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Section Editors: Mark D. Weber RN, CPNP (email: mark.weber2@duke.edu) and Judy Verger RN, PhD, CRNP (email: jtv@nursing.upenn.edu)

Advanced Practice Nursing in Pediatric Critical Care



The Role of the Advanced Practice Nurse in the Pediatric ICU

M.J. Grant, P. Moloney-Harmon, S. Irving, T. Andrade, J. Verger

Advanced Practice Nurses (APN) are functioning as Nurse Practitioners (NP) and Clinical Nurse Specialists (CNS) in Pediatric Intensive Care Units (PICU) throughout the country. These individuals are expert nurses with a strong foundation and dedication to pediatric critical care. They are comfortable with the PICU environment and skilled at coordination of services.

The responsibilities of many pediatric critical care APN's represent a continuum, inclusive of the responsibilities of the traditional CNS and the emerging role of the PICU NP. The classic role of PICU CNS influences practice through staff education, practice, consultation, research, research dissemination and administration. . In the ICU, NP's with attending physician collaboration perform history and physical examinations, evaluate clinical data, provide standardization of care by reducing fragmented care and perform invasive procedures. Pediatric critical care APN's are employed in practice groups with other APN's or as the only APN member of the management team. APN's work in teaching and community hospitals and provide coverage in the PICU, as well as, other areas of the hospital and community.

Definition of the Acute Care PNP (2004):

Developed by a national panel of expert AC PNP educators, clinicians and policymakers

The CPNP Acute Care role is designed to meet the specialized physiologic and psychological needs of children with complex acute and chronic health conditions. AC-PNPs respond to rapidly changing clinical conditions, including the recognition and management of emerging health crises, organ dysfunction and failure. In accordance with this practice focus, CPNP-AC role activities encompass a wide range of NP practice strategies including contributions to the management of childrens' illness/health states, the client-nurses relationship, the teaching-coaching function, the professional role, managing and negotiating healthcare delivery systems, monitoring and ensuring the quality of health care practice, providing family-centered care, and demonstrating cultural competency. The short-term goal of care is stabilization of the child, minimizing complications, and providing physical and psychological care measures. The long-term goal of care is to restore maximal health potential through implementation of NP strategies to reduce health risks. The continuum of care spans the geographic settings of the home, emergency departments, hospitals, sub-specialty clinics, and intensive care units. (referenced on: http://www.pncb.org/ptistore/control/exams/ac/index )


Literature on APNs in the PICU & Acute Care

    • Bolick BN, Bevacqua J, Kline-Tilford A, Reuter-Rice K, Haut C, Cavender J, Verger JT. Recommendations for Matching Pediatric Nurse Practitioner Education and Certification to Pediatric Acute Care Populations. J Ped Health Care 2013 27: 71-77. [abstract]
    • Fry, M. Literature review of the impact of nurse practitioners in critical care services. Nurs Crit Care. 2011 16(2): 58-66 [abstract]
    • Sorce L, Simone S, Madden M. Educational preparation and post graduate training curriculum for pediatric critical care nurse practitioners* Pediatr Crit Care Med 11:205–212 [abstract; full-text (pdf 197K)]
      • See Appendix B: Orientation Checklist (pdf; 134K) [ "This information is intended for the Public Domain and access is allowed by the authors (L. Sorce, S. Simone and M. Madden)" ]
    • Brown AM, Besunder J, Bachmann M. Development of a pediatric intensive care unit nurse practitioner program. J Nurs Adm. 2008 Jul-Aug;38(7-8):355-9. [abstract]
    • Kline AM, Reider M, Rodriguez K, Van Roeyen LS. Acute care pediatric nurse practitioners: providing quality care for acute and critically ill children. J Pediatr Health Care. 2007 Jul-Aug;21(4):268-71. [citation]
    • Kleinpell RM, Ely EW, Grabenkort R. Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review. Crit Care Med. 2008 Oct;36(10):2888-97. [abstract]
    • Verger, JT; Marcoux KK, T; Madden, M; Bojko, T; Barnsteiner, JH. Nurse practitioners in pediatric critical care: results of a national survey. AACN Clin Issues. 2005 Jul-Sep;16(3):396-408. [abstract]
    • Molitor-Kirsch, S.; Thompson, L.; Milonovich, L. The Changing Face of Critical Care Medicine: Nurse Practitioners in the Pediatric Intensive Care Unit. AACN Clinical Issues: Advanced Practice in Acute & Critical Care. 16(2):172-177, April/June 2005.
    • Verger, J., Trimarchi, T., & Barnsteiner, J. H. Challenges of advanced practice nursing in pediatric acute and critical care: education to practice. Critical Care Nursing Clinics of North America 2002; 14, 315-326.


APN Examinations

Pediatric Nurse Practitioner - Acute Care Certification Examination

The Pediatric National Certification Board (PNCB) is currently offering certification as a pediatric nurse practitioner in acute care. For more information please see the website.


Pediatric Critical Care APNs & Professional Organization Activity

  • A committee of the Pediatric Section of SCCM meets annually during SCCM’s annual congress for APN’s in Pediatric Critical Care.
  • The next meeting will be held at the SCCM Critical Care Congress in San Francisco, January 9-13, 2014
  • How does one navigate SCCM?
    • There are two arms of interest to most pediatric APN's at SCCM - the Nursing Section and the Pediatrics Section. If you join SCCM you can chose up to 3 sections to join. Once you have joined the sections you will receive the blast emails that offer volunteer opportunities and dates/times of subcommittee meetings. The committee meetings are open to all who would like to visit and participate. These meetings are a great way to meet other APN’s and get involved.
      • The Nursing Section meetings of interest are:
        • Advisory Council meeting
        • Business meeting
        • Membership subcommittee
        • Education subcommittee
        • Research subcommittee
        • Advanced Nursing Practice and Professional Development subcommittee
        • The Pediatrics Section meetings of interest are:
          • Advanced Practice Nursing committee
            • Minutes from the January 2013 APN Subcommittee of the Pediatric Section of SCCM are here... (pdf; 102K)
          • Business meeting

  • The National Association of Pediatric Nurse Practitioners (NAPNAP)
    • The goals of the Acute Care SIG of NAPNAP include developing educational opportunities, providing a forum to discuss clinical practice, certification and legislative issues (via List-Serve and Newsletter) and designing multi-center research activities. For more information, or to join this new SIG, please contact the NAPNAP national office (1-877-662-7627), or Chair: Karen Reuter-Rice, PhD, CPNP, FCCM (Email: karin.reuter-rice@duke.edu ) or Co-Chair: Maureen Madden, MSN, RN, PNP-AC, CCRN, FCCM (Email: maddenma@umdj.edu)

  • The American Association of Critical Care Nurses http://www.aacn.org/
    • AACN Standards for Establishing and Sustaining Healthy Work Environments (pdf)

Upcoming National Conferences for Pediatric Critical Care and Nursing

  • AACN National Teaching Institute – Boston, MA; May 19-23, 2013
  • NAPNAP- Orlando FL; April 17-20, 2013
  • SCCM Critical Care Congress, San Francisco, Jan 9-13, 2014



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    Training Program Information:Acute/ Critical Care Nurse Practitioner Programs

    Rush University, Chicago, Illinois

    Duke University School of Nursing, Durham, North Carolina

    University of Pennsylvania, Philadelphia, PA

    The University of Alabama School of Nursing at Birmingham

    University of Texas at Arlington

    Vanderbilt University School of Nursing, Nashville, TN

    Emory University, Atlanta, GA

    University of Maryland

    University of California, San Francisco


    Mentorship Program

    As a way to assist APN’s who may either be new in their role or are looking for ways to make contact or collaborate with other APN’s we have started a mentorship program. Below is a list of APN’s who have volunteered their resources to assist you with your professional development. Whether it is a simple question or help in building your CV feel free to contact anyone on the list.

    Maureen Madden New Jersey Maureen_madden@hotmail.com
    Lauren Sorce Chicago lsorce@childrensmemorial.org
    Kari Rajzer Florida krajzer@mcw.edu
    Mark Weber N. Carolina mark.weber2@duke.edu
    Cheryl Barke Pennsylvania bartkec@email.chop.edu

    Other Critical Care Nursing Resources

    • The classic pediatric critical care nursing textbook: Critical Care Nursing of Infants and Children. 2nd edition, Curley MAQ, Moloney-Harmon PA, eds. 2001 is now freely online.

    • PICUAPN ListServ - an email/web-based discussion list just for PICU APN's. Read more and join here
    • Pediatric Critical Care Nursing Job Opportunities: now with a full-service PICU Nursing Jobs Database. Use the new web-based form here to submit a position to us. (All plain text job listings, such as the Nursing Jobs from the PICU list page are now NO LONGER being maintained; please make sure your listing is in the new database...)
    • PICU-Nurse-International is a nursing group interested in discussing any matters related to pediatric intensive care. This egroup serves as a principal meeting place for the International Pediatric Intensive Care Nurses Network. Therefore, in addition to addressing specific clinical topics, this nursing group is also interested in discussing issues from an international perspective

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