Critical Care Nurse Practitioner Outcomes: A Scoping Review of the Literature

AIM: To support the development of nursing-sensitive indicators specific to this role. BACKGROUND: The role of the advanced critical care nurse practitioner is a relatively new role in the Irish healthcare system. The role is attributed to the provision of high-quality care to patients. Preparing to evaluate the role is proving challenging due to the varying inconsistencies and responsibilities across hospitals. Nursing-sensitive indicators are measurements where nursing care has had a direct influence on patient outcomes. DESIGN: A scoping review. METHODS: The review was conducted using the Joanna Briggs Institute framework for a scoping review, using the population, context and concept search strategy. DATA SOURCES: In November 2023, seven databases were systematically searched including CINAHL via EBSCOhost, Medline via PubMed, Embase, ProQuest and TRIP. RESULTS: A total of 427 references were identified. Seventy-two duplicates were removed. A total of 303 studies did not meet the inclusion and exclusion criteria. Finally, 18 studies were selected for data extraction using the Donabedian framework of structure, process and outcome measures. Two distinctly different roles were determined: an in-reach role based within an intensive care department and an outreach role that provided a rapid response service around a hospital. The most reported outcome measure was in-hospital mortality, followed by length of stay. CONCLUSION: There was no purposeful use of nursing-sensitive indicators. Two distinctly different roles were determined. The outreach role was associated with more positive nursing measures. The unique contribution of a nurse practitioner leading the outreach team remains unclear. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: There is growing evidence to support a nurse-practitioner-led outreach service for deteriorating patients on wards. It is important to distinguish the advanced nurse practitioner position from physician associates. We need to establish a structure to highlight the unique impact of nursing roles within services. IMPACT: This scoping review synthesises the reported outcomes of acute critical care nurse practitioner roles in the literature. The review determined two distinct acute critical care nurse practitioner roles in the literature, namely in-reach and outreach positions, that are often indistinguishable from physician assistant/associate roles. The review identified, using the Donabedian framework, that there is a lack of a consistent approach to the collection and reporting of acute critical care nurse practitioner outcomes that, which fails to determine the unique impact of the acute critical care nurse practitioner role from other healthcare professional roles. REPORTING METHOD: Following the EQUATOR guidelines, the PRISMA-ScR checklist was applied. PATIENT OR PUBLIC CONTRIBUTION: This review did not include patient or public involvement in its design, conduct or reporting.