Planning, Training Crucial to Integrating New NPs

Dec 01, 2016

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Article in Critical Care Nurse describes how University of Maryland integrates new nurse practitioners into ICUs, improving retention and job satisfaction

ALISO VIEJO, Calif. – Dec. 1, 2016 – Successfully integrating new nurse practitioners into critical care delivery begins with strategic planning before they’re hired and continues with in-depth orientation programs and ongoing training, explains an article published in Critical Care Nurse (CCN).

The article in CCN’s December 2016 issue describes key strategic planning for new roles, training programs and other strategies that have resulted in successful nurse practitioners in all 10 intensive care units (ICUs) at University of Maryland Medical Center (UMMC), Baltimore. Of the 250 nurse practitioners currently employed at UMMC, 90 practice in ICU settings.

“Integrating Nurse Practitioners Into Intensive Care Units” presents key role preparation steps, orientation options and other information as a guide for healthcare organizations seeking to incorporate nurse practitioners into critical care delivery.

Shari Simone, DNP, CRNP, FAANP, FCCM, is a pediatric critical care nurse practitioner and senior nurse practitioner clinical program manager, Women’s and Children’s Services, UMMC. She also serves as an assistant professor at University of Maryland School of Nursing.

“New nurse practitioners enter practice with variable backgrounds in education and nursing experience,” she said. “UMMC developed a centralized leadership structure for advanced practice providers, including nurse practitioners, in 2008. This strategic approach has led to establishing new programs and processes that directly affect their success as clinicians.”

Competency-based orientation and fellowship programs are key elements of UMMC’s successful integration of nurse practitioners into its critical care units.

A special orientation program for novice providers focuses on critical care competencies and provides additional training to prepare them to practice autonomously. Each new nurse practitioner receives a manual filled with resources, including learning methods and a specialty competency-base assessment tool. Orientation is 12 to 26 weeks, depending on competency expectations and individual knowledge needs.

UMMC also developed an innovative postgraduate fellowship program to train a small cohort of adult critical care nurse practitioners. During the six-month program, fellows rotate through various ICUs and participate in weekly daylong classroom sessions and bimonthly procedural workshops or simulation sessions. Fellows are also required to develop and implement an evidence-based practice project.

Other elements UMMC used to integrate nurse practitioners into its critical care units include the following:

  • An initial needs assessment helped clarify the vision for the nurse practitioner role, define the model of care and outline implementation strategies.
  • Clearly written job descriptions identify the expected roles of nurse practitioners within the care delivery model.
  • Medical staff bylaws aligned with state regulations ensure nurse practitioners are able to practice to the highest level the law allows.
  • An advanced practice leadership team, with a lead nurse practitioner, coordinates the process of recruitment, interviews, selection, orientation, role development and performance management.
  • The lead nurse practitioner serves as a representative for the nurse practitioner workforce and a liaison with stakeholders when needed.
  • In addition to a two-day hospital orientation, all newly hired nurse practitioners participate in a one-day orientation for advanced practice providers, which includes material on regulatory requirements, computer training, access to systems and business and office supplies.
  • Evaluation of clinical performance includes a standardized competency assessment and weekly evaluation during orientation, a focused professional practice evaluation and an annual 360-degree performance evaluation with peer and multidisciplinary feedback.

UMMC’s strategic approach to improve the transition of novice nurse practitioners into critical care practice has decreased turnover and increased overall job satisfaction scores.

In addition, ongoing evaluation of the orientation program indicates a steady increase in novice nurse practitioners’ perception of readiness to practice. In the most recent UMMC survey, nearly 90 percent of the nurse practitioners who responded indicated they were ready to practice after completing the orientation program.

About Critical Care Nurse: Critical Care Nurse (CCN), a bimonthly clinical practice journal published by the American Association of Critical-Care Nurses, provides current, relevant and useful information about the bedside care of critically and acutely ill patients. The award-winning journal also offers columns on traditional and emerging issues across the spectrum of critical care, keeping critical care nurses informed on topics that affect their practice in high acuity, progressive and critical care settings. CCN enjoys a circulation of more than 107,000 and can be accessed at

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 225 chapters worldwide. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000;;;