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INNOVATION

A course in advanced critical care practice

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The advanced critical care practitioner education programme was developed in response to medical staff shortages and offers nurses a new career pathway

Citation: McQueen S (2015) A course in advanced critical care practice. Nursing Times; 111: 23/24, 27.

Authors: Sheila McQueen is head of department of public health and wellbeing, Alan Platt is a teaching fellow, faculty of health and life sciences, both at Northumbria University

Introduction

New advanced practitioner roles are emerging in response to changes in medical staffing and education within critical care. These roles offer a different career pathway for experienced nurses and other health professionals.

In 2009 Northumbria University developed an educational programme that selected a group of health professionals to be developed as advanced critical care practitioners (ACCP). The programme was designed to support Newcastle Hospitals Foundation Trust, which had identified the need for a new role for medical staff in critical care units, in response to concerns about medical staffing levels, the provision of skilled medical cover (Skinner et al, 2013) and rising workloads (Gardiner, 2013).

Defining the role

The ACCP role in critical care is designed to contribute to the care and management of critically ill patients and their families. It offers structured clinical career progression for members of the critical care team. The Department of Health (2008) identified that the role crossed the professional boundaries of many functions within critical care, including medicine, nursing, technical, physiotherapy and clinical pharmacology. It therefore recommended a curriculum based on medical, rather than non-medical healthcare education.

In view of the DH report (2008), when examining the requirements for the workforce and ACCP role with the commissioning trust, Northumbria University developed a curriculum based on medical education. This is fit for a specialised health care role that is an advanced role, but is not solely an advanced nursing role, as it does not specifically advance nursing practice.

A DH position statement (2010) defines advanced nursing practice as a registered nurse working at a level well beyond initial registration, using their knowledge and skills to inform and further develop their practice. The ACCP role is a level of practice that is beyond the first level of registration. The university has developed advanced nursing roles using this statement, which are clearly at a higher level of practice than a registered nurse - for example, advanced paediatric nurse practitioner.

The course

The ACCP course recruits suitably qualified and academically able health professionals with two years’ recent experience working within critical care. These include nurses, physiotherapists, pharmacists and operating department practitioners (Gardiner, 2013). This is advantageous as candidates are appointed from a range of professional backgrounds.

The programme has modules on physiology, altered physiology, history taking and examination, and the management and treatment of critically ill patients. The ACCP programme is at master’s level and reflects the unique focus on mastery of clinical theory and skills. Unlike other postgraduate qualifications, it is contingent on an assessment of clinical competence.

The role

As part of their role within the medical team ACCPs undertake extensive assessment and management of critically ill patients, prescribing medications and performing invasive interventions. These clinical activities, previously in the domain of medical practitioners, require the authorisation of the ACCP’s employer.

Each ACCP was to undertake a comprehensive set of clinical competencies based on the Competency-Based Training in Intensive Care Medicine in Europe syllabus (Bit.ly/ITUcompetencies). To enable the full integration of these competencies into the ACCP role, 70% of course time is spent in clinical environments under the supervision of a medical consultant.

Outcomes

Sixteen health professionals, mainly nurses and physiotherapists, have completed the ACCP programme since it was launched in 2010 and are now having a positive impact working in critical care units at three trusts.

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