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Activities performed by acute and critical care advanced practice nurses: American Association of Critical-Care Nurses Study of Practice.

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.