Diane Smith, right, graduate program director of the UIndy School of Nursing, oversees a nursing student in a simulation exercise. Smith says nurses are the captain of a patient’s caregiving team. (IBJ photo/Chad Williams)
The University of Indianapolis is launching a program this month to prepare nurse practitioners, long a fixture in primary care exam rooms, to care for complex and critically ill patients in hospitals.
The adult/gerontological acute-care nurse practitioner track within UIndy’s graduate school of nursing is beginning with seven students—with room to expand to 15. Adult/gerontological acute care is a specialty that’s growing amid predictions of a looming shortage of advanced care providers and physicians in the coming years.
Nurse practitioners—who have advanced education and training beyond their registered nurse training and experience—do much of the same work as physicians, including diagnosing conditions, writing prescriptions and educating patients or helping them manage chronic conditions.
Other nursing schools in the state, including at Indiana University and Purdue University (through its Purdue Global online program), also offer acute-care nurse practitioner programs. They are aimed at hospitals seeking to hire more nurse practitioners with specialized training and certification to care for patients admitted for reasons such as surgery, heart disease and critical care.
“We have provider shortages. We have sicker patients. We have older patients, and so we’re looking for ways to fill those gaps,” said Kelsey Watson, statewide advanced practice provider lead for Ascension St. Vincent. “Advanced practice providers, nurse practitioners, acute-care nurse practitioners are all very well-equipped to help us take care of patients.”
The nation faces a projected physician shortage of up to 86,000 by 2036, according to the Association of American Medical Colleges.
Many are looking for nurse practitioners to help make up for that shortfall. The U.S. Bureau of Labor Statistics projects that the number of employed nurse practitioners will soar from 292,500 in 2022 to 427,900 in 2033, an increase of 46%.
About 87% of nurse practitioners have trained in primary care with specialties that include family medicine, adult and geriatrics, pediatrics, and women’s health, according to the American Association of Nurse Practitioners.
Their duties include conducting physical exams, ordering diagnostic tests such as lab work, prescribing medicine and managing a patient’s overall care, including for chronic conditions such as type 2 diabetes or high-blood pressure.
As a family nurse practitioner, “I’m doing everything I can to keep that person well. It’s all about prevention, prevention, prevention,” said Wendy Stoelting-Gettelfinger, associate professor and graduate clinical program director at UIndy’s Graduate School of Nursing.
With acute care, she said, the nurse practitioner’s role flips from preventing serious situations to treating them.
Acute-care nurse practitioners perform procedures such as inserting central-line catheters and breathing tubes as well as responding to immediate life-threatening situations such as cardiac and respiratory arrest.
The UIndy adult/gerontological acute-care nurse practitioner track is designed to prepare graduates to work in hospitals treating patients 13 or older. Those specialist nurse practitioners often work in hospitals but also in specialty clinics or long-term-care facilities, according to the American Association of Nurse Practitioners.
The top clinical areas for certified adult/gerontological acute-care nurse practitioners are critical care, cardiovascular and hospitalists, who are care providers focused on the hospital setting.
Diane Smith, graduate program director of the UIndy School of Nursing, said acute-care nurse practitioners bring a nurse’s knack for coordinating care.
“Nurses are trained to look at a patient holistically. With that bedside experience, we’re kind of the captain of the team,” Smith said. “We deal with the physicians. We deal with respiratory therapists. We deal with the physical therapist. We deal with occupational therapists. We deal with the dietitians.
“We deal with everybody to take care of that patient.”
Critical care experience
UIndy’s track requires 750 clinical hours, which includes about 250 hours of training on high-tech medical training mannequins at UIndy’s Health Pavilion. Simulations include presenting students with fast-deteriorating patient conditions that require assessment, resuscitation and invasive procedures such as the insertion of a breathing tube.
The school is recommending that registered nurses interested in the acute-care nurse practitioner track have two years of experience in emergency rooms, intensive care units or units just below the ICU level where patients still require significant attention and monitoring.
Stoelting-Gettelfinger, who also works at Franciscan Health, said nurses with such experience often make the best acute-care nurse practitioners. “They’re already starting to make that transition into differential diagnosis and treatment plans and all of that,” she said.
Nick Saxton, 29, of Greenwood is among the registered nurses with critical-care experience starting UIndy’s acute-care track this month.
“In a critical care setting, you have lots of things you need to identify and you need to think about,” he said. “It’s something that can keep me on my toes every single day and help me critically think at all times to get the best outcome for the patient.”
Saxton graduated from Indiana University with a degree in exercise science but quickly switched course and earned his bachelor’s in nursing in early 2020 through IU’s accelerated program.
He’s worked as a nurse at Franciscan Health and as a traveling nurse around Indiana, working in emergency departments and ICUs and as part of Franciscan Health’s rapid response team, which responds to and works to prevent patient emergencies in the hospital.
Saxton said he is trying to dive into the process of critical thinking. For example, the rapid response team tries to prevent emergency situations by evaluating patients—identifying abnormal lab results early or knowing when to move a person to a hospital unit with more intense care.
“There is no better time than now,” he said of jumping into the new UIndy track.
‘What’s your end goal?’
Saxton is not alone.
Purdue Global has 203 students in its master’s and advanced practice registered nurse certificate programs for acute-care nurse practitioners. Those programs launched in 2018.
Sarah Holmes, UIndy’s undergraduate program director for nursing, estimated that about a quarter of the school’s nearly 400 nursing undergraduates are interested in continuing their education.
“We’ll talk to them about that: ‘What’s your end goal?’” said Holmes, adding that many times people start nursing school with plans to become a nurse practitioner.
Local hospitals are on the lookout for nurse practitioners with specialized training.
Indianapolis-based hospital system Community Health Network said it sees a growing need for nurse practitioners who specialize in gerontological acute care.
“We anticipate that demand will continue to rise,” said Mark Frazee, Community’s executive director of specialty care integration and advanced practice providers. “Their specialized training makes them well-suited for roles in hospital medicine, intensive care, cardiology, oncology and other high-acuity specialties.”
He added that Community does not require all nurse practitioners working in the hospital to hold the specialty certification because a variety of credentials might be appropriate, depending on the specific role.
“That said, the AGACNP certification is commonly held by our NPs who practice in higher-acuity inpatient environments due to the specialized training it provides,” Frazee said in an email.
Ascension St. Vincent employs acute-care nurse practitioners across the hospital systems, said Watson, statewide advanced practice provider lead for Ascension St. Vincent in Indiana.
“As nurses, a lot of us worked in the hospital, and that’s where we did our training,” Watson said. “I have talked to nurse practitioners who very specifically wanted that inpatient training. They wanted to be in that space, and they took a job with us because they knew they loved the team.”
“They had worked with that team for years as a nurse,” she said, “and they were really excited to be able to grow their career and stay with that group.”
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