Nurse practitioners and physician assistants in the intensive care unit: an evidence-based review.

BACKGROUND: Advanced practitioners including nurse practitioners and physician assistants are contributing to care for critically ill patients in the intensive care unit through their participation on the multidisciplinary team and in collaborative physician practice roles. However, the impact of nurse practitioners and physician assistants in the intensive care unit setting is not well known. OBJECTIVES: To identify published literature on the role of nurse practitioners and physician assistants in acute and critical care settings; to review the literature using nonquantitative methods and provide a summary of the results to date incorporating studies assessing the impact and outcomes of nurse practitioner and physician assistant providers in the intensive care unit; and to identify implications for critical care practice. METHODS: We conducted a systematic search of the English-language literature of publications on nurse practitioners and physician assistants utilizing Ovid MEDLINE, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases from 1996 through August 2007. INTERVENTIONS: None. RESULTS: Over 145 articles were reviewed on the role of the nurse practitioner and physician assistant in acute and critical care settings. A total of 31 research studies focused on the role and impact of these practitioners in the care of acute and critically ill patients. Of those, 20 were focused on nurse practitioner care, six focused on both nurse practitioner and physician assistant care, and five were focused on physician assistant care in acute and critical care settings. Fourteen focused on intensive care unit care, and 17 focused on acute care including emergency room, trauma, and management of patients with specific acute care conditions such as stroke, pneumonia, and congestive heart failure. Most studies used retrospective or prospective study designs and nonprobability sampling techniques. Only two randomized control trials were identified. The majority examined the impact of care on patient care management (n = 17), six focused on comparisons of care with physician care, five examined the impact of models of care including multidisciplinary and outcomes management models, and three assessed involvement and impact on reinforcement of practice guidelines, education, research, and quality improvement. CONCLUSIONS: Although existing research supports the use of nurse practitioners and physician assistants in acute and critical care settings, a low level of evidence was found with only two randomized control trials assessing the impact of nurse practitioner care. Further research that explores the impact of nurse practitioners and physician assistants in the intensive care unit setting on patient outcomes, including financial aspects of care is needed. In addition, information on successful multidisciplinary models of care is needed to promote optimal use of nurse practitioners and physician assistants in acute and critical care settings.