NEWS-Line Communications - Nurse Practitioners -
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Published on: 10/1/2001
Last Visited: 2/10/2002
Andrea M. Kline, RN, MS, PCCNP, CCRN, is a pediatric critical care nurse practitioner on the Pediatric Intensive Care Unit of Children's Memorial Medical Center in Chicago.The largest freestanding children's hospital in Illinois, Children's Memorial has more than 200 beds exclusively for the use of their pediatric patients.
Kline, came to Children's Memorial in 1994, after spending two years as a staff nurse in the Pediatric Intensive Care Unit (PICU) at the Children's Hospital of Michigan in Detroit.After about a year as a staff nurse on the night shift in the Children's Memorial PICU, she started in the Pediatric Critical Care Nurse Practitioner Program at Rush University, working nights and taking classes during the day.When she was nearing the end of her clinical studies at Rush, she discovered that the Children's PICU was looking for two nurse practitioner candidates."Until this point, PNPs (pediatric nurse practitioners) in the PICU did not exist at Children's Memorial Hospital.I was fortunate to start as an NP at the same time as another nursing colleague, Lauren Sorce Grehn, who was simultaneously completing a Pediatric Nurse Practitioner Program at Rush University.Lauren and I have been practicing together in the ICU for more than four years now.It was very helpful to start as novice NPs together, forging new waters in the Pediatric ICU NP role.It has proven to be an extremely rewarding experience."
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According to Kline, the most common diagnosis in the ICU is respiratory failure.This can be due to infection, aspiration, seizures, among other causes.
"As NPs in the PICU," Kline explains, "we are responsible for the assessment, diagnosis and treatment of critically ill children."These responsibilities include taking admission histories and conducting physical examinations, ordering treatments, formulating diagnoses, interpreting laboratory data, participating in education and research, and communicating with patients, families and staff."The nurse practitioner is the first called by the bedside nurse when there are any questions or concerns regarding their patients," says Kline.This includes fevers, low or high blood pressures, respiratory difficulties and sedation/anxiolysis issues, providing the NP with an opportunity to assess the patient and order an appropriate intervention, if that is warranted.In addition, the hospital's medical team works in collaboration with various subspecialty teams, providing NPs with extensive exposure to all matters of emergency and long-term medical care cases.
Kline's day to day responsibilities begin early."A typical day starts by arriving at work between 6:30 and 7 a.m., follow-up on X-rays, review laboratory results, and formulate a tentative plan for the day before rounds begin.Generally, the nurse practitioner's load is three or four patients at a time.
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"We have recently added transpyloric feeding tube placement to our list," says Kline."Bedside placement of transpyloric feeding tubes is saving our critically ill patients money, as well as improving safety, since the patient does not have to move to the radiology suite.This is especially helpful for patients that are unstable."
As the day continues, patient progress is discussed with the ICU fellow and attending physician."At the end of the day, the nurse practitioners update the resident on-call on new issues and the status of each of our patients, as well as plans for the night.We cover our patients five days per week during daytime hours, generally 7 a.m. to 5 p.m. After we leave for the day, patient care is provided by the ICU resident, fellow and attending team on call."
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Kline and her fellow NP are a part of the hospital's ICU medical team."There are three primary services that can admit to the ICU.The cardiothoracic surgery team, the pediatric surgery team and the medical team.The four residents and the two nurse practitioners follow any patients admitted to the ICU under the medical team.The NPs follow children with every acuity level in the ICU.Admissions are assigned to the resident or nurse practitioner carrying the lightest load of patients."A main benefit for patients of NPs in the PICU, according to Kline, is the fact that the NPs are there month to month."This is especially helpful for those children who may have frequent admissions or complex medical issues," she says."This provides for excellent continuity of care for our patients."
Another component to the NPs role, says Kline, is their ability to function as a "resource" to others during morning patient rounds."Each day there is one attending who is the 'resource' attending.This person is responsible for fielding patient related calls and running the unit while the rest of the medical team is completing patient rounds."Kline feels that this allows the medical team to facilitate medical rounds in a complete and effective manner."One nurse practitioner each morning works with the 'resource' attending to address to patient management issues, including admissions and procedures that must occur during morning rounds.Lauren (Grehn) and I alternate this responsibility.This addition to our role has increased our assessment, management and problem solving skills."
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To Kline, the primary focus of the NPs position is clinical patient management, although other aspects such as educator, researcher, and patient and family advocate are very important."We speak at national conferences, participate in research studies and [serve on] hospital and unit based committees.I became a nurse practitioner to increase my knowledge base and increase my autonomy.I [have] found it to be an exciting and growing opportunity."
For as long as she can remember, Kline has always wanted to be a nurse.After she began nursing school, she spent one summer as a nurse's aide on a general medical unit in Michigan's Oakwood Hospital and was an extern in the PICU at St. John's Hospital in Detroit.
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Although Kline does not currently have any plans to return to school for further education, she leaves room open down the road for possibly a Ph.D. in education program."Lauren and I serve as guest lecturers for the Graduate School of Nursing at Rush University in Chicago, IL, and Lauren is our primary site investigator for a national, multi-center trial involving prone positioning in pediatric Acute Respiratory Distress Syndrome (ARDS) that begins this fall."Kline is also very excited by her role in a recently released publication.She, Grehn, and Joyce Weishaar, the team's Clinical Nurse Specialist, have written a chapter on renal critical care in the textbook "Critical Care Nursing of Infants and Children," edited by Martha A.Q. Curley.
With her extensive and challenging work in the area of children's health, Kline knows there is so much to do and so few hours in which to do it."The greatest challenge of my job is balancing all aspects of the NP role," she says."It is a constant struggle to provide excellent patient care, participate in research, prepare educational programs, and attend meetings on a regular basis.Currently, we do not have scheduled office time to complete all of our projects."
For Kline, the rewards of being an NP seem to far outweigh the almost exhaustive demands."I am continually striving to learn more.It takes a conscious shift in thinking to think about patients in the medical model, and then develop differential diagnosis and plans of treatment.I work on these skills every day.The best thing about my job is having patients who were gravely ill walk into the ICU to say 'hello.' That is what makes me come back to work everyday."
Andrea M. Kline, RN, MS, PCCNP, CCRN received her BSN at Michigan State University and her MS from Rush University in Chicago.She completed her PCCNP and Post-Master's PNP programs also at Rush University.She is certified in Pediatric Advance Life Support (PALS), is a Critical Care Registered Nurse (certified by the American Association of Critical Care Nurses) and a Pediatric Nurse Practitioner (certified by the American Nurses Credentialing Center).
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