What It’s Like in a Critical Care APP Fellowship
Why an APP Fellowship Exists (and Why ICU?)
Stepping from graduation into a high-acuity ICU is exhilarating—and terrifying. That’s where an APP Fellowship (Advanced Practice Provider Fellowship) comes in. These 12-month, salaried, post-graduate programs for nurse practitioners and physician assistants provide structured rotations, high-volume procedural exposure, and mentorship that transforms new grads into confident, autonomous ICU clinicians.
The ICU's complexity demands rapid, accurate decision-making, which is why structured onboarding through an APP fellowship is essential. It closes the gap between graduation and full autonomy, offering a guided pathway through high-stakes patient care.
What Is an ICU APP Fellowship?
APP Fellowships are typically 12-month, salaried, benefit-eligible positions designed for acute care nurse practitioners (ACNPs) and physician assistants (PAs). Fellows rotate through various ICU settings, gaining hands-on experience with high-acuity patients.
Tracks and Specialties
Medical ICU (MICU) - The MICU focuses on managing sepsis, shock, and complex medical conditions requiring ventilators and vasopressors.
Surgical ICU (SICU) - The SICU trains fellows in the post-op care of high-risk surgical patients, including vascular and abdominal procedures.
Cardiothoracic ICU (CTICU) - In the CTICU, fellows care for patients after open-heart surgery and gain experience with ECMO, chest tubes, and cardiac devices.
Neuro ICU - The Neuro ICU emphasizes the management of strokes, seizures, and brain injuries, including ICP monitoring and EVDs.
Trauma ICU - The Trauma ICU prepares fellows to manage critically injured patients with polytrauma, massive transfusions, and spinal precautions.
Step-down Units - Step-down rotations focus on stable but complex patients transitioning from ICU, including trach, PEG, and rehab planning.
Procedural/Simulation Blocks - Simulation and procedural blocks teach APPs hands-on skills like line placement, ultrasound, and airway management in a low-risk setting.
The Curriculum You Can Expect
Rotations
You will rotate through a variety of ICUs, ensuring exposure to conditions like sepsis, ARDS, post-op cardiac surgery, ECMO, neurocritical emergencies, and trauma.
Didactics, Simulation Labs, and Certifications
Expect:
Weekly lectures
High-fidelity simulation
POCUS labs
Certifications like difficult airway and ACLS
Structured studying (and learining how to fetch!)
Curious how this experience is built at our program? Our 12‑month APP Fellowship at Piedmont is designed exactly like this—immersive, structured, mentored, and paid. We offer rolling enrollment to motivated NP and PA applicants and encourage shadow rotations to explore our culture firsthand.
Express interest or apply now →
Competency Milestones
Programs often follow structured frameworks with defined competency milestones. Supervision levels progress from direct to indirect as milestones are achieved.
A Day in the Life of an ICU APP Fellow
Here’s a typical weekday in the MICU:
06:00 – Sign-out from the night team
06:30 – Coffee & chart review
07:00 – Bedside pre-rounds & point-of-care ultrasound
10:00 – Multidisciplinary rounds
11:30 – Procedures (A-lines, central lines, etc.)
13:00 – Didactics/Simulation/Journal Club
15:00 – Documentation & quality metrics
18:00 – Handoff to night team
Night shifts include rapid responses, new admits, and codes. These shifts build autonomy and confidence quickly.
Skills You'll Develop
Ventilator management
Hemodynamic monitoring
Shock phenotype differentiation
Goals-of-care and end-of-life conversations
Quality metrics (e.g., VAP, CLABSI prevention)
Mentorship and Evaluation
Fellows are guided by experienced APPs and attendings. Feedback is frequent and structured. Evaluation is based on:
Preceptor feedback
Competency checklists
Simulation assessments
Salary and Benefits
Most ICU APP fellowships are paid positions with full benefits. Compensation is slightly lower than independent APP roles, but the investment in structured learning and mentorship is worth it.
Choosing the Right Fellowship
Hard Metrics:
ICU acuity and case volume
Procedural exposure
Certifications offered
Post-fellowship placement rates
Soft Metrics:
Culture and mentorship
Feedback structure
Protected didactic time
How to Apply
Timeline:
Fall to early winter for most programs
Submit personal statement, resume, and letters of recommendation
Tips to Stand Out:
Highlight resilience and teachability
Show pattern recognition in your clinical reasoning
Demonstrate leadership or teaching interest
Myths About APP Fellowships
Myth 1: They are just cheap labor.
Reality: High-quality programs prioritize education, mentorship, and skill development.
Myth 2: You won't gain autonomy.
Reality: Autonomy is earned progressively through structured milestones.
Burnout and Wellness
Top programs offer:
Formal debriefs
Peer support
Employee assistance programs
Encouragement of work-life balance (check out our podcast we did on this - Candid Conversations)
Career Paths After Fellowship
ICU lead APP
Education or simulation specialist
Quality and safety officer
Research coordinator
Subspecialty ICUs (ECMO, transplant, CTICU)
Quick Takeaways
ICU APP Fellowships are 12-month, paid programs with full benefits.
Fellows rotate through multiple ICUs and receive didactic, procedural, and simulation training.
Structured feedback and mentorship lead to rapid growth.
Choosing the right program depends on both hard and soft metrics.
Graduates are equipped for leadership and high-acuity roles.
FAQs
1. Are these fellowships paid?
Yes. Most are salaried and benefit-eligible.
2. Who is eligible?
Generally, ACNPs and PAs. Some accept experienced providers changing specialties.
3. What procedures will I learn?
Central and arterial lines, intubations, chest tubes, thoracentesis, and more.
4. How am I evaluated?
Via milestone checklists, preceptor evaluations, and simulations.
5. What's the biggest advantage?
Structured learning and mentorship in a high-acuity environment.
Interested in Joining Our ICU APP Fellowship at Piedmont?
ICU APP Fellowships provide a safe, structured bridge between graduation and autonomous ICU practice. In just one year, fellows develop clinical, procedural, and interpersonal skills needed for high-level ICU care. If you’re a PA or NP student interested in critical care, start shortlisting programs and preparing a standout application today.
Georgia’s premier Pulmonary & Critical Care APP Fellowship offers a 12‑month immersive, paid program with structured rotations, simulation training, procedural exposure, and one-on-one mentorship led by expert critical care clinicians.
Rolling admissions available year-round
Optional ICU shadow/rotation for interested candidates
Formal offer of permanent APP placement at one of Piedmont’s hospitals upon completion
Apply to Our ICU APP Fellowship
The Pulmonary & Critical Care APP Fellowship at Piedmont Atlanta is a paid, 12-month ICU training program designed to accelerate your autonomy.
- ✅ Day and Night Shifts in our MICU
- ✅ Simulation & procedures: lines, POCUS, difficult airway, ACLS
- ✅ Expert mentorship & didactic time
- ✅ Rolling applications accepted year-round
