What I do at work: consultant nurse in critical care

Advanced practitioners play a central role in critical care, bringing advanced clinical assessment, diagnostic decision‑making and invasive procedural skills to some of the sickest patients.

In this article, we use the phrase Advanced Nurse Practitioners (ANPs) to describe nursing staff working at an advanced level of practice, recognising that “advanced practitioner” encompasses a range of established and vital nursing roles.

Advanced roles in intensive care have developed significantly over the past decade with advanced critical care practitioners (ACCPs) recognised as highly experienced and trained clinicians. They're able to undertake comprehensive assessments, request and interpret investigations, prescribe, and perform key interventions under a consultant‑led model of care. 

What still drives me is being at the bedside, delivering hands-on care

For consultant nurse Suman Shrestha, RCN Professional Lead for Critical Care, this progression reflects the depth of expertise experienced nurses bring to ICU. He leads a team of ACCPs and ANPs and serves as the trust lead for advanced practice.

As a registered ACCP and member of the Faculty of Intensive Care Medicine, Suman works alongside intensivists, trainees and the wider multidisciplinary team to provide continuity, leadership and a patient‑centred perspective that strengthens care around the patient.

Here, Suman shares how he built his career in critical care, the value ANPs bring and why the four pillars of advanced practice are so important to the profession. 

How would you describe your role in a sentence? 

My role involves providing holistic care to critically ill patients, managing a team, and bringing together years of nursing experience with advanced training. 

What’s your nursing background? 

Since qualifying as a registered nurse, I began my career on a rotation programme that exposed me to a wide range of settings, from medical to surgical and the private sector.

The programme eventually led me to intensive care and, from my very first day, I knew I’d found my place. I was drawn to the complexity of the patients, the depth of physiological understanding required and the way technology, expertise and compassion come together to support patients and their families.

From that moment, I committed to a career in intensive care. Over the years, I’ve worked in a variety of roles within critical care including technical support, clinical education, critical care outreach, nurse in charge and team leader, before progressing into advanced practice.

What still drives me is being at the bedside, delivering the highest standard of hands-on care. That passion is why I chose the clinical route rather than the administrative or managerial path to progress my career. It wasn’t an easy journey at the time; the lack of clear competency frameworks, governance and structured development pathways created significant scepticism.

While it’s not perfect today, critical care and emergency care now offer far clearer progression routes than many other specialties.

What’s the training route for ANPs?

Becoming an ANP usually involves:

• a combination of academic education at master's degree level and training in clinical practice
• postgraduate clinical experience within your chosen specialty to build depth of expertise and confidence
• a formal training post or structured development role, allowing supervised practice and progressive responsibility
• meeting the specific requirements of the role, such as non‑medical prescribing, advanced clinical competencies and evidence of ongoing professional development.

What are the four pillars of advanced practice?

Clinical practice, leadership, education, and research. These form the nationally recognised framework that defines what it means to work at an advanced level of nursing in the UK. 

They outline the professional clinical judgement, autonomous decision‑making and person‑centred care expected of advanced practitioners; the leadership skills needed to support teams and ensure safe, effective service delivery; the educational role practitioners play in developing colleagues and fostering a learning culture; and the commitment to using and contributing to evidence that underpins high‑quality care.

How do ANPs work within a multidisciplinary team?

ANPs work alongside the medical team and wider multidisciplinary colleagues. In ICU, we work within the team led by an ICU consultant (intensivist) performing a variety of clinical activities.

These include conducting physical examinations, initiating and adjusting treatment plans (including prescribing), referring patients to other specialties, and performing invasive procedures such as inserting central and arterial lines and managing the airway.

What value do ANPs bring to a health care team?

ANPs bring a huge amount to any team, and a lot of it comes from the years of experience they have. Most are experienced nurses moving into advanced practice, so they’re used to handling complex situations and can spot when something isn’t quite right straight away.

They’ve seen a variety of clinical cases before, so stepping into decision‑making roles might not be too daunting with appropriate level of training, education, supervision, competencies and within agreed scope of practice.

Their practical skills really shine too. Because they’ve spent years assisting with and delivering some of the procedures, they understand not just how to do something like a central line insertion, but how it feels for the patient.

This helps them explain procedures clearly, keep patients calm and bring families along with the plan. And with their solid grounding of knowledge in medicines and therapies and how they are applied by the bedside, they can talk through treatment options in a way that’s both reassuring and realistic.

And at the heart of everything, ANPs hold onto that holistic nursing approach. Even with the advanced responsibilities, they still see the whole person, not just the clinical problem. Their familiarity with local policies and procedures means they help keep practice safe and consistent, making day‑to‑day care smoother for everyone.

What’s most challenging about the job? 

One of the biggest challenges is still recognition and acceptance. Even though advanced practice has become well established in critical care, not everyone fully understands the depth of training, governance and responsibility that sits behind the role.

There can still be misconceptions about what ANPs are “allowed” to do, or assumptions that their role is simply an extension of experienced nursing rather than a distinct advanced clinical role.

That means part of the job involves gentle education, role‑modelling, building trust and improving the quality of care. This shows, through consistent practice, that advanced practitioners are safe, competent and add real value to the team. It’s getting better, but it can still be a hurdle.

And the most rewarding?

I love my job. It’s so varied, and I get to see a lot of the patient’s journey in intensive care. You get to deliver high‑level interventions, for example, invasive procedures like line insertions, formulate treatment plans, make complex decisions, while keeping the human side of care front and centre.

Continuity is another huge reward. Because ANPs are permanent, consistent team members augmenting the medical provision of the service, they follow patients from the moment they arrive in ICU through some of the most vulnerable points in their ICU stay.

That continuous ongoing connection allows you to build relationships with patients, families and colleagues in a way that rotating staff simply can't. 

It’s a role where you can see the impact of your work every single day, and that’s incredibly fulfilling.