The inpatient nurse practitioner teams at The Children's Hospital of Philadelphia (CHOP) reflect an important trend in hospital care and a showcase for pediatric practice by nurse practitioners.
"We were primarily a resident model, and we're transitioning to a more NP-dominant model," explained Sara Sheils, RN, MSN, CPNP-AC, lead for the inpatient NP team in the hospital's cardiac care unit (CCU).
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The CCU NP team at CHOP. From left to right: Lexie Armstrong, Clare Ryan, Sara Sheils, Amanda Jones, Katie Andronaco, Annie Joseph and Ali Cianni. Lisa Connell is not pictured.
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Numerous departments at CHOP use NPs as frontline providers. These include the neonatal intensive care unit, the pediatric intensive care unit, the cardiac intensive care unit, the oncology unit and the seasonal-stay unit.
"The CCU is the first unit at CHOP to transition to a primarily nurse practitioner model," Sheils explained, noting that the hospital employs approximately 365 NPs. Seven of these NPs are on the CCU team.
As CHOP's NP-led teams continue to grow, new NPs are being added to the staff. Recent additions in cardiac care are Ali Cianni, RN, MSN, CPNP-AC, and Amanda Jones, RN, MSN, CPNP-PC/AC. A veteran on the CCU team is Clare Ryan, RN, MSN, CPNP-PC, who transitioned into cardiac care about 3 years ago.
"It's great coming into a warming welcome from everyone, but it's a challenge coming into a role that is evolving," Cianni said. ". there is strength in numbers with all of my colleagues."
In units like the CCU, skills learned during an NP's pediatric specialty education must be further developed to the subspecialty of cardiology. The hospital achieves this through individualized, focused orientation.
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Each new NP on the unit works with an NP preceptor for 3 to 4 months. They participate in observation experiences in each specialized area of cardiology. They attend didactic lectures given by other NPs and by attending physicians. These lectures review multiple aspects of cardiology, including congenital heart disease and related surgeries, cardiac catheterization findings, EKG readings, etc. Each NP also has a physician mentor who reviews case studies and provides additional information.
A Typical Day on the Unit
The CCU is a 24-bed unit that admits patients with a variety of cardiac presentations. They may include patients recovering from cardiac surgery, patients waiting for transplants with ventricular assist devices, and patients in heart failure who are on inotrope therapy.
The NP on duty functions as the frontline provider in the CCU, performing physical examinations, assessing diagnostic studies and laboratory results, teaching patients and families, and coordinating discharges. "We work in conjunction with our collaborating physicians to create a plan of care," Shiels said. "We work 12-hour shifts and care for an average of 6 patients per shift."
Shaping the Program
Because the NP CCU team is a new model for the hospital, the members of the team have the opportunity to help shape it. The CCU NP staff and all other NPs at the hospital work as a team with each other and with medical residents, cardiologists, PAs and the nursing staff.
Members of the CCU staff offered a few pieces of advice for NPs and PAs moving into a subspecialty, paraphrased here: Be patient with yourself, embrace the learning offered in orientation and ensure that you have accurate data because you are accountable for decision making.