ; Lincoln, ; Mayo et al, ; Rosenfeld et al, ; Wickham, ; Woo et al, ). However, recurring limitations in these studies are as follows: no random selection of the sample, unclear inclusion criteria, a lack of reasons explaining attrition, and a risk of self‐reporting bias.…”