In response to the recent guest editorial that discussed intensivist training programs and outcomes for critically ill patients, I agree there is a need for further education of those responsible for care of the critically ill. Perhaps the answer to this dilemma is to employ acute care nurse practitioners (ACNPs) for 24-hour coverage of the intensive care unit (ICU), certify specially trained, experienced ICU registered nurses (RNs) to perform certain procedures, and allow them to follow certain protocols independent of a physician. According to the editorial, “Further expansion of the role of critical care nurses, pharmacists, and respiratory therapy practitioners into the critical care environment would be important to improve outcomes for patients in ICUs.”

The current models for employing ACNPs in the ICU transfer tasks to ACNPs to allow residents to obtain more uninterrupted sleep. This, however, does not help...

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