Acute Care Nurse Practitioner: Collaboration in a Postpandemic World

Collaboration is one of the 11 practice standards outlined in the American Association of Critical-Care Nurses (AACN) Scope and Standards for Adult-Gerontology and Pediatric Acute Care Nurse Practitioners1 that acute care nurse practitioners (ACNPs) must uphold. For each of the 11 standards, there are 3 to 10 competencies that ACNPs are expected to demonstrate. For instance, there are 4 competencies clustered around the communication standard, including building relationships, collaboration, coordination, and mentoring. Although these standards are not unique to the ACNP role, the ACNP has a responsibility to seek out opportunities to demonstrate collaboration intra-professionally and interprofessionally. The COVID-19 pandemic diminished collaboration in acute and critical care; social distancing was necessary, and isolation was a fact of professional life. ACNPs were among the frontline workers helping patients affected by the pandemic. Yet as the virus becomes part of the new normal and restrictions are lifted, collaboration is perhaps more necessary and significant than before the pandemic.Throughout the COVID-19 pandemic, there were barriers and disruptions to collaborative professional practice for ACNPs. As the pandemic took hold on the health care system, clinical rotations were suspended by universities, limiting mentorship and preceptorship opportunities.2 Notably, the presence of the virus became part of the work environment; as a result, the pandemic changed many ACNPs' physical and professional practice areas. Many ACNPs worked under stressful conditions that included being redeployed and experiencing changes to clinical workload. Burnout and compassion fatigue not only impacted clinical practice; for some, it changed their professional priorities. For example, findings of one study3 showed that the COVID-19 pandemic negatively impacted ACNPs' quality of life, leading to increased burnout and secondary traumatic stress.Moreover, ACNPs working at the bedside had first-hand experience of the effects on health care delivery of the pandemic, including decreased overall quality of care and less time spent on indirect clinical care. Despite the changed landscape in health care delivery systems and processes as a result of the pandemic, ACNPs must keep up with the established professional competencies essential for professional growth, development, and sustainability of the role and the profession at large. This article discusses the importance of collaboration among ACNPs in the postpandemic world, as framed within the context of AACN practice standard competencies.1As outlined by the Institute for Healthcare Communication (IHC)4 in 2011, effective communication is crucial because lack of communication (ie, ineffective communication) results in poor health outcomes, decreased patient satisfaction, an unhealthy work environment, and medication errors.5 The IHC reports that communication accounts for approximately 66% of medical errors.4 As key members of interprofessional teams, ACNPs must use effective communication to build relationships with interprofessional teams, as well as with patients and families; this competency is especially important in the acute care setting.6 A study conducted in 2017 found that nurse practitioners provided high-grade knowledge that enhanced communication with the team and patients to improve quality and care flow.7 The pandemic led to gaps in communication with the elimination of visitors and with more communication taking place over the telephone or via tablet or personal computer. In a postpandemic world, ACNPs need to take ownership of this competency again. Medical residents rotate and have varied call shifts, whereas the ACNP is a consistent provider in communicating plans of care with patient and family members and other interdisciplinary teams.Consulting is an integral aspect of the ACNP role. Consulting relationships can include those with physician colleagues regarding the management of a patient condition or answering a specific clinical question. The ACNP collaborates with consulting services regarding the individualized plan of care for a given patient.8 Through communication and consultation, the ACNP can facilitate optimal evidence-based care for patients. The ACNP may have years of experience with a given patient condition, some as a nurse and then with more advanced training as an ACNP. This knowledge can inform patient care by the ACNP through provision of patient-specific education and real-world examples that address the overall trajectory of patient care and ultimately the discharge process.Additionally, there can be consultation between the ACNP and staff nurses, through individual teaching, mentoring, or educating groups of staff nurses on the clinical management of a commonly treated disease state.8 Such education to staff nurses or other members of the health care team can help them better understand a new disease as well as manage the care and education that their patients need. As a further benefit, this consulting and collaboration enhances the ACNP's own knowledge.Amid the resource demands of the pandemic, consultations were limited. As COVID-19 becomes endemic, ACNPs need to refocus their attention on their consultative role to facilitate high-quality care through such activities as holding in-services for the bedside nurse, arranging monthly journal clubs for colleagues to discuss the latest research, or continuing to consult with fellow clinical nurse specialist and physician colleagues to provide evidence-based care.Teaching, coaching, and mentoring are part of the daily work of the ACNP as a member of the interprofessional team. O'Grady and Johnson9 define mentoring as a 1-on-1 relationship through which one person has more proficiency in a particular area and provides guidance to another person.9 Different than preceptorship, which is limited to new graduates, mentoring can occur at various stages in the career of a nurse practitioner. The AACN scope of practice cites mentoring as a standard that the ACNP should demonstrate in order to advance best practices.1 When the ACNP teaches, coaches, and mentors other members of the interprofessional team—including other ACNPs, residents, medical students, nurse practitioner students, physician assistants, physician assistant students, or nurses—the ACNP fulfills an essential function for the team. Link10 describes how mentoring develops clinicians to be confident care providers who are committed to "lifelong learning." Whether through formal or informal mentoring, the ACNP can impact other members of the health care team by investing in others to support their professional growth and development. Mentoring is an excellent way for an experienced ACNP with the desire to help others succeed share their knowledge and support the next generation of ACNPs.Mentoring can foster professional and career development in others. McCloughen and colleagues11 noted that many nurses are influenced by their own experience as a mentee, in which a genuine connection led to a lasting impact; although the mentoring relationship ended, the professional connection remains. A mentorship can be focused on a specific professional area in which the mentee needs support and guidance, such as manuscript writing.12 At the local, state, and national level, professional organizations can provide potential mentees access to mentors across all nursing disciplines and specialties.The pandemic required both experienced and novice clinicians to care for patients amid the landscape of a new and evolving disease. Luis and Vance13 describe how receiving mentoring during this time was an asset, providing support and wisdom. The actions of mentors and colleagues have had an immeasurable impact on those who worked through the pandemic. And mentoring does not just benefit the mentee; the mentor also experiences professional growth and rewards through participating in a mentoring relationship.10,12 There is satisfaction in aiding the growth of another and guiding another clinician to meet their professional goals.In an observational study, members of the interprofessional team indicated that nurse practitioners ease their workload, hold patient care together, and promote evolving practice.14 As an integral part of the continuum of care, the ACNP is also demonstrated by the literature to have a positive impact on overall patient care. ACNPs increase the efficiency and quality of patient care and reduce physician burnout through their active collaboration with physician colleagues.15Furthermore, a report from the Institute of Medicine (IOM) notes the need for coordinated care. During an acute illness, patients can transition from one level of care to another, such as from an intensive care unit to a general practice unit and then discharge to a community setting.16 Each transition in the care level necessitates communication about patient history and plan of care. The quality of the handoff communication can directly impact safety, quality of care, and patient experience.17 The ACNP works to help each patient navigate the complex health care system and other barriers, including health care literacy or other social determinants of health. The IOM report shows that coordinated health care delivery not only leads to quality care but is a fiscal imperative.16 The ACNP is in an ideal position to facilitate and coordinate that care.The ACNP is an integral member of the interdisciplinary team, collaborating with the team on rounds and in the implementation of the plan of care. The professional connections and relationships built through daily practice can be a foundation for further research partnerships, which can further not only the ACNP's knowledge base but also other disciplines' knowledge. In addition, the ACNP can further technology in daily practice. Whether implementing a new computer charting system or developing virtual realities for clinical simulation,18 the ACNP is at the forefront of technology use in both clinical and professional practice.Attending and participating in professional educational activities are also important to ACNP practice and collaboration among the interprofessional team. Professional societies and health care institutions adapted in order to provide continuing education during the COVID-19 pandemic. As COVID spread, regional conferences initially were canceled. Many national organizations were able to offer virtual conference options, allowing nurse practitioners to earn the continuing education credits required for recertification and engage with colleagues from all disciplines. As professional conferences and meetings return to an in-person format, hybrid and virtual options are still being offered, which can benefit attendees with various learning styles and institutional budget constraints.19 It should be noted, however, that limited data are available about how presentation formats affect knowledge acquisition or information retention.20 Moving forward in a post-COVID world, more research is necessary to address those gaps.During the COVID pandemic, ACNPs were siloed into their clinical practice environment, with social distancing limiting opportunities to network and collaborate. Now, ACNPs need to seek opportunities for networking and collaboration. A key factor in collaboration, networking is defined as the act of making contact and exchanging information with other people, groups, or institutions to develop mutually beneficial relationships.21 Volunteering through professional events or with organizations at the local, state, and national level creates opportunities for ACNPs to meet one another,21 communicate, ask questions, find common interests and topics for discussion, and promote collaboration.22Networking is an essential component of professional growth and development, allowing for the sharing of ideas, clinical practice issues, and professional growth opportunities. However, the patient census and clinical demands during a shift do not always allow for collegial discussions and networking. The ACNP community can advocate for time at work for continuing education and networking. Creative ideas include use of online platforms that remove travel time, informal opportunities such as coffee break–style networking, and finding a mutually convenient time of the day to meet that accommodates shift work.Conference attendance can often inspire professional passion for ACNPs, leading to changes in practice or a renewed investment in the daily work. This inspiration often comes from attending educational sessions but also from spontaneous conversations. Scheduled networking events at conferences can give dedicated time and space to discuss practice topics, ask questions, and make professional connections, and the scheduled versus impromptu nature of such an event can increase participation and thus the potential for connection.The pandemic led to APRNs not only being socially distanced but clinically distanced from colleagues. ACNPs may have not realized the importance of networking with colleagues from around the United States and discussing clinical practice until opportunities to do so were limited. Now that ACNPs can refocus on educational professional activities, we need to cultivate collegial relationships for collaboration, individual practice, and professional development. The AACN scope and standards highlighted this relationship between colleagues by making collaboration a standard for ACNP practice.1 In a post-COVID world, opportunities to collaborate may present themselves differently, however, the onus is on the ACNP to seek out these possibilities. ACNPs may leverage the information depicted in the Figure23 as a guiding framework for developing and mastering collaboration competencies situated in the "communication" practice standard.1A question that the authors posed to one another: With the pandemic behind us, are ACNPs too burned out to even attend conferences, professional organization meetings, or continuing education classes, activities essential to nurturing collaboration? The AACN scope and standards for ACNP practice1 is clear that collaboration is one of 11 standards that ACNPs must continually demonstrate. In a postpandemic world, the authors agree that ACNPs need to again hold themselves to such professional standards.Rowley et al24 evaluated factors affecting nurse practitioners' decisions to join a nurse practitioner professional organization. Nurse practitioner organizations offer a variety of member benefits, including continuing education, mentoring, networking, and opportunities for volunteering or leadership development. Professional organizations continue to look to grow membership and membership engagement. The American Association of Nurse Practitioners (AANP) reports a membership of 121 000 members among 355 000 licensed nurse practitioners in the United States.25 Rowley et al24 found that nurse practitioners who join a professional association commonly are looking to improve the profession, promote personal development, and access education through professional programs.This article seeks to not only encourage collaboration among ACNPs but to reengage our profession. The Table highlights how the ACNP can easily add collaboration into their everyday practice. Health care is a complex and dynamic landscape. The power of a community collaborating and professionally engaging would positively impact the ACNP, the community of professional ACNPs, and most importantly, the patients the ACNP serves. Together ACNPs need to engage our peers to collaborate and enhance each other's professional practice. Further research is needed to identify the barriers to and opportunities for effective collaborations and how ACNPs and other advanced practice nurses can more easily integrate collaboration into everyday professional practice.AACN has set the scope and standards of ACNP practice. The ACNP role is not limited to the clinical expertise and care ACNPs provide. ACNPs can have a profound impact through engagement in varied professional practice activities. The professional growth of ACNPs as individuals and as a profession depends on collaboration among ACNPs and between ACNPs and the interprofessional health care team. The IOM report16 provides targets and goals for the role of nursing as an integral part of health care delivery. The ACNP is at the forefront of this work and needs to continue to lead the way. Although our world and health care delivery have been reshaped by COVID-19, ACNPs need to again collaborate to provide excellent evidence-based care and continue to grow professionally. Postpandemic research is needed to explore and elucidate multiple factors influencing or affecting effective communication competencies among ACNPs.