Building and Sustaining Advanced Practice Careers in the CICU

It takes a certain type of person to thrive in the high-acuity environment in pediatric cardiac intensive care units (PCICU). The fast-paced, ever-evolving field is appealing to new graduate advanced practice providers (APPs) eager to put their critical thinking skills to the test. The transition from trainee to provider is a steep learning curve in any field, particularly this one. The nuances of congenital heart disease, cardiac physiology, and critical care medicine take many months and intentional time to begin to understand. After several years in this stimulating field, working days, nights, weekends, and holidays, a provider may look around and wonder: Is this maintainable? How do I continue to grow? What’s next? Building a sustainable career in pediatric cardiac critical care is not an easy mission but can be achieved with several key components in place.

First, cultivating interests in the field. After an APP has found their footing in cardiac critical care, they should be encouraged to explore special interests in this unique field. Whether through education, quality improvement, or clinical research, involving them in projects and activities outside the unit engages them in a new way, piques their curiosity, and contributes to longevity in the PCICU. There is something so rewarding about seeing a part of cardiac critical care medicine through the eyes of an educator or process developer. This opens the door to teaching on newfound expertise and sharing knowledge with other providers, trainees, and bedside staff. These contributions are not only fulfilling and stimulating, but they elevate the playing field of cardiac critical care medicine for everyone involved.

Second, a cohesive team. Healthy team dynamics most certainly contribute to provider retention and enhance patient care. The ideal team acknowledges that physicians, APPs, nurses, respiratory therapists, pharmacists and many others play an important role in delivering exceptional patient care. Each of these disciplines should be challenged to think critically and contribute meaningfully to the conversation. Diminishing the role of the APP to a “scribe” who is only expected to update notes and orders will lead to dissatisfaction and high turnover rates. Instead, a dedicated team should invest in APPs, teach them at the bedside, partner with them both on and off the unit, and mentor them through professional advancement. This will pay dividends as they reach their full potential. When APPs are treated as medical professionals and held to the highest standard of understanding cardiac critical care, they are more engaged and determined to become better clinicians. They will, in turn, contribute to patient care in a more meaningful way and share this knowledge with trainees and junior providers.

Finally, the potential for protected time. This is, no doubt, a physically, mentally, and emotionally taxing field. After clinical mastery is achieved, non-clinical time is crucial in fostering professional growth. Time spent off the unit is also key in maintaining mental health and mitigating burnout. It is only with this healthy balance that one can contribute to this field in the long term.

Advanced practice in the PCICU can be an incredibly fulfilling and impactful career. It must be treated as just that – a career, and not simply a bandage to aid in the unit’s workload. With the proper investment in the growth of each individual APP, sustainability is possible, and both the healthcare team and the patients reap the benefits. When we as a field commit to cultivating professional interests, promoting cohesive team dynamics, and protecting time for contributions and work-life balance, we move towards viable career longevity for APPs and all providers in pediatric cardiac critical care.