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My Journey in Progressing from ITU Nurse to Advanced Critical Care Practitioner

Intensive Therapy Unit is probably one of the highly specialised areas to work as a nurse. Extensive knowledge and skills, good critical thinking and keeping calm in high risk situations are just some of the many attributes that an ICU nurse must possess. Once proficiency in ICU nursing has been met, do you know you can progress to become an Advanced Critical Care Practitioner?

Meet Mr. Dennis Ong, a seasoned ITU nurse who’s currently training to become an autonomous Advanced Critical Care Practitioner (ACCP). ACCPs are highly experienced and skilled ITU nurses who received further training with extended roles to make decisions and provide treatment to critically ill patients within one’s own limitations. If you’re an ITU nurse who wants to expand your horizon within your practice, read Dennis’ story on this roadmap to become an ACCP.

My name is Dennis and I have been a nurse since 1995 with a Bachelor Science in Nursing from the Philippines. I arrived here In the UK in 1999 and since then I have studied and worked very hard in the Intensive Care Unit in many exciting roles such as Senior Charge Nurse and Clinical Nurse Specialist with 20 years experience in ICU.

I am now training as an Advanced Critical Care Practitioner (ACCP) working in a busy Intensive Care Unit and ECMO centre in one of London's tertiary teaching hospitals where I will be expected to qualify as a ACCP this coming November 2021. I got the job by applying for the fulltime ACCP post where I had to pass all required interviews from the assessment panel.

To become an ACCP, extensive clinical experience as a senior practitioner in acute settings such as emergency and critical care is essential. You can either be a nurse, physiotherapist or paramedic and must be registered with NMC or HCPC. The ACCP is a two year training programme with a combination of an Academic and Clinical programmes and must be registered with the Faculty of Intensive Care Medicine (FICM) prior to starting your training.

I have been a senior nurse (Clinical Band 7) since 2007 in the Critical Care Unit. Whilst I have enjoyed the clinical managerial roles and helping to develop my team of nurses, advanced clinical practice provided a different dimension to my career. Progressing from an ITU nurse to a clinical nurse specialist role in Critical Care as an ACCP gives me great satisfaction and fulfilment as a nurse.

ACCPs are very well experienced practitioners and have received further high standard education at Masters level combined with extensive clinical training in the ICU to be able to make critical decisions that can save lives of critically ill patients. We are trained to diagnose and treat patients or refer to an appropriate specialist if necessary. We work with all members of the multidisciplinary team including ICU Consultants, Surgeons, Nurses and other allied health professionals.

With my comprehensive knowledge, training and experience in critical care. I can apply the theory into practice to help patients independently once I have qualified. I will be able to fulfil some tasks that are traditionally performed by medical staff such as carrying out clinical assessments of patients, requesting and performing tests to diagnose a patient's condition, carrying some invasive interventions such as peripheral and central venous access, renal replacement lines, and arterial line as well as undertaking non-invasive and invasive airway and ventilations management.

I have recently completed my non-medical independent prescribing course so I can also prescribe essential medications for the critically ill patients. Some of the tasks an ACCP performs include coordinating the safe transfer of patients within our hospital or to other sites, supporting other healthcare staff in assessing and planning care for critically ill patients using a multitude of information from different disciplines involved, undertaking clinical audits and participating in valuable clinical research. I also regularly teach on national courses like Advanced Life Support (ALS) , Immediate Life Support (ILS) and First aid courses as I have always been passionate about clinical education.

I work on 37.5 hours per week contract under agenda for change with mixtures of long days, nights and weekend shifts. As part of our training, we also have allocated study time to attend University and local courses to keep well up to date to maintain safe practice.

In my daily clinical routine after receiving medical handover, we review our patients individually, preparing for our medical ward rounds, assessment of patients, planning of care and performing clinical intervention to improve patient condition. We see patients with a multidisciplinary team approach aimed to provide a holistic and individually tailored quality care. We also attend to all emergency calls such as cardiac arrest calls and review all critically unwell patients outside critical care as part of the medical emergency team.

In the afternoon we attend various clinical meetings such as radiology, microbiology and clinical governance meetings to discuss all our patient cases. We also take time speaking to the patient's family either face to face, virtual or telephone meetings to ensure they are updated on the condition and plan of care for their respective relatives.

In the evening, we review our patients again to ensure that all planned interventions have been achieved based on our ward round plan and finally prepare and handover our patients to the incoming team.

One of the benefits that I truly enjoyed in this role is becoming an independent practitioner. The autonomous role will allow me to extend my capacity to assess, diagnose and provide treatments that I was limited to fulfil as an ITU nurse. As a Band 8a clinical role, it definitely entails more responsibilities but the core goal is still to provide safe quality care to patients. Furthermore, it is a great career progression and provides an exceptional job satisfaction for me.

As the role encompasses enormous accountability, the challenge that I had to face was the intense training programme. Preparing to be an ACCP means a lot of studying, revising, resilience and continuously learning and developing skills in Critical Care. I have also received a lot of support from the multidisciplinary team (MDT) that really helped me get through this point in my training.

It will only be a few months from now and I will be practicing independently as an Advanced Critical Care Practitioner. I believe that being an ACCP can really make a huge difference to patient care. More so, helping ease the growing demands of the current health system by performing an extended role as a nurse is very rewarding. A job that provides satisfaction as I extend my role as a nurse who can make critical decisions and provide treatments in restoring the health of the critically ill and improve their condition whilst under our care. So if you are an experienced ITU nurse or adept with emergency and critical care, the ACCP role might be something that is missing in your career journey.


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