title: Neurocritical care clinicians' perceptions of nurse practitioners and physician assistants in the intensive care unit.
abstract: BACKGROUND
  The contributions and perceptions of staff regarding nurse practitioners (NPs) and physician assistants (PAs) in neuroscience intensive care units (ICUs) throughout the country are not well known. The objectives of this study were to determine the impact of neuroscience NPs and PAs and assess demographics of ICUs.
  
  
  METHODS
  All members of the Neurocritical Care Society were asked to complete a survey to obtain their perception regarding the addition of NPs and PAs to the ICU team. Participants rated the abilities of NPs and PAs to provide safe patient care, promote a team environment, anticipate or prevent neurological deterioration, address patient or staff concerns in a timely manner, and communicate effectively on a Likert scale of 1-5. In addition, members were asked to provide basic demographics and background information on the type and size of ICU, type of provider in charge, and role of NPs and PAs in their ICU, including procedures performed, documents written, and number of patients per provider. Both quantitative and qualitative data were collected and analyzed. A Mantel-Haenszel chi square and ordinal logistic regression model were used to determine the relationship between the background information and the perception of the abilities of NPs and PAs.
  
  
  RESULTS
  The study cohort was composed of 10% of Neurocritical Care Society members. Additional responsibility of NPs and PAs was associated with higher scores in safety, the ability to promote a team environment, address patient or staff concerns, communication, and most importantly, the ability to anticipate or prevent a neurological deterioration (all ps < .0001). Number of NPs and PAs, number of years of employing NP/PAs, number of procedures, and amount of documentation also positively affected safety.
  
  
  CONCLUSIONS
  Additional responsibility of NPs and PAs has strong potential to improve staff, patient, and family satisfaction and safety and prevent neurological deterioration. Thus, NPs and PAs should be utilized to the full extent of their role.
authors.affiliation: Questions or comments about this article may be directed to Jennifer Robinson, APRN MS CNRN at jennifer.robinson@yale.edu. She is a Neuroscience Nurse Practitioner at Yale New Haven Hospital, New Haven, CT. Sarah Clark, MHS PA-C RN BSN, is a Physician Assistant at Yale New Haven Hospital, New Haven, CT. David Greer, MD MS, is a Professor of Neurology and Neurosurgery at Yale University, New Haven, CT.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Robinson
authors.forename: Sarah
authors.initials: S
authors.lastname: Clark
authors.forename: David
authors.initials: D
authors.lastname: Greer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D009422:Nervous System Diseases / Q000628:therapy*; D009722:Nurse Practitioners / Q000523:psychology*; D061214:Patient Safety; D017060:Patient Satisfaction; D010823:Physician Assistants / Q000523:psychology*