Although nurse practitioners (NPs) are well-established internationally, their presence in Australian adult intensive care units (ICUs) remains limited, with fewer than 10 across the country. Currently, five of these NPs are working at Royal North Shore Hospital (RNSH), highlighting a critical need to expand these roles to meet the growing demand for specialised care in our healthcare system.
In 2015, the ICU NP role was implemented at RNSH ICU. The role has expanded since this time to focus on four key areas which may have traditionally been seen as the role of a doctor. These core areas include: tracheostomy management, vascular access, transfer of the ventilated patient within the hospital, and case management. The ICU NP service plays a pivotal role in the management of complex ICU patients, impacting the length of stay and reducing stress for staff and patients.
RNSH is motivated to become the first hospital in Australia to implement an NP led case management program and a fellowship style training program for adult ICU NPs. A program of this nature will allow NPs to train at RNSH, broaden and refine their skills before taking these learnings back to their own communities.
A nurse practitioner (NP) is a registered nurse (RN) with advanced education at the Master’s level and extensive clinical experience, endorsed by the Nurses and Midwives Board of Australia (NMBA) to provide comprehensive patient care. NPs can prescribe treatments, order diagnostic tests, and diagnose health conditions, collaborating with healthcare professionals to deliver holistic care. Their training includes a Master’s degree and at least 5000 hours of supervised advanced clinical practice, equipping them to assess and manage a wide range of health issues.
In today’s healthcare landscape, NPs are crucial for improving access to care, especially for underserved populations such as Aboriginal and Torres Strait Islanders, the elderly, and individuals in remote areas. They engage in health promotion, disease prevention, and patient education, helping individuals navigate their health journeys. By offering high-quality, accessible care, NPs address healthcare disparities and enhance treatment efficiency, ensuring timely and effective support for patients.
Australia has over 450,000 registered nurses (RNs) but only 2,500 nurse practitioners (NPs), with fewer than 10 working in ICU settings. NPs have been providing care across various specialties for over 20 years, primarily aimed at improving access to health services, while ICU care was not initially included.
In 2015, the Royal North Shore Hospital (RNSH) piloted its ICU NP service, which has since grown to four endorsed NPs and one transitional NP, creating a vital care model for patients in the Northern Sydney Local Health District. The RNSH ICU handles some of the longest patient stays in Australia, including those with burns, spinal cord injuries, and brain injuries, often facing complex medical needs and family challenges.
Despite strong interest from nursing staff in transitioning to ICU NPs, many remain uncertain about how to begin this journey.
The case management program will enhance the existing service, improving continuity of care for complex, long-stay ICU patients while also providing increased education and training for nursing and medical staff. Patients will be identified using a ‘trigger system’ based on indicators like prolonged ICU stays, with an estimated 60 patients per year potentially suitable for the programme.
Long-stay ICU patients often require care from multiple teams due to complex and prolonged treatments, facing challenges like delayed mobilisation, rehabilitation, and transitions between hospital wards. These factors place them at risk for healthcare-associated infections, iatrogenic complications, delirium, and extended needs for basic care, nutrition, pain management, and ventilation weaning.
In this case management role, the ICU NP will engage in daily consultations and communication with the ICU and treating teams, focusing on care planning and coordination. This includes facilitating intra-hospital transfers for scans, managing line and drain procedures, overseeing tracheostomy care, and supporting patient mobilisation.
The concurrent objective of the project is to create a pathway towards the standardisation of the ICU Nurse Practitioner role in Australia. The initial ICU NP role developed at RNSH reflects the dynamic nature of the intensive care unit and offers highly transferrable skills that are beneficial across all levels of ICUs nationwide. The ICU NPs at RNSH aim to train registered nurses from metropolitan, regional, and rural areas to become ICU NPs within their own health districts.
While the RNSH ICU NP team is ambitious, the ultimate goal is for NPs to be present in every ICU across Australia. This represents a transformative approach to healthcare and a new perspective on patient care for the future.
The proposed outcomes will enhance patient care by reducing complications, fostering partnerships with patients and their families, and involving them in comprehensive care planning. Additionally, the program aims to have a broader impact by contributing to reduced ICU and hospital lengths of stay.
The cost of enabling these two pilot projects is approximately $560,000 across two years. Ongoing funding of $280,000 per year will be needed to facilitate the long-term establishment of this program.
The implementation of nurse practitioners (NPs) in Australian ICUs brings significant benefits for patients and staff. For patients, NPs reduce waiting times for vascular access procedures and ensure continuity of care, enhancing satisfaction for those with complex needs.
Staff benefit from increased continuity of care, particularly for patients requiring tracheostomy or vascular access management. This model enhances governance, promotes ongoing education for nursing and medical staff, and creates more career opportunities for nurses, improving retention and job satisfaction. Overall, this innovative care model enhances efficiency and effectiveness within the ICU.
