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ACNP Fellowship: The Next Step

Vanderbilt University Medical Center has developed a pilot Acute Care Nurse Practitioner (ACNP) Intensivist Fellowship program unlike any other in the country.  The program is jointly run through the Vanderbilt University School of Nursing and the Department of Anesthesiology – Division of Critical Care Medicine.

“Much like physicians prepare for their subspecialty with a fellowship, the new ACNP Fellowship provides an opportunity for master’s-prepared nurses to further refine skills and knowledge in experiential learning environments,” said Josh Squiers, MSN, ACNP-BC, who co-directs the Fellowship, with Nathan Ashby, MD, assistant professor of Anesthesiology and Critical Care.

Specifically, the program combines an Intensive Care Unit-focused fellowship with the School of Nursing’s Doctor of Nursing Practice (DNP) program.  Students can pursue their DNP degree and work at the Medical Center.  The result is an advanced critical care curriculum at the doctoral level.

“Our DNP program is about preparing practice scholars as leaders in bringing evidence-based knowledge into practice,” said Donna McArthur, PhD, FNP-BC, FAANP, the Doctor of Nursing Practice program director.  “The intensivist fellows practice on multidisciplinary teams, develop competencies in performing advanced procedures and skills, participate in research initiatives within the intensive care units… and when they have successfully completed the program, they are clinical scholars who will have a profound impact on patient outcomes.”

“My role is to try and provide participants with very concentrated, face-to-face learning.  The student looks at the patient from different angles and forms a plan working with multiple disciplines,” said Ashby, ACNP Fellowship co-director.  “It’s about making connections to see how this pathology affects patients and multiple different phases.”

There is an important teaching component to the fellowship, one that the fellowship directors hope to grow over time.  For instance, the first ACNP Fellow Briana Witherspoon recently participated in a clinical conference for the master’s-level ACNP Intensivists.  With experience writing notes herself in the fellowship program, Witherspoon was the ideal person to critique the students’ notes from the hourlong clinical case conference.

“My favorite part is meeting with the directors and discussing articles – determining their strength and how to apply those findings into my practice,” said Witherspoon, a nurse practitioner in the Neurology ICU at Vanderbilt.  “The program molds to my personal needs.  I pick my weaknesses and the directors arrange ways for me to make them strong.”

Both Squiers and Ashby believe the culture at VUMC, one of the largest employers of nurse practitioners in the country, makes this pilot possible.

“The patient demand in Intensive Care Units is more than what any one group can fill.  Nurse practitioners are going to be how you fill that need.  You need to give them the best training possible,” said Ashby.

There are several practice models for nurse practitioners in the Intensive Care Units throughout the Medical Center.  Some integrate nurse practitioners and residents.  Some are non-teaching services that handle less critically ill patients, and others are the team like in the Cardiac Surgery ICU.

All involved in developing the ACNP Fellowship program have discussed future ways to interact with VUSN’s ACNP master’s curriculum.  The pilot program plans to enroll up to four more students in August 2012.



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