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The Roles of Critical Care Advanced Practice Nurse

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The Roles of Critical Care Advanced Practice Nurse Journal of Korean Academy of Nursing (2006) Vol. 36, No. 8, 1340-1351 The Roles of Critical Care Advanced Practice Nurse Sung, Young Hee1, Yi, Young Hee1, Kwon, In Gak1, Cho, Yong Ae1 Purpose. To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. Method. This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). Results. Both the nurses’ and the doctors’ groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counsel- ing, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by educa- tion and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. Conclusion. Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs. Key Words : Critical care APN, Roles Nurses Association has since developed several ways of INTRODUCTION introducing APNs in Korea. As a result, the term “spe- cialized nurses” in Article 56 of Medical Law was Advance practice nurses (APNs) emerged in the U.S. in changed to “APNs” in 2000 (declared on January 12, the 1970s as a response to the dynamic changes and so- 2000), and in 2003, 6 more divisions (Infection Control, cial needs of that time. In Korea, issues related to APNs Geriatric, Occupational Health, Emergency, Hospice started being discussed in the 1990s, and the Korean Care, Critical Care APN) were added to the existing 1. Graduate School of Clinical Nursing Science, Sungkyunkwan University This study was supported by the In-Sung Foundation for Medical Research. Corresponding author: Yi, Young Hee, The Research Institute for Clinical Nursing Science, Samsung Medical Center, 50, Ilwon-Dong, Gangnam-Gu, Seoul 135-710 Korea Tel: 82-2-3410-6430 Fax: 82-2-3410-0035 E-mail: [email protected] Received April 17, 2006 ; Accepted June 21, 2006 Sung et al. The Roles of Critical Care Advanced Practice Nurse 1341 four divisions of nursing (Family, Public Health, social systems are different. Psychiatric Mental Health, and Anesthesia) to give a to- As for critical care in Korea, no APNs are active in this tal of 10 divisions. In 2004, 22 educational institutions area, making it impossible to gain basic information on in Korea were given the task of establishing the first their roles through a survey. Furthermore, in the absence graduate programs for APNs, as required by the Ministry of many studies on the roles of critical care APNs except of Health and Welfare’s Curricula for APNs (The Korean Ahn (2000)’s study, data on their roles are limited. Nurses Association News, 2004). Therefore, the present study was instigated to fill this APNs refers to nurses who had supervised practice need by clarifying the roles of critical care APNs and de- during their graduate education and who manifest a high veloping a curriculum exclusively for critical care APNs. level of expertise in a specific area of advanced nursing practice along with ongoing clinical experience (ANA, OBJECTIVES 1996). In addition, they must obtain all required certifi- cations to be able to perform treatments and prescrip- This study was conducted with the aim of establishing tions independently. They must have the autonomy and the roles and tasks of critical care APNs, and of aiding in competence to perform many interventions in nursing the development of curriculum that could adequately practice more independently than general nurses do, and prepare them for the job. The following two objectives must take full responsibility for their performance (Kim, were set: 2000). 1. To determine the roles and tasks of critical care Since the roles of APNs are regarded as more ad- APNs as perceived by nurses and doctors. vanced than those of general nurses, a standardized 2. To compare this perception between nurses and specification of the scope of advanced practice nursing, doctors. clearly and legally distinguished from that of general nursing, is required before APNs can be introduced to DEFINITION OF TERMS the Korean medical field (Kim, 1996). In addition, a cur- riculum for the adequate preparation of APNs to per- 1. Critical Care APN form advanced practice must be developed. Critical care APN refers to nurses specializing in cer- In Korea, several general hospitals with a need for tain fields and who have clinical experience, special APNs have already independently educated some nurses knowledge and skills obtained from graduate or post- and appointed them as APNs without consent from the graduate educational programs at accredited institutions, nursing or medical field. As a result of discussions re- and the required certifications (Medical Law, 2003) to be garding the qualifications and roles of APNs, however, able to perform advanced nursing practice for critically only those who have had at least three years of experi- ill patients. ence in a specialized field of nursing and who have passed a qualification examination after completing an 2. Roles advanced practice nursing program at an accredited insti- A role is a function one is expected to carry out in re- tution are qualified to receive a certification from the lation to a position or status. In this study, the APN role Minister of Health and Welfare (Medical Law, 2003). was established through the nurses’ and doctors’ percep- Each division of nursing has established higher standards tions of the roles of critical care APNs. for their advanced nursing practice, and has been trying to define clearly the roles and tasks of APNs through the METHODS studies. Various Korean studies on APN roles (Lee, 1996; Lim, Park, & Kim, 1997; Kim, 2003; Kim et al., 1. Research Design 2003; Hong, 2004) have used the five APN subroles A cross-sectional survey was conducted to find out the specified by the American Nurses Association in 1986: necessity of each role and task of critical care APNs, as practitioner, educator, consultant, researcher, and leader perceived by nurses and doctors, in order to establish the and change agent. However, it is essential that Korea es- roles of critical care APNs. tablishes standards distinct from those established by the U.S. since the two countries’ medical environments and 1342 Journal of Korean Academy of Nursing Vol. 36, No. 8 2. Participants residents, and fellows who had used the ICU at least Two hundred nurses and doctors assigned to 7 inten- once within the previous year. sive care units (ICUs: Internal Medicine, General CLS I nurses must pass an examination and certain Surgery, Thoracic Surgery, Neurosurgery, Coronary Care, programs, such as basic critical care nursing, neonatal in- Neurology/Pediatrics, and Neonatal) in a general hospi- tensive care nursing, and advanced cardiac life support, tal located in Seoul were surveyed. The nurses included and must have 3 to 5 years of clinical experience as 7 head nurses and 73 CLS I and II nurses, classified ac- nurses and preceptors. CLS II nurses must complete a cording to the clinical ladder system of the hospital. The preceptor program and an intermediate critical care pro- CLS I and II nurses who were selected as study partici- gram or an APN program, must pass the bi-annual ex- pants had knowledge of all the nurses’ tasks in ICUs. aminations administered by the personnel committees of The doctors included 120 randomly selected specialists, the hospital, and must have at least 5 years of clinical ex- Table 1-1. General Characteristics of the Participants (Nurses) (N = 71) Category Frequency Percentage (%) Mean±S.D. Unit (Intensive care unit) Cardiology 06 08.5 General Surgery 09 12.7 Thoracic Surgery 14 19.7 Internal Medicine 09 12.7 Neurosurgery 09 12.7 Neurology/Pediatrics 12 16.9 Infant Care 12 16.9 Age 25-29 37 52.1 30.15±4.30 30-34 25 35.2 35-40 05 07.0 40 and older 04 05.6 Educational Background Associate 05 07.0 Bachelor’s 51 71.8 Master’s 15 21.1 Position Head Nurse 05 07.0 CLS I 47 66.2 CLS II 19 26.8 Clinical Experience (Years) Head Nurse 19.28±2.53 7.71±4.15 CLS I 5.83±2.00 CLS II 9.31±2.47 Experience in ICUs (Years) Head Nurse 12.43±5.48 7.04±3.09 CLS I 5.74±1.97 CLS II 8.84±2.15 Table 1-2.
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