BACKGROUND: Nurse practitioners (NPs) in pediatric intensive care units have increased dramatically over recent years. Although state regulations are changing pediatric nurse practitioner certification, licensure and credentialing requirements, available acute care, and critical care educational programs are limited. Thus, entry-level practitioners continue to have varied clinical experience and educational preparation. OBJECTIVE: To describe the current educational preparation and scope of practice of pediatric NPs and provide guidelines for postgraduate training to successfully integrate NPs into the pediatric intensive care unit (PICU). DESIGN: A group of NPs practicing in pediatric critical care recognized the imminent need for comprehensive orientation guidelines that are readily accessible to physicians and other nurse practitioners to successfully transition entry-level NPs into the PICU. The NPs held many discussions to identify commonalities and differences in the education foundation in pediatric NP programs, expected clinical experience and knowledge of NP students, and anticipated needs and gaps for the entry-level practitioner. A convenience sample of 20 pediatric critical care nurse practitioners practicing for > or =5 yrs were interviewed to examine current orientation processes for entry-level NPs into the PICU. Sample orientation guidelines, job descriptions, and procedural competency forms were collected and reviewed from various PICUs across the United States. An orientation model was drafted and distributed to a secondary panel of ten experienced practitioners to gather expert opinions. Responses were reviewed and a revised draft of the document was distributed to a group of APNs involved in postgraduate education. RESULTS: A PICU orientation model for entry-level pediatric critical care nurse practitioners was developed. CONCLUSIONS: The orientation curriculum presented here may serve as a resource for NPs and collaborating physicians who are developing a training program for entry-level practitioners.