The Role Development Of Advanced Practice Nurse In ICU

AIMTo explore the process of the role development of Advanced Practice Nurse (APN) of Intensive Care Unit (ICU) from a practical level. To draft the job description and formulate the model of practice of ICU-APN. To evaluate the practice process of ICU-APN.MethodsThe action research was conducted. Through the mutual cooperation between researchers and ICU-APNs, the research began with establishing an action group. At first, an action group meeting was used to determine the main issues of the role development and to discuss the possible answers. A questionnaire was used to investigate the cognitive and expectations of ICU medical staffs about APN to complement the main issues. At second, referring to the results of the questionnaire, the APNs drafted their job description on the basis of the possible answer of the issue. At third, before action, in order to prepare the practical environment, APNs were looking for the practical environmental support, ICU was adjusted the manpower allocation, and researchers was offered necessary study resources. At forth, after job description was conducted, another action group meeting was conducted to collect the data of their changes of practice and to summarize the practice model. At last, self evaluation and peer review were conducted to appraise the influence of the practice of APNs.Results1. Four specific issues were determined, there were job description, practice model, possible obstacles, required resources. The optimum practice model is that the APN in charge of the whole unit as supervisors instead of just to be the direct care provider of critical patients. The possible obstacles were role conflicts with head nurse, incomprehension by working colleagues,limited human resource of nurses, imposter phenomenon, and so on. The required resources were the supports of nursing department and head nurse, additional nursing manpower complement, and learning opportunities. The questionnaire survey results showed that the cognitive and expectations of ICU medical staffs about APN were basically the same. The results about the competences and job duties had been refer to make ICU-APN job description at next stage.2. The job description of ICU-APN has60items. There were12items in direct clinical practice category,8items in consultation category,8items in clinical and professional leadership category, and8items in collaboration category,16items in expert coaching and guidance category,4items in research category,4items in ethical decision-making category.3. Through the orientation of ICU, APNs got the understanding and support of the key persons from hospital, ICU and physicians. ICU adjusted its internal structure of manpower to adapt the lack of human resources. Researchers kept in touch with APNs to provide the necessary materials for their role development.4. With the implementation of job description, APNs’practice contents were gradually changed. And three different practice models have been formulated. The model one was about how inofficious nurses to be APNs performing practice. Its characteristics were that these APNs managed a part of nursing professional affairs in ICU, focused on expanding scope of practice, but still severed as bed nurses. The model two was about how senior nurses to be APNs performing practice. Its characteristics were that these APNs managed the whole nursing professional affairs in ICU, focused on extending the practice, but still severed as bed nurses. The model three was about how the nurses in administrative position to be APNs performing practice. Its characteristics were that these APNs reduced the working time on administrative work, increased the time on nursing professional management, fully authorized senior nurses, managed the ICU with the senior nurses together.5. The practice process made the ICU-APNs themselves achieved approval, challenge, leading, grow up and change. Also, it enhanced the initiative of nurse staff, elevated the nurses’knowledge, changed the traditional perception of nursing, created a positive working atmosphere and expanded the influence of APN. Conclusion1. The implementation of ICU-APN job description and the change of their practice are the prerequisite for the formation of practice models.2. The role development of ICU-APN is affected by the practice background.3. The role of ICU-APN has positive effects on clinical nursing.4. The role of ICU-APN can be developed on the stages of determining main issues, drafting job description, preparing practice environment, practicing then formulating the model of practice, and evaluating.