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Acute Care Nurse Practitioner as Hospitalist: Role Description

There has been an explosive growth in the practice roles of acute care nurse practitioners (ACNPs) since the administration of the first certification examination in December 1995. The expansion of these roles is largely due to changes in medical residency requirements, pressures frommanaged health care organizations to reduce inpatient length of stay, increases in patient acuity, and the overall need for cost containment. Because of these changes, nurse practitioners (NPs) are now employed in emergency departments, tertiary care settings, intensive care units (ICUs), trauma centers, and specialty medicine areas, including oncology, interventional radiology, and neurology. NPs are performing more clinical skills such as central line catheter placement, ventilator management, and interpretation of radiographs. In addition, increasing numbers of NPs are taking responsibility for teaching roles, quality improvement, formulation of standards of care, and participation in research within the aforementioned settings. A literature review of articles from 1995 to the present places ACNPs in teaching, community, rural, and military hospitals. Kleinpell surveyed ACNPs over a period of 5 years, revealing over 50 practice settings. A small sampling of practice settings within the hospital include adult and pediatric cardiac surgery, neonatal ICUs, oncology, general surgery, and neurosurgery. In 2006, Becker et al published results from a single survey of 77 ACNPs in which 34 primary practice units were identified. In these 2 articles, the largest reported practice areas were cardiovascular ICUs, surgical ICUs, and step-down