- Email: [email protected]
The acute care pediatric nurse practitioner
Professional Issues
www.jpedhc.org
Department
Section Editor Maureen Van Dinter, MS, CPNP, FNP-C Department of Family Medicine University of Wisconsin Madison, Wisconsin
The Acute Care Pediatric Nurse Practitioner Patricia Clinton, PhD, RN, CPNP, & Arlene M. Sperhac, PhD, RN, CPNP
Traditionally, pediatric nurse practitioners (PNPs) have practiced in primary care. In the past several years, in response to opportunities in the changing health care system, some PNPs have moved into the acute care (AC) setting. A growing number of State Boards of Nursing have responded and demanded certain educational and credentialing requirements. The emergence and credentialing of the acute care PNP has raised questions from both acute and primary care PNPs. The purpose of this article is to address those questions and provide the reader with the most updated information regarding this issue.
Patricia Clinton is Clinical Associate Professor and Director of the Masters Programs in Nursing at the University of Iowa College of Nursing, Iowa City. Arlene M. Sperhac is Professor and Coordinator of the Pediatric Nursing Practitioner Program at the Rush University College of Nursing, Chicago, Illinois. Reprints not available from the author. J Pediatr Health Care. (2005). 19, 117120. 0891-5245/$30.00 Copyright © 2005 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2005.01.006
Journal of Pediatric Health Care
BACKGROUND The role of the PNP in acute care (PNP AC) has followed the development of the acute care adult nurse practitioner role. In the mid-1990s, responding to changes in physician residency practice as well as economic factors impacting health care costs associated with the care of acutely ill patients, nurse practitioner practice evolved to meet those needs and the role of the acute care nurse practitioner was established. The new role of the acute care NP was initially centered on the acute health care needs of adults. Clinical experts and educators in adult acute care worked through the mid-
1990s to define educational requirements for the new role. In 1996, the American Nurses Association (ANA), together with the American Association of Critical Care Nurses (AACN), created the first statement of standards and scope of practice for the acute care nurse practitioner (ANA, 1995). Referring to those statements, national leaders saw that the new role was not reflected within the current primary care adult NP certification exams offered by the American Nurses Credentialing Center (AN CC). As a result, the AACN and the ANCC agreed to collaborate on the development of a new certification exam that would reflect the new practice standards and scope of the acute care NP. Similar to the development of the adult acute care nurse practitioner, pediatric nurse practitioners have evolved the practice and role of the PNP in acute care. Formal recognition and credentialing of the PNP AC is rapidly moving forward: 1) position papers on scope of practice for the PNP AC are being formalized and distributed to parties of interest for endorsement; 2) new acute care educational programs are joining established programs, bringing the number to approximately 20 graduate level acute care offerings; 3) a certification exam is available as of March/April 2005
117
TABLE. Eligibility requirements Pathway I
Pathway II
Pathway III
Type/level of program
Acute care PNP Master’s in Nursing, Acute care PNP Master’s in Nursing, Post-Master’s, or Doctorate in Nursing Post-Master’s, or Doctorate in Nursing
Time from graduation to examination
Within 24 months
Licensure, other qualification Active RN, current PALS Clinical skills
Met through educational program
Clinical hours
Met through education program
Continuing education
None
January 2005 from the Pediatric Nursing Certification Board (PNCB); and 4) the National Organization of Nurse Practitioner Faculties (NO NPF) has developed the acute care nurse practitioner entry-level competencies which have been endorsed by PNCB. Pressure to differentiate the primary and acute care role also comes from the National Council of State Boards of Nursing (NCSBN). The Council has stated that the focus of advanced practice education and subsequent certification must correspond (NCSBN, 2002). In other words, it is understood that educational preparation as a PNP prepares one for the primary care role. To practice in acute care, the educational preparation must prepare one for that role by providing content with a focus on acute care. Based on the different needs of children in primary care and in acute care, the roles of the NP vary, thus different educational programs and different certification exams are necessary. Recognition of the acute care role has also come from NAPNAP members who have been practicing in the acute care role and have requested a more visible position within NAPNAP, which has been focused on the primary care PNP since its inception. In July of 2004, the Acute Care PNP 118
Volume 19 • Number 2
Primary care PNP Master’s in Nursing, Post-Master’s, or Doctorate in Nursing More than 24 months Limited offering. This pathway available for only 24 months from onset of exam Active RN, current PALS Active RN, current PALS, certified PNP Skills verification form (with signature Skills verification form (with verifying person signing has worked signature verifying person with applicant) signing has worked with applicant) 1000 clinical hours within past two years 1000 clinical hours within past two years None 10 contact hours in acute care PNP education within past two years
special interest group (SIG) was officially created. The leadership by members of this SIG offers opportunities for expanding NAPNAP membership, diversifying educational offerings, and fulfilling NAPNAP’s mission, vision, and goals to promote optimal health care for children and families. The NAPNAP Executive Board approved a position paper in 2004 that recognized and described the role of PNPs practicing in the acute care role (NAPNAP, 2004). DEFINITION Acute care PNPs function in a variety of settings to provide care to children with complex physiologic conditions and rapidly changing clinical conditions (PNCB, 2003). Like their primary care counterparts, PNP ACs are grounded educationally in growth and development, health promotion, and disease prevention. What distinguishes the PNP AC from the primary care PNP, however, is the type of care delivered to infants, children, adolescents, and young adults. The acute care PNP provides care “…to meet the specialized physiologic and psychological needs of patients with complex acute, critical, and chronic health conditions including the recognition and management of emerging crises
and organ dysfunction and failure” (NAPNAP, 2004). The skill set required for this role is generally much more invasive than the skill set commonly practiced in the primary care role. For example, depending on the specialty area of practice, an acute care PNP may insert or remove chest tubes, perform lumbar punctures, or tap a ventricular shunt (Pediatric Nursing Certification Board Acute Care PNP Expert Panel, 2003). The focus of care is to restore the functional health of the child and to promote maximal health and minimize complications (PNCB, 2003). As one might expect, however, there are many skills and procedures that overlap between the two roles. ANOTHER CREDENTIAL? Although some would argue that a PNP is a PNP despite the practice setting, it is very clear that PNP AC practice differs significantly from the PNP in primary care. The focus for the PNP in acute care is on complex acute, critical, and chronic health conditions and emergent crises (NAPNAP, 2004). Currently practicing PNPs in acute care have been educated in either primary or acute care programs and occasionally both. Up Journal of Pediatric Health Care
until now, there has not been a mechanism for certifying PNPs in the acute care specialty. State Boards of Nursing are increasingly requiring adherence to the regulatory requirements promoted by the NCSBN in their document Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements (NCSBN, 2003). The requirement for advanced practice registered nurse licensure is for graduate level education that includes both the didactic knowledge and clinical competency skills unique to the specific advanced practice role (NCSBN, 2003). The development of national consensus-based core competencies for the new role of the acute care NP is an important step in identifying and matching knowledge and skills to the specific NP role. Using the framework developed for core NP competencies in primary care, the National Organization of Nurse Practitioner Faculties (NONPF), together with more than 20 other national nurse practitioner organizations, developed the new core acute care nurse practitioner competencies. The new specialty acute care NP competencies differ from the primary care PNP competencies but build upon the seven domains of core competencies for NPs that serve as the foundation for all advanced practice specialty education. In the survey of PNP ACs, PNCB identified areas of overlap between the primary and acute care NP roles. As one would expect, there is a strong foundation of knowledge and clinical assessment and management skills related to growth and development that is inherent to both roles (PNCB Acute Care PNP Expert Panel, 2003). The new acute care exam will reflect the concepts common to both roles but also acknowledge and utilize the core competencies for acute care nurse practitioners identified by the national Organization of Nurse Practitioner Faculty Acute Care Nurse Practitioner Competencies (NONPF, 2004). Journal of Pediatric Health Care
ELIGIBILITY The eligibility requirements for PNPs in acute care are determined by the certifying agency in accordance with national standards for education and practice. The PNCB has identified and published the eligibility requirements acknowledging that the circumstances of a candidate’s educational preparation may differ. Requirements include graduate level education, active RN licensure, and current PALS credential. The PNCB has recognized that the certification of a new subspecialty necessitates recognition of practitioners already practicing in that role and the reality of different educational preparation. Accommodations for these differences have been incorporated into the eligibility requirements. However, the accommodations are time-limited and thus compliance with the time frame is important. The Table summarizes the three ways that potential candidates can meet the eligibility requirements. Pathway III is a limited offering that will only be available until January of 2007. Pathways I and II will continue as the two means through which candidates will have to access the exam. QUALIFYING EXAMINATION Voluntary certification by advanced practice nurses has been associated with personal growth, credibility, and the ability to call on advanced knowledge and clinical skills to achieve improved patient outcomes (Cary, 2001). The value of certification is intrinsic in that nurses report that becoming certified is a personal goal not necessarily related to rewards from employers (Cary, 2001). There may also be extrinsic value associated with certification manifested by hospitals seeking Magnet Status and who are aware that certification of nurses is part of the eligibility criteria in achieving that goal. The process of certification has been recognized by the State Boards of Nursing and the National Council of State Boards of Nursing as one mechanism in combination with ed-
ucational preparation to license and regulate advanced practice nursing. State Boards recognize certain agencies (Pediatric Nursing Certification Board and American Nurses Credentialing Center among others) as qualified to develop and administer certification exams. The exam that the PNCB has developed is based on a role delineation survey conducted in 2002-03 of over 350 acute care PNPs. Respondents were asked to identify the knowledge, tasks, and clinical skills that were integral to their practice as acute care PNPs. The data was analyzed and the core knowledge and skills common across all subspecialties was identified. The goal of this process is to ensure that the certification exam is representative of actual practice of acute care PNPs in a variety of settings (PNCB Acute Care PNP Expert Panel, 2003). Candidates for this exam are not expected to possess in-depth knowledge of every subspecialty but to incorporate the advanced knowledge and skills associated with the National Task Force acute care competencies. Based on the practice survey, a test content outline was developed. Test specifications were developed from this to ensure the validity of the exam. Item writers were then convened to write questions that reflected the content outline. Candidates for the acute care exam should refer to the PNCB website for the content outline, exam specifications, and study resources. In the future, publishers who provide review material and courses in other advanced practice specialties may add acute care content to their offerings. CERTIFICATION PNPs who graduated from a primary care PNP program and who are now practicing in acute care will have two years after the acute care exam is launched to sit for the exam if they meet eligibility criteria. After this two-year window of opportunity closes, candidates for the exam must graduate from an approved acute care PNP program. This differs from other mechanisms for licensing or March/April 2005
119
certifying current practitioners, such as “grandfathering,” in that no one will be granted the acute care credential (CPNP-AC) without taking the exam. PNPs who are certified in primary care and who also will take the acute care exam should consider the certification issue very carefully. Once a person is certified in a specialty, it is generally advised to maintain the initial certification as well as any additional certifications unless it would be unduly burdensome to do so. This will protect the ability of that person to practice in either area given that Boards of Nursing are requiring advanced practice nurses to obtain and maintain certification in the area of specialty. The PNCB has considered mechanisms for maintaining both certifications that will be cost-effective and educationally sound. These new recertification guidelines are available on the PNCB website www.pncb.org. SUMMARY For the past 30 years, the nurse practitioner role has evolved to meet growing demands for health care services among many populations. From the beginning, the PNP role in primary care, developed
120
Volume 19 • Number 2
through the collaboration of Loretta Ford and Henry Silver, was developed to respond to the then-current health care needs. Over time, additional NP specialty roles have developed as NPs have been alert and eager to address and meet the changes in the health care system. As is true with the evolution of advanced practice nursing roles, the role of the NP in acute care has evolved and been strengthened by the expert practice of NPs in primary care who have added new skills. These pioneering practitioners led the development of the acute care competencies and worked with their professional organizations to develop position statements, scope and standards of practice, educational guidelines, and new certification examinations. Being responsive to the needs of children and families and to the various legislative and institutional mandates, NAPNAP and PNCB have been very quick to respond. Such actions as a Special Interest Group within NAPNAP, the PNCB Acute Care PNP Program Review, and a certification examination by PNCB provide support for this important group of PNPs who care for these complex, acutely ill children.
REFERENCES American Nurses Association & American Association of Critical Care Nurses. (1995). Standards of clinical practice and scope of practice for the acute care nurse practitioner. (MS-22 10M 5/95). Washington, DC: Author. Cary, A. H. (2001). Certified registered nurses: Results of the study of the certified workforce. American Journal of Nursing, 101, 44-52. National Association of Pediatric Nurse Practitioners. (2004). Position statement on the acute care nurse practitioner. Available online at http://www.nap nap.org National Council of State Boards of Nursing. (2002). Regulation of advanced practice nursing: 2002 National Council of State Boards of Nursing position paper. National Council of State Boards of Nursing. (2003). Uniform advanced practice registered nurse licensure/authority to practice requirements. Retrieved November 18, 2004, from http://www. ncsbn.org/pdfs/uniformaprn.pdf National Organization for Nurse Practitioner Faculties. (2004). Acute Care Nurse Practitioner Competencies. Available online at http://www.nonpf.com/AC NPcompsfinal2004.pdf Pediatric Nursing Certification Board. (2003). Definition of ACPNP. Available online at: http://www.pnpcert.org/ptistore/control/exams/ac/index. Pediatric Nursing Certification Board Acute Care PNP Expert Panel. (2003). A practice analysis of the acute care nurse practitioner (Report for National Certification Board of Pediatric Nurse Practitioners and Nurses).
Journal of Pediatric Health Care
www.jpedhc.org
Department
Section Editor Maureen Van Dinter, MS, CPNP, FNP-C Department of Family Medicine University of Wisconsin Madison, Wisconsin
The Acute Care Pediatric Nurse Practitioner Patricia Clinton, PhD, RN, CPNP, & Arlene M. Sperhac, PhD, RN, CPNP
Traditionally, pediatric nurse practitioners (PNPs) have practiced in primary care. In the past several years, in response to opportunities in the changing health care system, some PNPs have moved into the acute care (AC) setting. A growing number of State Boards of Nursing have responded and demanded certain educational and credentialing requirements. The emergence and credentialing of the acute care PNP has raised questions from both acute and primary care PNPs. The purpose of this article is to address those questions and provide the reader with the most updated information regarding this issue.
Patricia Clinton is Clinical Associate Professor and Director of the Masters Programs in Nursing at the University of Iowa College of Nursing, Iowa City. Arlene M. Sperhac is Professor and Coordinator of the Pediatric Nursing Practitioner Program at the Rush University College of Nursing, Chicago, Illinois. Reprints not available from the author. J Pediatr Health Care. (2005). 19, 117120. 0891-5245/$30.00 Copyright © 2005 by the National Association of Pediatric Nurse Practitioners. doi:10.1016/j.pedhc.2005.01.006
Journal of Pediatric Health Care
BACKGROUND The role of the PNP in acute care (PNP AC) has followed the development of the acute care adult nurse practitioner role. In the mid-1990s, responding to changes in physician residency practice as well as economic factors impacting health care costs associated with the care of acutely ill patients, nurse practitioner practice evolved to meet those needs and the role of the acute care nurse practitioner was established. The new role of the acute care NP was initially centered on the acute health care needs of adults. Clinical experts and educators in adult acute care worked through the mid-
1990s to define educational requirements for the new role. In 1996, the American Nurses Association (ANA), together with the American Association of Critical Care Nurses (AACN), created the first statement of standards and scope of practice for the acute care nurse practitioner (ANA, 1995). Referring to those statements, national leaders saw that the new role was not reflected within the current primary care adult NP certification exams offered by the American Nurses Credentialing Center (AN CC). As a result, the AACN and the ANCC agreed to collaborate on the development of a new certification exam that would reflect the new practice standards and scope of the acute care NP. Similar to the development of the adult acute care nurse practitioner, pediatric nurse practitioners have evolved the practice and role of the PNP in acute care. Formal recognition and credentialing of the PNP AC is rapidly moving forward: 1) position papers on scope of practice for the PNP AC are being formalized and distributed to parties of interest for endorsement; 2) new acute care educational programs are joining established programs, bringing the number to approximately 20 graduate level acute care offerings; 3) a certification exam is available as of March/April 2005
117
TABLE. Eligibility requirements Pathway I
Pathway II
Pathway III
Type/level of program
Acute care PNP Master’s in Nursing, Acute care PNP Master’s in Nursing, Post-Master’s, or Doctorate in Nursing Post-Master’s, or Doctorate in Nursing
Time from graduation to examination
Within 24 months
Licensure, other qualification Active RN, current PALS Clinical skills
Met through educational program
Clinical hours
Met through education program
Continuing education
None
January 2005 from the Pediatric Nursing Certification Board (PNCB); and 4) the National Organization of Nurse Practitioner Faculties (NO NPF) has developed the acute care nurse practitioner entry-level competencies which have been endorsed by PNCB. Pressure to differentiate the primary and acute care role also comes from the National Council of State Boards of Nursing (NCSBN). The Council has stated that the focus of advanced practice education and subsequent certification must correspond (NCSBN, 2002). In other words, it is understood that educational preparation as a PNP prepares one for the primary care role. To practice in acute care, the educational preparation must prepare one for that role by providing content with a focus on acute care. Based on the different needs of children in primary care and in acute care, the roles of the NP vary, thus different educational programs and different certification exams are necessary. Recognition of the acute care role has also come from NAPNAP members who have been practicing in the acute care role and have requested a more visible position within NAPNAP, which has been focused on the primary care PNP since its inception. In July of 2004, the Acute Care PNP 118
Volume 19 • Number 2
Primary care PNP Master’s in Nursing, Post-Master’s, or Doctorate in Nursing More than 24 months Limited offering. This pathway available for only 24 months from onset of exam Active RN, current PALS Active RN, current PALS, certified PNP Skills verification form (with signature Skills verification form (with verifying person signing has worked signature verifying person with applicant) signing has worked with applicant) 1000 clinical hours within past two years 1000 clinical hours within past two years None 10 contact hours in acute care PNP education within past two years
special interest group (SIG) was officially created. The leadership by members of this SIG offers opportunities for expanding NAPNAP membership, diversifying educational offerings, and fulfilling NAPNAP’s mission, vision, and goals to promote optimal health care for children and families. The NAPNAP Executive Board approved a position paper in 2004 that recognized and described the role of PNPs practicing in the acute care role (NAPNAP, 2004). DEFINITION Acute care PNPs function in a variety of settings to provide care to children with complex physiologic conditions and rapidly changing clinical conditions (PNCB, 2003). Like their primary care counterparts, PNP ACs are grounded educationally in growth and development, health promotion, and disease prevention. What distinguishes the PNP AC from the primary care PNP, however, is the type of care delivered to infants, children, adolescents, and young adults. The acute care PNP provides care “…to meet the specialized physiologic and psychological needs of patients with complex acute, critical, and chronic health conditions including the recognition and management of emerging crises
and organ dysfunction and failure” (NAPNAP, 2004). The skill set required for this role is generally much more invasive than the skill set commonly practiced in the primary care role. For example, depending on the specialty area of practice, an acute care PNP may insert or remove chest tubes, perform lumbar punctures, or tap a ventricular shunt (Pediatric Nursing Certification Board Acute Care PNP Expert Panel, 2003). The focus of care is to restore the functional health of the child and to promote maximal health and minimize complications (PNCB, 2003). As one might expect, however, there are many skills and procedures that overlap between the two roles. ANOTHER CREDENTIAL? Although some would argue that a PNP is a PNP despite the practice setting, it is very clear that PNP AC practice differs significantly from the PNP in primary care. The focus for the PNP in acute care is on complex acute, critical, and chronic health conditions and emergent crises (NAPNAP, 2004). Currently practicing PNPs in acute care have been educated in either primary or acute care programs and occasionally both. Up Journal of Pediatric Health Care
until now, there has not been a mechanism for certifying PNPs in the acute care specialty. State Boards of Nursing are increasingly requiring adherence to the regulatory requirements promoted by the NCSBN in their document Uniform Advanced Practice Registered Nurse Licensure/Authority to Practice Requirements (NCSBN, 2003). The requirement for advanced practice registered nurse licensure is for graduate level education that includes both the didactic knowledge and clinical competency skills unique to the specific advanced practice role (NCSBN, 2003). The development of national consensus-based core competencies for the new role of the acute care NP is an important step in identifying and matching knowledge and skills to the specific NP role. Using the framework developed for core NP competencies in primary care, the National Organization of Nurse Practitioner Faculties (NONPF), together with more than 20 other national nurse practitioner organizations, developed the new core acute care nurse practitioner competencies. The new specialty acute care NP competencies differ from the primary care PNP competencies but build upon the seven domains of core competencies for NPs that serve as the foundation for all advanced practice specialty education. In the survey of PNP ACs, PNCB identified areas of overlap between the primary and acute care NP roles. As one would expect, there is a strong foundation of knowledge and clinical assessment and management skills related to growth and development that is inherent to both roles (PNCB Acute Care PNP Expert Panel, 2003). The new acute care exam will reflect the concepts common to both roles but also acknowledge and utilize the core competencies for acute care nurse practitioners identified by the national Organization of Nurse Practitioner Faculty Acute Care Nurse Practitioner Competencies (NONPF, 2004). Journal of Pediatric Health Care
ELIGIBILITY The eligibility requirements for PNPs in acute care are determined by the certifying agency in accordance with national standards for education and practice. The PNCB has identified and published the eligibility requirements acknowledging that the circumstances of a candidate’s educational preparation may differ. Requirements include graduate level education, active RN licensure, and current PALS credential. The PNCB has recognized that the certification of a new subspecialty necessitates recognition of practitioners already practicing in that role and the reality of different educational preparation. Accommodations for these differences have been incorporated into the eligibility requirements. However, the accommodations are time-limited and thus compliance with the time frame is important. The Table summarizes the three ways that potential candidates can meet the eligibility requirements. Pathway III is a limited offering that will only be available until January of 2007. Pathways I and II will continue as the two means through which candidates will have to access the exam. QUALIFYING EXAMINATION Voluntary certification by advanced practice nurses has been associated with personal growth, credibility, and the ability to call on advanced knowledge and clinical skills to achieve improved patient outcomes (Cary, 2001). The value of certification is intrinsic in that nurses report that becoming certified is a personal goal not necessarily related to rewards from employers (Cary, 2001). There may also be extrinsic value associated with certification manifested by hospitals seeking Magnet Status and who are aware that certification of nurses is part of the eligibility criteria in achieving that goal. The process of certification has been recognized by the State Boards of Nursing and the National Council of State Boards of Nursing as one mechanism in combination with ed-
ucational preparation to license and regulate advanced practice nursing. State Boards recognize certain agencies (Pediatric Nursing Certification Board and American Nurses Credentialing Center among others) as qualified to develop and administer certification exams. The exam that the PNCB has developed is based on a role delineation survey conducted in 2002-03 of over 350 acute care PNPs. Respondents were asked to identify the knowledge, tasks, and clinical skills that were integral to their practice as acute care PNPs. The data was analyzed and the core knowledge and skills common across all subspecialties was identified. The goal of this process is to ensure that the certification exam is representative of actual practice of acute care PNPs in a variety of settings (PNCB Acute Care PNP Expert Panel, 2003). Candidates for this exam are not expected to possess in-depth knowledge of every subspecialty but to incorporate the advanced knowledge and skills associated with the National Task Force acute care competencies. Based on the practice survey, a test content outline was developed. Test specifications were developed from this to ensure the validity of the exam. Item writers were then convened to write questions that reflected the content outline. Candidates for the acute care exam should refer to the PNCB website for the content outline, exam specifications, and study resources. In the future, publishers who provide review material and courses in other advanced practice specialties may add acute care content to their offerings. CERTIFICATION PNPs who graduated from a primary care PNP program and who are now practicing in acute care will have two years after the acute care exam is launched to sit for the exam if they meet eligibility criteria. After this two-year window of opportunity closes, candidates for the exam must graduate from an approved acute care PNP program. This differs from other mechanisms for licensing or March/April 2005
119
certifying current practitioners, such as “grandfathering,” in that no one will be granted the acute care credential (CPNP-AC) without taking the exam. PNPs who are certified in primary care and who also will take the acute care exam should consider the certification issue very carefully. Once a person is certified in a specialty, it is generally advised to maintain the initial certification as well as any additional certifications unless it would be unduly burdensome to do so. This will protect the ability of that person to practice in either area given that Boards of Nursing are requiring advanced practice nurses to obtain and maintain certification in the area of specialty. The PNCB has considered mechanisms for maintaining both certifications that will be cost-effective and educationally sound. These new recertification guidelines are available on the PNCB website www.pncb.org. SUMMARY For the past 30 years, the nurse practitioner role has evolved to meet growing demands for health care services among many populations. From the beginning, the PNP role in primary care, developed
120
Volume 19 • Number 2
through the collaboration of Loretta Ford and Henry Silver, was developed to respond to the then-current health care needs. Over time, additional NP specialty roles have developed as NPs have been alert and eager to address and meet the changes in the health care system. As is true with the evolution of advanced practice nursing roles, the role of the NP in acute care has evolved and been strengthened by the expert practice of NPs in primary care who have added new skills. These pioneering practitioners led the development of the acute care competencies and worked with their professional organizations to develop position statements, scope and standards of practice, educational guidelines, and new certification examinations. Being responsive to the needs of children and families and to the various legislative and institutional mandates, NAPNAP and PNCB have been very quick to respond. Such actions as a Special Interest Group within NAPNAP, the PNCB Acute Care PNP Program Review, and a certification examination by PNCB provide support for this important group of PNPs who care for these complex, acutely ill children.
REFERENCES American Nurses Association & American Association of Critical Care Nurses. (1995). Standards of clinical practice and scope of practice for the acute care nurse practitioner. (MS-22 10M 5/95). Washington, DC: Author. Cary, A. H. (2001). Certified registered nurses: Results of the study of the certified workforce. American Journal of Nursing, 101, 44-52. National Association of Pediatric Nurse Practitioners. (2004). Position statement on the acute care nurse practitioner. Available online at http://www.nap nap.org National Council of State Boards of Nursing. (2002). Regulation of advanced practice nursing: 2002 National Council of State Boards of Nursing position paper. National Council of State Boards of Nursing. (2003). Uniform advanced practice registered nurse licensure/authority to practice requirements. Retrieved November 18, 2004, from http://www. ncsbn.org/pdfs/uniformaprn.pdf National Organization for Nurse Practitioner Faculties. (2004). Acute Care Nurse Practitioner Competencies. Available online at http://www.nonpf.com/AC NPcompsfinal2004.pdf Pediatric Nursing Certification Board. (2003). Definition of ACPNP. Available online at: http://www.pnpcert.org/ptistore/control/exams/ac/index. Pediatric Nursing Certification Board Acute Care PNP Expert Panel. (2003). A practice analysis of the acute care nurse practitioner (Report for National Certification Board of Pediatric Nurse Practitioners and Nurses).
Journal of Pediatric Health Care