Availability of Advanced Practice Providers in Adult Intensive Care Units in the United States: A Survey.

Publication date: Jul 01, 2025

How advanced practice providers (APPs) are deployed in adult US intensive care units (ICUs) is understudied. Further, whether state-level restrictions on practice affect the availability of these providers is unknown. To describe staffing patterns of ICU APPs (nurse practitioners, physician assistants) in the context of physicians-in-training (interns, residents, fellows) and to explore the association between state-level APP practice restrictions and employment. Data from a national survey of pre-COVID-19 (steady-state) ICU staffing linked to the 2020 American Hospital Association survey were used to examine staffing patterns (via descriptive statistics) and to explore the association of state-level practice restrictions with the presence of APPs in ICUs (via multivariable regression). The cohort included 588 adult ICUs, of which 336 (57. 1%) reported both APPs and physicians-in-training, 124 (21. 1%) APPs only, 73 (12. 4%) physicians-in-training only, and 55 (9. 4%) neither. Units with both provider types were more commonly surgical ICUs (17. 6% vs ≤9. 6%; P < .001), whereas those with neither were 98. 2% mixed units. Those units with neither were smaller and more often in smaller, nonteaching, for-profit hospitals in nonmetropolitan areas. Two hundred twenty-five ICUs (38. 3%) were in states allowing full APP practice scope. After adjustment, the odds of employing APPs were nonsignificantly higher in ICUs in full-practice states. Both APPs and physicians-in-training are commonly deployed in US adult ICUs, often together. Laws limiting practice scope may impede deployment of these providers in ICUs.

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