As a teen, Jamie Hill, BSN, RN, CEN, CCRN, CFRN, CTRN, thought being a flight nurse on a helicopter would be the "coolest career." Fast forward 15 years. Hill now has that coolest career, but after working with CALSTAR (California Shock Trauma Air Rescue)  for 4 years, the Gilroy nurse wanted to find a way to deepen his knowledge and bring more to his patients.

The answer for Hill and 25 other students joining him in the fall 2009 cohort is the Acute Care Nurse Practitioner (ACNP) program at the University of California, San Francisco School of Nursing. He knows he's in for the ride of his life.

Extensive Curriculum

One of only a handful of programs on the West Coast, UCSF's ACNP program graduates some 18-22 students annually. Roxanne Garbez, PHD, CNS, ACNP, RN, program director, said students can enter the program in three ways: as traditional master's or master's entry program in nursing students, who take the program over 2 years, or as post-master's students, who only complete an ACNP certificate program over 12 months. She receives far more applications than slots for the program, which begins each fall.

Hill, who said he still loves flight nursing, plans to continue to work while he's in school. While most students continue to work, Garbez said many find the pace of the class too intense for full-time work. She should know - she's also a graduate, one of the first post-master's students in the first class. She has been faculty for the ACNP program since 1999. She explained program graduates are trained in care for acutely ill patients with multiple comorbidities.

"Our students spend the first year focused on didactic learning, with 2 days a week devoted to the classroom," she said. "The students immerse themselves in advanced health assessment, pharmacology and pathophysiology. But they also begin clinical practice immediately, spending 1-2 days a week in clinical preceptorships. Almost 50 percent of the preceptors are ACNP graduates themselves."

"In the second year, the process is reversed," she continued. "They have class 1 day and spend a majority of their time in clinical practice."

School to Work

By contrast, post-master's students (those who come into the program with an MSN) do it all in 12 months, with their main focus on clinical practice. They put in a minimum of 540 hours in clinical practice while spending 2 days a week in class. It takes the intense program to another level, but Garbez said students don't seem to mind.

"They can go back to their jobs and apply what they've learned in school to what they're doing immediately," she said. "It's great feedback for them and excellent follow through related to their patient care."

For Pam Dudley, MS, ACNP, RN, CCRN, that opportunity to translate education to practice was a big draw. Dudley was the first nurse practitioner hired by Regional Medical Center of San Jose and continues to be the only ACNP. Working with the trauma team at Regional means she works throughout the house, caring for trauma patients on any unit. It's a good fit, made better by the education she received in the ACNP program.

"I worked surgical ICU for 10 years before I decided to apply for the ACNP program," Dudley said. "For the first year of the program, I kept saying, 'I'm never going to get this. There's so much to learn.' Then in the beginning of the second year, your mind begins to change to start thinking about patient care in a more global way using differential diagnosis. It stretched me and the way I look at nursing in a very positive way."

New Model

Because the role of acute care NPs is so new, many may have to carve out their own niche, Garbez said. That suited Dudley just fine.

"I got the job and my manager and supervising physician asked me, "What do you want to do?" I worked in tandem with them to create my role," she said. "Now, with their blessing, I'm expanding to work on my RNFA, to be more valuable to the team."

Garbez said the need for - and interest in - the program is evident from the phone calls she receives from facilities looking for her graduates.

"ACNPs work with acutely ill hospitalized patients, which is different than other nurse practitioners who work in primary care or clinic settings," she explained. "Acute care facilities are beginning to realize the ACNP can play a very important role on the healthcare team in the critical care environment. As a result, hospitals are looking specifically for ACNPs and using them in a way that patients are best served by their different skill sets."

Dudley said use of ACNPs is positively correlated with decreased length of stay, improved patient and family satisfaction and, most importantly, improved team communication and patient outcomes.

"We're a hybrid between the medical model and the nursing model, and I have learned to work closely with a lot of different providers, all with the patient at the center of what I do," she said. "I've had to find ways to let the doctors and other team members know how my role is to provide continuity for patient care. There's a new doctor looking at the patient every 24 hours, but I'm there every day. I even follow up with them after discharge."

For Hill, those parameters sound like a perfect fit. Before he made the decision to apply for the program, he shadowed Dudley to get a sense of the role. It's one he's looking forward to.

"I have truly found my home as a flight nurse," he said. "The ACNP goes hand-in-hand with that role, and will also allow me to do other challenging patient care. I'd like to work with an intensivist group and continue flight nursing. I want to be part of someone's worst day and help make it better, to make a difference."

For more information on the ACNP program, go to http://nurseweb.ucsf.edu/www/spec-acp.htm.

Candy Goulette is regional public relations/editorial liaison at ADVANCE.