Letter to the Editor

The world of postgraduate nurse practitioner (NP) and physician assistant (PA) training is bursting with possibility and is full of supporters and skeptics alike. The authors of "Development of postgraduate training in critical care medicine for nurse practitioners and physician assistants" present more compelling evidence that postgraduate education programs increase participants' knowledge and clinical skills required to work in critical care. This type of investigation is relevant and informative.

I would like to draw the authors' attention to their statement that "NPs and PAs do not have formalized or standardized training in critical care medicine before they enter the workforce." This is not true. NPs are educated and certified in patient population foci. Three of these foci are the neonatal, pediatric, and adult/gerontology acute care populations. Many institutions offer accredited, Acute care population-focused education to NP students. Multiple nursing organizations regulate this preparation and many programs include all the elements described in your study such as didactics in critical care clinical knowledge areas, simulation, and supervised procedural instruction.

This is not to say that adult/gerontology acute care nurse practitioner (AGACNP) graduates would not benefit from a thoughtful training program, such as Dr. Zhou and Dr. Pathak's; however, the non-NP authors have incorrectly described their program candidates. I would point them to the "AACN Scope and Standards for Acute Care Nurse Practitioner Practice 2017" for further definition and standards of the AGACNP practice.1

It is important that NPs be a part of this research of postgraduate education to educate our interprofessional team members about NP training and education. Additionally, this point highlights the urgent need for our colleagues, administrators, and the public to be educated around NP education and scope of practice.

Sincerely

Carolina D. Tennyson, DNP, ACNP-BC, AACC, CHSE

Response

Thank you for this thoughtful response. The authors would like to provide clarity on the statement "NPs and PAs do not have formalized or standardized training in critical care medicine before they enter the workforce." This statement was intended to reflect that while AGACNPs (referred to as NPs for ease) and PAs do receive some standardized didactic education in critical care medicine and laboratory simulated procedures, this is typically insufficient to allow for entry into critical care practice unless followed by a robust training program that facilitates putting these principles into practice and hands-on training.

Additionally, there is much variability in the student clinical setting because most students are allowed to choose their last two semesters of clinicals. They do not always choose critical care. Those who do choose critical care are more prepared for entry into the critical care setting. This does allow for variability in readiness for entry into critical care practice. Another variable seen by the authors has been prior nursing experience, which may lead to impact with familiarity of the intensive care unit.

Although NPs and PAs do receive some basic intensive care training in their curricula, the authors believe that entry into critical care practice as a functional NP or PA must be backed by a robust training program to ensure that the provider practices safely and at the top of their license.

Vikas Pathak, MD, FACP, FCCP, ATSF and Christine Y. Zhou, DO.

Reference