SCCM Resource Library-PICU Overnight INTerprofessional Education of Residents (POINTER) Improves Bedside Care Knowledge, Comfort & Participation

Video Transcription

Thank you so much for joining me today. I am recording this on a very cold Wisconsin winter morning, and I wish I could have been with you in person in Puerto Rico.  But as critical care providers, we are more than accustomed to pivoting and being flexible.  My name is Christine Schindler, and I currently serve as the Advanced Practice Provider Director  for Critical Care and Palliative Care Services at the Medical College of Wisconsin and Children's Wisconsin.  We are a large group of 24 critical care advanced practice providers and two palliative care advanced practice providers.  I also serve as the Program Director for the Acute Care Pediatric Nurse Practitioner Program at Marquette University.  When I was asked to speak today, I was asked to talk about the Pediatric Intensive Care Unit non-physician workforce.  My hope is that in our discussion today, I'll be able to highlight that advanced practice providers are defined in terms of who they are and what they bring to the interprofessional  team rather than what they are not. They are uniquely trained healthcare providers who bring a different perspective and skill set to the team.  The literature is clear that rather than being a non-physician workforce, they are dynamic providers that enhance the team-based care we provide in the PICU.  As we get started, I want to provide some brief historical context on the role development of nurse practitioners and physician assistants who are collectively described as advanced  practice providers. The advanced practice registered nurse role began in the U.S. in 1965 when public health  nurse Loretta Ford and pediatrician Henry Silver established the first nurse practitioner program at the University of Colorado.  During these early years, the program prepared nurse practitioners through a certificate program with the primary goal of relieving the healthcare system of its shortage of  primary care providers in both rural and urban settings. The American Nurses Association offered nurse practitioner certification exam for the first time in 1977.  And by the end of the 1980s, 90% of nurse practitioner certifications were associated with a master's degree.  The first physician assistant program was established at Duke University in 1965 as a two-year course that trained students to practice medicine and provide healthcare services  under a doctor's supervision. The program was designed to provide formal education to returning military medics who  had clinical on-the-job training during the Vietnam War, and the program was completed by the first three PAs in 1967.  The physician assistant program was aimed to address the problem of the physician shortage, particularly in rural North Carolina.  In recent years, there have been many disruptive forces that have changed the face of the Pediatric Intensive Care Unit.  During the last two decades, many hospitals have increased their PICU capacity, increasing number of beds by 43% to meet demand, while at the same time, there have been shortages  of physicians trained in critical care. The Association of American Medical Colleges projects that by 2033, there will be shortages  of somewhere between 54,100 and 139,000 physicians, and of that, the shortage across non-primary care specialties, somewhere between 33,700 and 86,700 physicians.  In 2003, the ACGME rules changed and significantly reduced the number of hours residents were available to work. This added to the strain placed on PICU staffing models.  In 2003, the critical care leadership at Children's Wisconsin and Medical College of Wisconsin  hired the first critical care pediatric nurse practitioners to start to address the changes that we were seeing in resident coverage in the PICU.  I will talk more specifically about the growth and the number of, in both number and scope of practice for our team, but first want to take a few moments to describe the role more  broadly. Nationally, there's a well-established advanced practice registered nurse regulatory model. Under this APRN regulatory model, there are four unique roles.  These include Certified Registered Nurse Anesthetist, or CRNA, Certified Nurse Midwife, Clinical Nurse Specialist, and Certified Nurse Practitioner.  Within each role, there are additional population foci, such as adult gerontology or pediatrics,  and finally, it's further subdivided into APRN specialties that focus the practice beyond the role and population, and focus then is linked to individual healthcare needs, such  as oncology or palliative care or critical care as examples. Within the APRN regulation, the LACE consensus model provides guidance for states to adopt  uniformity in the regulation of APRN role across licensure, accreditation, certification, and education.  There has been variable adoption of the LACE consensus model by states and by individual institutions.  For example, the state of Texas requires education and certification to match practice, but here  in Wisconsin, our division of critical care requires acute care PMP certification, while our state regulations do not.  The idea of incorporating nurse practitioners in the ICU is a relatively recent development.  Historically, nurse practitioners were trained to provide primary care in lieu of a primary care physician.  Specialty nurse practitioners, such as acute care nurse practitioners, were introduced in the 1990s when the need for advanced practice providers was identified in the acute and  critical care setting. Currently, there are more than 325,000 nurse practitioners in the U.S., and according to  the American Academy of Nurse Practitioners, just over 7% of NPs are trained in acute care.  Roles for advanced practice providers in the intensive care unit setting include performing  history and physical examinations, diagnosing and treating illnesses, and performing a wide  variety of procedures, such as arterial line insertion, central line insertion, chest tube insertion, intubation, managing ventilators, and managing critically ill patients.  Advanced practice providers also receive training in care coordination and consultation. As of 2020, there are over 148,000 certified PAs in the country.  Physician assistant training programs do not offer a focus specifically on critical care. However, their broad-based lifespan education is a strong foundation on which PA training  can continue in an ICU setting. Currently, there are 282 physician assistant programs accredited by the Accreditation Review  Commission on Education for the Physician Assistant, and PAs do have the opportunity to pursue a limited number of postgraduate fellowships in critical care.  While APPs provide a much-needed expansion of the critical care workforce, the acute care PNP workforce has not experienced similar growth to other nurse practitioner specialties,  and demand is likely surpassing supply. Family nurse practitioners make up about 70% of the nurse practitioner workforce, while  acute care pediatric nurse practitioners make up less than 1% of the workforce. Kristen Geely and colleagues described the challenges related to growing the workforce.  The distribution of acute care pediatric nurse practitioner programs is not uniform across the country.  When considering the distribution of acute care pediatric nurse practitioner programs in relationship to hospitals in which there are PICUs and the possibility of employment,  there are regional disparities that are highlighted on these maps. The average distance from a PICU in the U.S. to a school of nursing with an acute care  pediatric nurse practitioner program is about 56 miles. However, in the West North Central and the West South Central regions, the distance from  most pediatric intensive care units to acute care PNP programs was more than 100 miles. The greatest distance was the mountain region, where more than 75% of PICUs are more than  200 miles from schools of nursing that have acute care pediatric nurse practitioner programs.  While we know Milwaukee to be a lovely area, albeit very cold this time of year, Medical College of Wisconsin and Children's Wisconsin had a hard time recruiting acute care PNPs  to Milwaukee. So the critical care leadership team approached Marquette University, which is located just  down the street here in Milwaukee, about developing an acute care PNP program. The leadership at all three institutions, so Children's, Medical College, and Marquette,  completed a joint needs assessment and the university agreed to move forward with the plan. I was hired as the first program director and worked very closely with the faculty to  develop the curriculum. One of the advantages of a joint venture is that all three institutions are invested in the success and outcomes of the program.  At a time when clinicals are very difficult to secure, we are able to have really high quality clinical sites here at Children's Wisconsin. The first class graduated in 2011.  The program currently has three pathways. So we have postgraduate certificates, traditional MSN, as well as DNP tracks.  Currently five of the critical care advanced practice providers have joint appointments between the Medical College of Wisconsin and the Marquette University College of Nursing.  The Marquette program accelerated the growth of the critical care APP team, and we currently have 15 Marquette acute care PNP grads on the team.  The graduates of the program also serve in many APP roles across the institution, including  with hospital medicine and a variety of subspecialty programs. Early in the program's history, we progressed from a several-week onboarding process to  a several-month onboarding process. But as the APPs became integral members of the team with 24-7 coverage, we recognized the need for a much more formal process for onboarding.  In 2010, Lauren Source, Sherry Simone, and Maureen Madden articulated the clinical foundation as well as the educational foundation for postgraduate training and orientation, which  was used to formalize our structure. We have continued to update and refine this process, but this was an important contribution  to our understanding of how to onboard APPs successfully. In addition to direct clinical mentorship with a graduated responsibility, the APPs  participate in our simulation lab for several specific purposes. One is for procedural training on commonly performed procedures, including airway management,  central line placement, arterial line placement, lumbar puncture, suturing, and thoracostomy tube placement.  Additionally, they undergo acute CPR coach training and participate in simulations focused on high-risk, low-frequency clinical scenarios.  The new APPs spend time in an anesthesia rotation to gain advanced airway management skills,  and they participate in professional development, including unconscious bias training, EHR optimization, disc assessment, and crucial conversations.  There are some really unique needs to onboarding in the cardiac ICU, and we prioritize sending  our advanced practice providers to the PCICS APP program developed by Lindsay Justice and her collaborators at PCICS.  The advanced practice providers earn graduated amounts of academic time once they are off orientation for one year.  This time is used to focus on supporting the division goals through research, quality improvement, education, hospital and college committees, as well as community engagement.  Trends suggest that advanced practice providers are taking on increased responsibilities that  have increasing complexity, and the literature suggests that novice nurse practitioners specifically have difficulty transitioning to practice due to a lack of support.  The Institute of Medicine, which is now the National Academy of Medicine, their seminal report on the future of nursing recommends that state boards of nursing, accrediting  bodies, the federal government, and health care organizations should take action to support  nurses' completion of transition to practice programs, such as nurse residency or fellowships, when they are transitioning into a new clinical practice area.  In response to this need for postgraduate training, a number of health care organizations have developed advanced practice provider residency and fellowship programs that provide  the APP's additional training in addition to their formal graduate programs. More recently, the National Nurse Practitioner Residency and Training Consortium has emerged  to offer national accreditation for NP residency and fellowship programs. In 2018, there were a total of 91 active postgraduate APP residency and fellowship programs in the  U.S., eight of which were focused on acute and critical care. In general, residencies focus more on primary care transition to practice, while fellowships  focus on specialty care and are typically administered by hospitals and large health care systems.  In 2017, the Medical College of Wisconsin opened the first postgraduate advanced practice provider pediatric critical care fellowship.  It's a one-year-long postgraduate training focused on offering the opportunity to gain specialty experience, enhancing leadership skills, completing an academic project, and  entering the workforce with very minimal additional onboarding. So in addition to the direct clinical mentorship, the fellows experience a formal curriculum  that includes time in the simulation lab, specifically designed didactic modules and skills training.  They receive additional training in professional development topics, as well as specific training and support around role transition.  They have one-on-one teaching experience with pediatric critical care experts, both physician and APP colleagues.  They are able to complete three electives in subspecialties that support their ongoing critical care development.  In order to help them both with leadership skills and academic development, they complete a quality improvement project with formal guidance from both APP and physician mentors.  The goal of this project is that they will be able to present or hopefully publish the results of their project by the end of their fellowship.  They gain presentation skills through presentations of cases through the team, and ideally transition to full-scope practice by the end of the fellowship.  The salary is about two-thirds of what a full advanced practice provider salary is. And so it's a really effective, efficient, and cost-effective way to onboard new advanced  practice providers in the most supportive environment possible. We believe a key to our team's success is a strong APP leadership model.  The role of an APP leader who manages larger APP groups has recently been described and is recommended in the literature.  The triad of a unit medical director, a lead APP, and unit nursing director or leader provides  a solid foundation for critical care operations, governance, and this allows that any issues that arise to be managed in a multidisciplinary approach.  In our division, I serve as the current APP director who oversees and leads clinical operations,  including the staffing model and scheduling, hiring and onboarding, dealing with conflict  or performance concerns, as well as professional development, including mentorship for education, research, QI, and administration.  Each unit, so we have a cardiac ICU, a surgical trauma ICU, and a medical oncology ICU, also has a clinical lead who partners with the associate medical director of that unit as  well as the unit nursing manager to lead clinical practice within each unit. Once the APPs have been in practice for two years, they're able to identify a home base  in which they spend approximately 50% of their clinical time. We have found that our practice is unique and that the APPs cover both the PICU as well  as the CICU, and by establishing a home base, we develop pockets of expertise without sacrificing flexibility in our staffing model.  The APPs also have a formal leadership structure in the academic side of the division. We have two co-directors, and as a team, we lead the Critical Care Advanced Practice  Provider Fellowship Program. This includes recruitment and hiring decisions, curriculum development, evaluation, and academic mentorship to complete the quality improvement project.  Nurse practitioners are licensed by the State Board of Nursing and certified based on the population served.  The National Academy of Medicine and the American Associations of Nurse Practitioners recommend that individual states support full practice authority for nurse practitioners.  Despite that, some states still mandate reduced or restricted NP practice. Reduced nurse practitioner practice requires nurse practitioners to maintain career-long  collaborative practice agreements with another healthcare provider, typically a physician, and restricted practice requires career-long supervision.  In 2011, the Institute of Medicine report developed several key recommendations to transform the nursing profession.  These include nurses should practice to the full extent of their education and training.  Nurses should achieve a higher level of education and training through improved education systems that promote seamless academic progression.  There's still some debate about DMP as entry into practice, but current headwinds indicate that this model is gaining traction.  Nurses should be full partners with physicians and other health professionals in redesigning  healthcare in the U.S., and finally, effective workforce planning and policymaking require better data collection and an improved information infrastructure.  Four primary categories that determine the scope of practice for physician assistants, including state and federal laws and regulation, facility policy, education and training, and  delegation by the supervising physician. Many states designate the supervising physician to assist with determination of scope of practice for a physician assistant.  This is partly because the American Medical Association asserts that physicians should maintain the ultimate responsibility for patient care.  Jigley and colleagues conducted a national survey of pediatric intensive care unit nurse practitioner practice, which found several key findings. One was that most respondents  reported that organizational regulation of PICU-NP practice and prescribing is in fact in alignment with the state scope of practice regulation. Most PICU medical directors and  lead PICU-NPs are generally in agreement with regards to alignment of organizational regulations  of NP practice and prescribing within the state scope of practice. And three, organizational level restriction and PICU-NPs can introduce redundant oversight and limit visibility of  PICU-NPs practice and billing policies. When considering the APP development of the role,  it's really important to think about the APPs more holistically beyond their clinical contributions.  They can and should be developed more holistically to really substantively contribute to the  division's academic goals. In our team, the APPs contribute widely to the division goals. A few examples would include in the area of quality improvement, they take responsibility  for the ongoing development and QI processes around QCPR coach training. They're involved  in code review, death committee, as well as our three-time-a-week rolling refreshers aimed at  providing just-in-time education for the clinical team caring for patients identified as high risk.  In terms of research, they've done research regarding pressure ulcer prevention, skin failure,  more broadly patient safety, simulation, graduate student pedagogical research, as well as many of  the nurse practitioners are key collaborators with physician colleagues on research. In terms  of education, our nurse practitioners teach both in the medical school as well as do a lot  with nursing education. They participate in the fellow boot camp, formally teach as well as precept  graduate nurse practitioner and PA students. They run the Marquette acute care PMP program with those  formal joint appointments that I highlighted earlier. In terms of administration, the APPs  are really involved with leadership within the division, hospital, and at the college-wide levels  and are deeply engaged with the community in terms of professional organizations, writing for certification exams, and other community outreach endeavors such as Be the Match.  We wouldn't be critical care providers if we weren't deeply interested in evaluation. I'll  present the evaluation of the role in context of the Donabedian framework. The Donabedian framework represents a complex system of interrelated factors that are present in APP  practice and that affect role effectiveness. It includes three main components. One, structure,  which encompasses the patient, the advanced practice provider, and organizational variables.  The second is process. This really consists of the APP role components, including clinician,  educator, researcher, administrator, and the ways in which the role is enacted. And three, outcomes. The patient and cost-related outcomes and impact on the interprofessional team.  At present, no studies have outlined the optimal staffing model that allows the best patient  outcomes combined with the maximum education of trainees and job satisfaction for all team members. In addition, the literature for facilitating collaboration among team members  is also lacking. The mechanism for integration of advanced practice providers into academic ICUs is typically institution-dependent and has generally occurred in one of two ways.  The first is that APPs are assigned to a separate team from house staff and care for different  patients, or APPs and house staff are members of the same team and their duties overlap.  In the Pediatric Intensive Care Unit at Children's Wisconsin, we currently have three teams,  each covering 16 patients within our general Pediatric Intensive Care Unit. There are two what we would consider more traditional academic teams that include an attending physician,  a physician fellow, and two residents. There's one of these teams on our surgical trauma ICU  and one on our medical oncology ICU. The APP team has an attending physician, a fellow in a  graduated leadership role, and one advanced practice provider on the medical oncology unit  and one on the surgical trauma unit. This, the graduated leadership role for the fellows is a  really important role as the fellows will likely work with advanced practice providers in whatever  role they take as an attending physician as APPs continue to work in more and more intensive  care units. I do want to point out that on nights and in our cardiac ICU, which I'll review  those staffing models in the upcoming slides, the fellows and APPs work side by side rather than in  this graduated leadership model. This works well and the team is able to flex back and forth  between the different reporting structures but does take some intention and planning between  the fellowship, physician fellowship director and the APP director to make sure that everyone  really understands their roles in both type of models. As I mentioned on the last slide, the structure in the cardiac ICU is slightly different than in the pediatric ICU. There are  no residents assigned to the CICU so the physician fellows and the APPs share responsibility for  first call on all patients in the unit. The unit is split into two, an A team which primarily focuses  on post-surgical patients and the B team which traditionally focuses on heart failure and transplant patients. APP provider to patient ratios have been reported to be anywhere in  the range of 1 to 3 to 1 to 8 with a mean of about 1 to 5 patients in the adult ICUs and in pediatric ICUs that ratio was closer to 1 to 4. When planning for APPs in the  staffing model, these ratios are dependent on factors including number of ICU consults, number  of admissions or discharges a day, bed occupancy, number of residents and or fellows, the patient  acuity and time of day. Much more work is needed to determine the optimal ratio that best impacts  patient care outcomes. I want to take a moment just to call out our night structure. A night call,  the cardiac ICU has one attending in-house and is covered either by one physician fellow or two  advanced practice providers while the 48-bed PICU is covered by one attending physician and a  combination of three to four advanced practice providers and fellows. An important consideration  in building teams is for leaders to remain cognizant that the ICU workforce requirements  and ICU provider workload are inextricably linked to operational variables and when out of balance  may lead to provider burnout which is typically characterized by emotional exhaustion,  depersonalization and diminished personal accomplishment. Importantly, burnout is associated with higher rates of medical errors, reduced quality of care and lower patient  satisfaction. Currently, the literature offers incomplete guidance regarding the determination  of optimal intensivist and APP workload requirement. The term strain has been applied to the time  varying in balance between supply of available beds, staff and other resources and the demands  to provide high quality care. ICU strain correlates highly with healthcare professional stress and  burnout. Further research is needed around risk factors and drivers for ICU burnout,  novel approaches to staffing, strategies for handling ICU surge and volume and acuity and optimization of team culture, collaboration and communication.  Dr. Tom Reeder and team proposed an ICU team performance framework that consolidated the existing knowledge regarding teamwork and outcomes in the ICU and provides a structure  against which to design and evaluate teamwork interventions. Key teamwork processes consistently  shown to predict ICU outcomes include team communication, team leadership, team coordination  and team decision making. A high functioning team with standardized expectations and professionalism  should be the goal in the ICU. The ideal multidisciplinary approach mitigates patient care conflicts, truncates financial issues and sets expectations regarding foreseeable areas  of disagreement. We know that conflicts within the ICU team are important drivers for job strain  and burnout. The literature supports numerous benefits of integrating APPs and ICU staffing  models, including an increase in efficiency in rounds, that APPs are able to help maintain  continuity of care and communication with the healthcare team and with family members of the  ICU patients, as well as improved compliance with clinical practice guidelines and quality  initiatives. A survey of critical care fellowship program directors indicated that they believe  patient care was positively impacted when advanced practice providers and fellows work together on a  team. The majority of program directors also reported that fellowship education was improved  by having advanced practice providers on the team. One example of our fellows and advanced  practice providers collaborating is during rolling refreshers, which is pictured here on this slide.  Each day we have an interdisciplinary morning huddle that's conducted to review admissions,  discharges, identify any staffing issues, talk about intra-hospital transports, as well as  identify high-risk patients. Three times a week, both on day and night shift, the advanced practice  providers and fellows conduct intra-professional, just-in-time resuscitation training for patients  identified as high-risk. This has been a terrific collaboration in which the APPs and fellows both  get to teach, as well as have the opportunity to learn from one another. Another terrific opportunity within our own institution has been having the fellows on the advanced practice  provider team in a graduated leadership role. This allows the fellows to develop those leadership  skills, as well as for the advanced practice providers to provide feedback to the fellows to help with their own professional growth. Additionally, having the two large robust teams  working together allows to manage any schedule interruptions in a very robust and timely fashion.  APPs are highly effective at delivering and improving the quality critical care when integrated into ICU teams. There are several studies that endorse similar patient-level  risk-adjusted mortality and length of stay in centers with advanced practice providers  with decreased cost compared to centers without APPs in their ICU staffing models. Data also suggests that residents feel APPs have a positive effect on their ICU experience.  They specifically cite an initial orientation by the APPs that includes procedural protocols, followed by a structure with greater responsibility can really enhance their  training. Most residents report a more cohesive experience when rotating on services with advanced practice providers versus those without advanced practice providers.  Kristin Gigli and colleagues published a seminal work in 2021 looking at APP-inclusive staffing models on clinical outcomes and resource utilization in the United States Pediatric  Intensive Care Units. This retrospective study used multivariate regression modeling to evaluate  in-hospital mortality, odds of hospital-acquired conditions, and ICU and hospital length of stay.  Their sample included more than 38,000 children across 40 Pediatric Intensive Care Units. Patients admitted to PICUs with APP-inclusive staffing were younger and more likely to have  complex chronic conditions and organ failure in admission compared with patients in Pediatric  Intensive Care Units with physician-only staffing. There is no difference on mortality or length of  stay between PICU types, but patients in Pediatric Intensive Care Units with APP-inclusive  staffing had lower odds of central line-associated bloodstream infections and lower catheter-associated  urinary tract infection rates. It is essential for APPs to be engaged in diversity, equity,  and inclusion work in the pediatric ICU. Health inequities are defined as systematic differences  in the opportunities that groups have to achieve optimal health, leading to unfair and unavoidable differences in health outcomes. They disproportionately impact people of color,  the LGBTQ plus community, people with disabilities, those with low income, and those living in rural  areas. There's a growing body of literature that demonstrates health inequities in the Pediatric  Intensive Care Unit, including children living in poverty, children with medical complexity,  and children of color. A word about our workforce as well. A diverse workforce, including diversity  of age, gender, race, sexual orientation, ethnicity, socioeconomic status, and so on, adds value and  enrichment to the overall work environment. There are more effective collaboration and higher and  higher collective intelligence in groups that are gender diverse. Although most medical schools are  approaching gender equality, women physicians continue to work fewer hours over the course of  their careers and are underrepresented in leadership in senior positions. A team of women leaders in pediatric critical care medicine developed a list of interprofessional pediatric  critical care medicine women speakers with a goal of using the list to identify women from different backgrounds and nationalities to speak and be heard in their area of expertise.  I included the link here, so please go to that link and add your name in your area of expertise  so we can continue to work towards gender parity in pediatric critical care.  So what does health equity look like here in Milwaukee? In Milwaukee, in 2019, close to 40%  of children were living in poverty. It's defined as less than or equal to the 100th percentile of  poverty, which for a family of four was just under $26,000 a year. Close to 12% of Milwaukee's live births resulted in children and babies that were low birth weight. Milwaukee had  1,323 violent crimes per 100,000 population, and when we looked at cities of comparable size,  they had on average 431 violent crimes per 100,000. And in Milwaukee, we know that individuals have  lower than average rates of overall access to dental care, prenatal care, and preventative services.  In 2021, the National Academy of Medicine published the Future of Nursing 2020 to 2030, charting a path to achieve health equity. This report notes that nurses, including advanced  practice nurses, are the largest health care workforce and act as the first and most frequent  line of contact with people of all backgrounds and experiences seeking care. Nursing history  is grounded in social justice and community health advocacy, and this report is a call to action  for nurses to deeply engage in the work to address health inequities over the next decade.  The American Nurses Association President Ernest Grant endorses that the Nursing Code of Ethics  obligates nurses to be allies and to advocate and speak up against racism, discrimination,  and injustice. Answering the call to work towards health equity starts with nursing curricula, which needs to include content on the complex linkages among population health,  social determinants of health, and health outcomes. Essential for nurse practitioners  and all advanced practice provider is the need to assess for food insecurity, housing instability,  utility needs, transportation needs, interpersonal violence, and be prepared to make appropriate  referrals to social services. Nurse practitioners and advanced practice providers need to work in  concert with other sectors and disciplines to develop interventions that address multiple  and complex needs of individuals and communities. This report features a variety of models that feature nurses directly addressing health and social needs through multidisciplinary,  multi-sectoral, and collaboration. Public policies have a major influence on health  care providers, systems, and the populations they serve. Accordingly, nurses can help promote health  equity by bringing health lens to bear on the public policies and decision making at the  community, state, and federal levels. Informing health-related policy can involve communicating about the health disparities and social determinants of health with the public,  policy makers, and organizational leaders, focusing both on challenges and solutions  for addressing health through actions targeted to achieving health equity. At Children's Wisconsin,  we encourage all of the advanced practice providers to be a part of the Children's Advocacy  Network. The Advocacy Network keeps APPs up to date on what Children's Wisconsin is doing to  help children and families and how to get involved. As a member, the APPs receive updates on activities  and opportunities to contact their legislator or participate in community events. This report is  really a must read for all advanced practice nurses and nursing leaders. There are so many opportunities to build upon the science of teamwork and collaboration within the Pediatric  Intensive Care Unit, whether it's through studying optimal team composition and how it relates to  patient safety or strategies to mitigate burnout, to best practices and increasing the diversity  within our workforce, or how advanced practice providers can really deeply engage in diversity,  equity, and inclusion work and start to address the health disparities we all see in our communities. There are countless opportunities for collaboration, as well as ongoing  interprofessional teamwork in the service of our patients and their families.  Thank you so much for your time and really taking the time to listen to this talk. If you are  interested in doing any additional reading or seeing the articles which were referenced today,  you can click on this QR code. I'd really love to continue this conversation. I wish we could  have been together in person as I suspect it would have been a really robust conversation  or answer any questions you might have. If you are interested in reaching out for discussion, questions about anything that you heard today, or potential collaborations,  I did include my email here and would love to hear from you. Thank you so much. I hope you really enjoy the rest of the virtual SCCM conference.

Video Summary

In this video, Christine Schindler, the Advanced Practice Provider Director for Critical Care and Palliative Care Services at the Medical College of Wisconsin and Children's Wisconsin, discusses the role of advanced practice providers (APPs) in the Pediatric Intensive Care Unit (PICU). She highlights that APPs bring a unique perspective and skill set to the team, and the literature supports their role as dynamic providers that enhance team-based care. She provides a historical context of the development of nurse practitioners and physician assistants, who are collectively referred to as advanced practice providers. She also discusses the growth and scope of practice for the PICU non-physician workforce. She emphasizes the importance of onboarding and ongoing training for APPs, as well as the need for a strong leadership model to support and develop the role. The video also touches on the integration of APPs into the ICU team, their impact on patient care outcomes and resource utilization, and the importance of diversity, equity, and inclusion in the PICU. The video concludes with a call to action for nurses and APPs to address health inequities and achieve health equity in their practice.

Asset Subtitle

Professional Development and Education, Administration, 2022

Asset Caption

Resident education is increasingly focused on knowledge and skill acquisition rather than on mechanics of bedside care. Hands-on aspects of patient care (e.g. suctioning oral secretions, drawing blood), are often carried out by non-resident team members. Interprofessional education (IPE) programs represent an opportunity to enhance unit culture, promote collaborative behavior, and reduce error. A critical care hospitalist, nurse (RN), and respiratory therapist (RT) developed an IPE-based series for PICU residents facilitated by multi-professional content experts. The primary aim was to deliver a supplemental curriculum to improve resident knowledge of ICU bedside care. Secondary aims were to improve self-reported confidence/comfort, participation in bedside care, and interprofessional collaboration.

Meta Tag

Content Type Presentation

Knowledge Area Professional Development and Education

Knowledge Area Administration

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Healthcare Delivery

Tag Workforce

Tag Communication

Tag Nursing

Tag Pediatric Intensive Care Unit PICU

Year 2022

Keywords

Christine Schindler

Advanced Practice Provider Director

PICU

APPs

team-based care

scope of practice

leadership model

health equity

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