Nurse practitioners and physician assistants have been used increasingly in intensive care units with promising results, says Ruth Kleinpell, R.N., director of the Center for Clinical Research and Scholarship at Rush University Medical Center in Chicago.

She co-authored a review of the literature in 2008 for Critical Care Medicine and found that research shows that integrating NPs and PAs into intensive care units enhances patient care and that outcomes are similar to those of resident physicians.

One driver of those results, Kleinpell says, is that NPs and PAs offer continuity of care in overseeing admission, management and discharge planning as opposed to care under medical residents and fellows who are rotated in and out of settings as they train.

"Also, by virtue of their background and training ... they are used to educating patients and families," she notes.

Beyond direct patient care, Kleinpell says advanced practice nurses are improving quality and safety with quality-improvement projects by teaching colleagues and by making sure evidence-based best practice protocols are being used.

The benefits of integrating NPs and PAs come without added liability costs to hospitals, she says. "Actually, there's some thought that patients and families are more satisfied and less likely to bring up litigation because there's someone there who's coordinating their care and educating more," she says.