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Position statement
PH NEWS C
Position Statement Age Parameters for Pediatric Nurse Practitioner Practice The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates for children (infants through young adults) and provides leadership for pediatric nurse practitioners (PNPs) who deliver primary health care in a variety of settings. NAPNAP broadly defines the patient population seen by PNPs as children, which supports PNPs’ scope of practice to incorporate all children from birth through 21 years of age, and in specific situations to persons older than 21 years. NAPNAP concurs with the parameter of pediatrics as described by the American Academy of Pediatrics (AAP) in the 1998 position statement entitled Age Limits of Pediatrics. However, NAPNAP believes that where the definition states “pediatrician,” the term “pediatric primary health care provider” should be substituted. The AAP statement is: “The purview of pediatrics includes the physical and psychosocial growth, development, and health of the individual. This commitment begins prior to birth when conception is apparent and continues throughout infancy, childhood, adolescence, and early adulthood, when the growth and developmental processes are generally completed. The responsibility of pediatrics may therefore begin with the fetus and continue through 21 years of age. There are special circumstances (e.g., a chronic illness and/or disability) in which, if mutually agreeable to the pediatrician, the patient, and when appropriate the patient’s family, the services of the pediatrician may continue to be the optimal source of health care past the age of 21 years” (AAP, 1998). NAPNAP works with the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) with the common goals of ensuring that children and families receive quality health care and ensuring that PNPs are educated and prepared to provide that care. The organizations collaboratively use an evidence-based approach to ensure congruency among PNP educational programs, national certification standards, and PNP practice. This rela-
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Volume 16 Number 4
tionship provides the essential foundation to ensure the highest standards of practice, education, and regulation for PNPs. The AFPNP (1996) has established core competencies for graduates of PNP programs. These competencies include providing health care to children from birth through adolescence. Nursing and medical textbooks used in PNP educational programs focus on the care of children through young adulthood. The NCBPNP/N (2001) examination for PNPs includes items related to the PNP’s role in caring for age categories of neonatal (0-30 days) to young adulthood (20-21 years). These core elements and existing congruencies in practice, education, and regulation ensure that the PNP has the expertise and qualifications to care for children of all ages through young adulthood. Recent studies (Brady & Neal, 2000, and Jackson et al., 2001) have validated the diverse and expanding role of the PNP in providing health care to children of all ages. Many PNPs work in the school health setting. Often high school children are 18, 19, or even up to 21 years of age. The pediatric health care provider is well prepared to deal with the physical health and psychosocial needs of high school students of all ages. Additionally, the PNP is educated to perform pre-participation athletic examinations for adolescents and young adults. Many PNPs also have the education to facilitate the transition to adulthood by performing precollege examinations (Muscari & Berkstresser, 2001) and providing health care to young adult college students. There are special situations in which it is appropriate for the PNP or other pediatric health care provider to care for an individual older than age 21 years until appropriate transition to adult health care is successful. There is a growing population of adolescents and young adults with special health
care needs, chronic conditions, and disabilities who need transition care from pediatric to adult health care settings. These adolescents and young adults face unique challenges in accessing adult health care providers who can provide adequate primary and specialized health care services (Betz, 1998a, 1998b). Pediatric health care providers have an extensive knowledge base regarding developmental issues and a unique awareness of the concerns pertaining to adolescent and young adult health care provider transitions and are qualified to assist these patients during the transition phase (Lindeke, Krajicek, & Patterson, 2001). Establishing exclusive upper age limits to PNPs’ practice may create a significant barrier for PNPs and may limit access to health care for this population. In summary, the PNP is highly qualified to provide care to individuals from birth to age 21 years and in special circumstances beyond age 21 years. NAPNAP firmly supports the scope of practice for PNPs to be inclusive of newborns, infants, children, adolescents, and young adults. NAPNAP additionally supports the PNP’s role as a provider of health care for individuals older than 21 years with unique needs and for young adults during the transition to adult health care.
REFERENCES American Academy of Pediatrics. (1998). Age limits of pediatrics. Retrieved January 8, 2002, from http://www.aap.org/policy/02031.html Association of Faculties of Pediatric Nurse Practitioners. (1996). Philosophy, conceptual model, terminal competencies for the education of pediatric nurse practitioners. In The National Certification Board of Pediatric Nurse Practitioners and Nurses PNP program review manual. Gaithersburg, MD: Author. Betz, C. (1998a). Adolescent transitions: a nursing concern. Pediatric Nursing, 24, 23-30. Betz, C. (1998b). Facilitating the transition of adolescents with chronic conditions from pediatric to adult health care and community set-
Reprint requests: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633. J Pediatr Health Care. (2002). 16, 42A-43A. Copyright © 2002 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2002/$35.00 + 0
25/8/126521
doi:10.1067/mph.2002.126521
JOURNAL OF PEDIATRIC HEALTH CARE
PH NEWS C tings. Issues in Comprehensive Pediatric Nursing, 21, 97-115. Brady, M., & Neal, A. (2000). Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions. Journal of Pediatric Health Care, 14, 149-159. Jackson, P. L., Kennedy, C., Sadler, L. S., Kenney, K. M., Lindeke, L. L., Sperhac, A. M., et al. (2001). Professional practice of pediatric nurse practitioners: Implications for education and training of PNPs. Journal of Pediatric Health Care, 15, 291-298. Lindeke, L. L., Krajicek, M., & Patterson, D. L.
(2001). PNP roles and interventions with children with special needs and their families. Journal of Pediatric Health Care, 15, 138-143. Muscari, M. E., & Berkstresser, M. (2001). The precollege examination: Fostering a healthy transition. Journal of Pediatric Health Care, 15, 63-70. National Certification Board of Pediatric Nurse Practitioners and Nurses. (2001). PNP test blueprint for 2000-2002. Gaithersburg, MD: Author.
Supporting Organizations • Association of Faculties of Pediatric Nurse Practitioners (AFPNP) • National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N)
Approved by the NAPNAP Executive Board: April 9, 2002 Designation: Regular
KySS Certificate Course Pediatric CD-ROM Available The KySS I Certificate Course Pediatric CD-ROM Program is available at a cost of $39. Go online to www.digitellinc.com or call (800) 679-3646 for more information.
JOURNAL OF PEDIATRIC HEALTH CARE
July/August 2002
43A
Position Statement Age Parameters for Pediatric Nurse Practitioner Practice The National Association of Pediatric Nurse Practitioners (NAPNAP) advocates for children (infants through young adults) and provides leadership for pediatric nurse practitioners (PNPs) who deliver primary health care in a variety of settings. NAPNAP broadly defines the patient population seen by PNPs as children, which supports PNPs’ scope of practice to incorporate all children from birth through 21 years of age, and in specific situations to persons older than 21 years. NAPNAP concurs with the parameter of pediatrics as described by the American Academy of Pediatrics (AAP) in the 1998 position statement entitled Age Limits of Pediatrics. However, NAPNAP believes that where the definition states “pediatrician,” the term “pediatric primary health care provider” should be substituted. The AAP statement is: “The purview of pediatrics includes the physical and psychosocial growth, development, and health of the individual. This commitment begins prior to birth when conception is apparent and continues throughout infancy, childhood, adolescence, and early adulthood, when the growth and developmental processes are generally completed. The responsibility of pediatrics may therefore begin with the fetus and continue through 21 years of age. There are special circumstances (e.g., a chronic illness and/or disability) in which, if mutually agreeable to the pediatrician, the patient, and when appropriate the patient’s family, the services of the pediatrician may continue to be the optimal source of health care past the age of 21 years” (AAP, 1998). NAPNAP works with the Association of Faculties of Pediatric Nurse Practitioners (AFPNP) and the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) with the common goals of ensuring that children and families receive quality health care and ensuring that PNPs are educated and prepared to provide that care. The organizations collaboratively use an evidence-based approach to ensure congruency among PNP educational programs, national certification standards, and PNP practice. This rela-
42A
Volume 16 Number 4
tionship provides the essential foundation to ensure the highest standards of practice, education, and regulation for PNPs. The AFPNP (1996) has established core competencies for graduates of PNP programs. These competencies include providing health care to children from birth through adolescence. Nursing and medical textbooks used in PNP educational programs focus on the care of children through young adulthood. The NCBPNP/N (2001) examination for PNPs includes items related to the PNP’s role in caring for age categories of neonatal (0-30 days) to young adulthood (20-21 years). These core elements and existing congruencies in practice, education, and regulation ensure that the PNP has the expertise and qualifications to care for children of all ages through young adulthood. Recent studies (Brady & Neal, 2000, and Jackson et al., 2001) have validated the diverse and expanding role of the PNP in providing health care to children of all ages. Many PNPs work in the school health setting. Often high school children are 18, 19, or even up to 21 years of age. The pediatric health care provider is well prepared to deal with the physical health and psychosocial needs of high school students of all ages. Additionally, the PNP is educated to perform pre-participation athletic examinations for adolescents and young adults. Many PNPs also have the education to facilitate the transition to adulthood by performing precollege examinations (Muscari & Berkstresser, 2001) and providing health care to young adult college students. There are special situations in which it is appropriate for the PNP or other pediatric health care provider to care for an individual older than age 21 years until appropriate transition to adult health care is successful. There is a growing population of adolescents and young adults with special health
care needs, chronic conditions, and disabilities who need transition care from pediatric to adult health care settings. These adolescents and young adults face unique challenges in accessing adult health care providers who can provide adequate primary and specialized health care services (Betz, 1998a, 1998b). Pediatric health care providers have an extensive knowledge base regarding developmental issues and a unique awareness of the concerns pertaining to adolescent and young adult health care provider transitions and are qualified to assist these patients during the transition phase (Lindeke, Krajicek, & Patterson, 2001). Establishing exclusive upper age limits to PNPs’ practice may create a significant barrier for PNPs and may limit access to health care for this population. In summary, the PNP is highly qualified to provide care to individuals from birth to age 21 years and in special circumstances beyond age 21 years. NAPNAP firmly supports the scope of practice for PNPs to be inclusive of newborns, infants, children, adolescents, and young adults. NAPNAP additionally supports the PNP’s role as a provider of health care for individuals older than 21 years with unique needs and for young adults during the transition to adult health care.
REFERENCES American Academy of Pediatrics. (1998). Age limits of pediatrics. Retrieved January 8, 2002, from http://www.aap.org/policy/02031.html Association of Faculties of Pediatric Nurse Practitioners. (1996). Philosophy, conceptual model, terminal competencies for the education of pediatric nurse practitioners. In The National Certification Board of Pediatric Nurse Practitioners and Nurses PNP program review manual. Gaithersburg, MD: Author. Betz, C. (1998a). Adolescent transitions: a nursing concern. Pediatric Nursing, 24, 23-30. Betz, C. (1998b). Facilitating the transition of adolescents with chronic conditions from pediatric to adult health care and community set-
Reprint requests: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633. J Pediatr Health Care. (2002). 16, 42A-43A. Copyright © 2002 by the National Association of Pediatric Nurse Practitioners. 0891-5245/2002/$35.00 + 0
25/8/126521
doi:10.1067/mph.2002.126521
JOURNAL OF PEDIATRIC HEALTH CARE
PH NEWS C tings. Issues in Comprehensive Pediatric Nursing, 21, 97-115. Brady, M., & Neal, A. (2000). Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions. Journal of Pediatric Health Care, 14, 149-159. Jackson, P. L., Kennedy, C., Sadler, L. S., Kenney, K. M., Lindeke, L. L., Sperhac, A. M., et al. (2001). Professional practice of pediatric nurse practitioners: Implications for education and training of PNPs. Journal of Pediatric Health Care, 15, 291-298. Lindeke, L. L., Krajicek, M., & Patterson, D. L.
(2001). PNP roles and interventions with children with special needs and their families. Journal of Pediatric Health Care, 15, 138-143. Muscari, M. E., & Berkstresser, M. (2001). The precollege examination: Fostering a healthy transition. Journal of Pediatric Health Care, 15, 63-70. National Certification Board of Pediatric Nurse Practitioners and Nurses. (2001). PNP test blueprint for 2000-2002. Gaithersburg, MD: Author.
Supporting Organizations • Association of Faculties of Pediatric Nurse Practitioners (AFPNP) • National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N)
Approved by the NAPNAP Executive Board: April 9, 2002 Designation: Regular
KySS Certificate Course Pediatric CD-ROM Available The KySS I Certificate Course Pediatric CD-ROM Program is available at a cost of $39. Go online to www.digitellinc.com or call (800) 679-3646 for more information.
JOURNAL OF PEDIATRIC HEALTH CARE
July/August 2002
43A