The need for an acute care textbook has been growing. Although outpatient practices have long seen the value of utilizing advanced practice providers (APPs), the surge in acute care providers has been relatively recent. I remember when I was a registered nurse back in the 1990s, I had no idea there was such a role as a nurse practitioner (NP) or a physician assistant (PA) in the hospital, despite the fact they have been around since the 1960s!
I was immediately fascinated and intrigued by the role of APPs. It was not long before I found myself enrolled in an NP program. When I graduated, I was one of the first NPs on the neurosurgery service in the facility where I practiced. The service appreciated the help, but they did not really know what to do with me. It took many months for me to garner the trust of the surgeons, and to show them the true capacity of what APPs could do and how we could really become essential parts of the team.
APPs have come a long way over the years. I have seen the role of NPs and PAs expand tremendously since I first began practicing in this role. I have seen the negative terms to describe us, such as midlevels, physician extenders, and helpers, evolve into advanced practice providers.
I have also seen collaborative growth and mutual respect grow between NPs and PAs, a relationship that was previously more isolated. I respect my PA colleagues, and as an NP I have learned quite a bit from their struggles with role and identity. I find that I personally relate to these struggles in how I practice and how I see my own role on the healthcare team. I have also learned the value of combining resources and focusing on how we are similar, rather than different.
It was important to write this textbook with PAs and NPs together. Both groups have immense knowledge, resources, and experience to share with each other.
Finally, it was essential to write this textbook because it fills a void in the marketplace. Countless times my students have asked if there were an acute care textbook that they could use. I have tried many different textbooks, but either I found them to be too cumbersome or the information provided was just too scant.
This final iteration of the textbook came about as a result of those experiences and discussions with students about what they needed and they wanted. We all suffer from information overload and overwhelm, so the focus of this textbook was to provide the minimum of what new graduate students need to know in order to be competent when they start practice.
We are now in our second edition of this book and the value of it has been an incredible resource. This edition has added new sections to cover COVID and to update best practices for a variety of conditions. In addition, we have added case studies and quiz questions to help the reader to best synthesize the material and prep for the board.
ORGANIZATION
This book is organized into four major sections.
Section I: Acute Care Guidelines by System—In Section I, the APP is exposed to the most common medical conditions organized by system. Although it is by no means comprehensive or inclusive of every medical condition, the section is meant to provide APP students with an overview of very common medical conditions that they should focus on during their studies. In my teachings, I have found students tend to gravitate toward understanding the “zebras” in medicine, or those conditions that are unusual, instead of diagnosing common problems or unusual variants of common problems. This phenomenon might have to do with the common practice of testing on zebras or the student perception that we (as academic institutions) are out to trick them on a test. By not introducing zebras into the context of this book, the students can maintain focus on the most common disease states.
Section II: Perioperative Considerations—Section II contains an operative overview. Again, this section is not a comprehensive review of the operating room, but it does provide APP students an overview of what they should know regardless of where they work. In the acute care setting, operative procedures are very common. It does not matter if acute care practitioners work directly or indirectly with patients in the perioperative period. A review of the common issues is mandatory.
Section III: Procedures—Not all APPs will perform procedures, but students frequently feel a sense of accomplishment in being able to do something tangible. It is difficult to measure the progress of one’s own critical thinking, but if a student can perform a procedure, their confidence level goes up quickly. In this section, some of the more common procedures are listed.
Section IV: Special Topics—There are many issues that we will deal with as APPs; however, these issues do not all fall neatly into predefined categories. This section was created for select topics that could not be defined by systems but were equally important to address. These topics include end-of-life issues, palliative care, health promotion, hemodynamic monitoring devices, telemedicine, transitions of care, and acute care billing. All APPs will deal with these issues during the course of their careers. These topics will also continue to evolve as we conduct more research and clinical studies and as technology improves.
WHAT IS DIFFERENT ABOUT THIS BOOK
This book was created for APP students in the acute care setting. In talking to students about their wants and needs in a textbook, I found students were not able to absorb and assimilate information in heavy, dense textbooks that we had been using. I also found myself telling my students not to bother with a large portion of the textbook because it was not immediately relevant to their basic knowledge. Students struggled to understand what to focus on and what they needed to know versus what was nice to know.
No one can memorize everything they need to know about medicine. As students specialize in various fields, they will learn in-depth information about their specialties that is beyond the scope of this book. However, there is a body of knowledge that every APP should know, and I have done my best to include those topics in this book.
