A Day in the Life of an Acute Care Nurse Practitioner – Expert Interview

“It’s a challenging job, but a rewarding one. I like the puzzle of figuring out what’s going on with a patient, doing the tests, studying the scans. You put the pieces together with a knowledge of pharmacology, anatomy, and physiology while working with patients and their families to achieve the best outcomes. It’s always interesting.”

Dr. Kelly Thompson-Brazill, Program Director & Associate Professor in the Department of Advanced Nursing Practice at Georgetown University

Nurse practitioners (NPs) play a crucial role in increasing access to high-quality healthcare for millions of Americans. While the majority of NPs still practice primary care, a growing number are choosing instead to practice acute care, which is based on the short-term treatment of, and recovery from, complex, severe, and urgent conditions.

Acute care nurse practitioners (ACNPs) can work with either pediatric or adult populations. And within those populations, ACNPs may choose to subspecialize further in areas like cardiology, oncology, neurology, or surgery. 

Their work environment can vary, too: the majority of ACNPs work in intensive care units (ICUs) or acute care units, but they can also work in specialty clinics and long-term care facilities. And today’s ACNPs are involved in not only providing care to patients but also contributing to translational research and new best practices that help shape the field as a whole. 

Acute care is a deep, complex, and constantly evolving specialty practice area for NPs. It’s also an in-demand one: as the population ages and people live longer than ever before, the nation will need more and more expertly trained ACNPs. 

To learn more about the ACNP role and where it’s going, read on.

Meet the Expert: Kelly Thompson-Brazill, DNP, ACNP-BC, RN, CCRN-CSC, FCCM

Dr. Kelly Thompson-Brazill is the director of the adult-gerontology acute care program and an associate professor in the Department of Advanced Nursing Practice at Georgetown University. She earned her DNP and MSN degrees at Duke University, and her BSN at the University of Scranton.

Dr. Thompson-Brazill is an active member and fellow of the Society of Critical Care Medicine (SCCM), where she serves as a member of the Nursing Research and Scholarship Committee. She is also a panelist on the ICU Design Guidelines Panel, which is producing SCCM’s 2024 ICU Design Guidelines for use in creating evidenced-based critical care environments across the globe. 

Dr. Thompson-Brazill serves as a journal reviewer for AACN Advanced Critical Care, Critical Care Nurse, and the Journal of Emergency Nursing. She is a national expert on both the Critical  Care (CCRN) and Progressive Care Nursing (PCCN) certifications. She was inducted as a fellow of the American College of Critical Care Medicine (FCCM) in 2014.

The Evolution of the Acute Care NP Role

While the primary care NP role dates back to the 1960s, it wasn’t until the mid to late 1990s that acute care NPs received licensure and certification, with the term ACNP entering into popular use. In those early years, it wasn’t uncommon for primary care NPs to flex into acute care positions, and the new crop of ACNPs created some initial confusion in healthcare organizations about who an NP was and how they were trained.

“I was in that first generation of ACNPs when I graduated from Duke in 2002,” Dr. Thompson-Brazill says. “In the beginning, people at my institution thought ACNPs were educated similarly to primary care NPs, and it took a while for them to fully grasp the difference. But as times have changed we’ve gotten more ACNPs, and we’ve gotten younger physicians who are aware of what ACNPs do because they’ve trained with them. Our role has expanded a lot.”

The expansion of the ACNP role is the result of a confluence of several different factors. As America’s largest generation, the Baby Boomers, enters old age, more and more people will need treatment for complex conditions. At the same time, medical science is helping people live longer overall. 

As patients are getting sicker and their conditions more complex, the educational and training options for ACNPs have needed to develop in tandem. Along with an increasing number of degree programs and post-graduate certificate programs specifically tailored to acute care, there are now a growing number of fellowship and residency programs that allow ACNPs to become highly specialized and make seamless transitions to practice. 

“ACNPs need to have a solid educational background, and a strong grasp of pathophysiology and pharmacology,” Dr. Thompson-Brazill says. “But it’s not rote memorization. It’s connecting the dots between the science, the patient’s history and review of systems, physical exam findings, and imaging and diagnostic test results. You have to be organized and detail-oriented, because these patients are extremely complex, and it’s easy to miss things.”

A Typical Day for an Acute Care NP

A typical day for an ACNP will vary based on where they work and the population with whom they work. The majority of ACNPs work in hospitals: in ICUs, in emergency departments, in step-down, and in progressive care. If an ACNP works for a service line or a physician practice group, they can see patients from admission to discharge in all areas of the hospital. 

ACNPs can also work in long-term acute care hospitals (LTACHs) and specialty clinics. Population-wise, the biggest distinction is between adult-gerontology or pediatrics. ACNPs can also subspecialize in a wide range of areas, including oncology, endocrinology, and neurology.

“As NPs we’re trained to take care of a specific population,” Dr. Thompson-Brazill says. “My population is adults who have acute illnesses, critical illnesses, and complex chronic illnesses. But you have to be able to take care of everything a patient presents with. Even if you’re not the one primarily managing one of your patient’s conditions, such as hemodialysis in a patient with end-stage kidney disease, you still need to understand the big picture. In this case, it may be how dialysis and the patient’s kidney disease affects which medications and therapies you prescribe.”

Dr. Thompson-Brazill has been working in cardiothoracic surgery for the last 14 years. When the surgeons on her team are in the OR, Dr. Thompson-Brazill is relied upon to make management decisions and therapeutic interventions. At night, she’ll cover the ICU. And she can provide a wide range of services: everything from attaching patients to pacemakers to determining the right IV medication to raise blood pressure or help the heart beat stronger. It’s a position that affords her a great deal of autonomy—and it’s autonomy that’s well deserved. 

“You don’t get to this point without a lot of hard work and putting time and effort in,” Dr. Thompson-Brazill says. “Continuing education is required for all healthcare professionals. We don’t know everything: new data and therapeutics are frequently developed. A good ACNP is going to belong to professional organizations, read journals, attend conferences, and  continuously learn. Graduation may be the end of formal education, but it’s important to know that even though you’re out of school it doesn’t mean that you’re done learning.”

The Future for Acute Care NPs

In addition to providing evidence-based care to patients, some ACNPs are helping to translate bench research into cost-effective and feasible means of improving care for patients. 

Currently, Dr. Thompson-Brazill and her colleagues are working on ways to reduce sternal wound infections in patients; they’re also looking at how to increase medication adherence in heart surgery patients. The continued involvement of ACNPs in the creation and consumption of new medical literature will help advance both the field of acute care and the role of the ACNP. 

Dr. Thompson-Brazill also contributes to the advancement of the ACNP role through interdisciplinary collaboration. As a member of the Society of Critical Care Medicine (SCCM), a multi-professional organization dedicated to acute and critical care, she serves on the SCCM’s 2024 ICU Design Guidelines Panel, which uses evidence-based methods for determining how to best design an intensive care unit. That panel includes physicians, physician assistants or associates (PAs), registered nurses (RNs), pharmacists (PharmDs), respiratory therapists (RTs), and architects; together, their design guidelines could help decrease ICU readmissions and generally improve patient care. 

“It’s an excellent way to engage multi-professionally,” Dr. Thompson-Brazill says. “It’s very exciting to contribute to patient care on a broad scale.”

As the next generation of ACNPs comes into practice, the days of NPs trained in primary care but being used in acute care settings may be ending. The number of degrees and post-graduate certificate programs for acute care NPs will continue to grow, and as more NPs are educated, trained, and licensed in the specifics of acute care, they’ll become an increasingly instrumental part of the research and practice of acute care. 

“It’s a challenging job, but a rewarding one,” Dr. Thompson-Brazill says. “I like the puzzle of figuring out what’s going on with a patient, doing the tests, studying the scans. You put the pieces together with a knowledge of pharmacology, anatomy, and physiology while working with patients and their families to achieve the best outcomes. It’s always interesting.”

Resources for Acute Care Nurse Practitioners

To learn more about the work and advocacy of acute care NPs, and to connect with the broader community, check out some of the resources below. 

  • American Association of Critical-Care Nurses (AACN): Established in 1969 to help educate nurses working in newly developed intensive care units (ICUs), the American Association of Critical-Care Nurses (AACN) now represents the interests of more than half a million nurses who care for acutely and critically ill patients.
  • American Association of Nurse Practitioners (AANP): With over 118,000 members, AANP is the largest organization for nurse practitioners, and they play a key role in advocating for NPs and their patients. You can find more information about their Acute Care Specialty Practice Group here.
  • Society of Critical Care Medicine (SCCM): With members in over 100 countries, SCCM represents all professional components of the critical care team. You can find more information about their nursing specialty section here.
Matt Zbrog

Matt Zbrog

Writer

Matt is a writer and researcher from Southern California. He’s been living abroad since 2016. Long spells in Eastern Europe, Southeast Asia, and Latin America have made the global mindset a core tenet of his perspective. From conceptual art in Los Angeles, to NGO work on the front lines of Eastern Ukraine, to counterculture protests in the Southern Caucasus, Matt’s writing subjects are all over the map, and so is he.

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