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Courtwright SE, Turi E, Barr EA, Burns JC, Gigli KH, Bennett CR, Sonney J, Francis L, Poghosyan L. Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review. J Pediatr Health Care 2024; 38:520-543. [PMID: 38284964 PMCID: PMC11222060 DOI: 10.1016/j.pedhc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.
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A curriculum to improve knowledge and skills of nurse practitioners and physician assistants in the pediatric emergency department. J Am Assoc Nurse Pract 2022; 34:1116-1125. [PMID: 36099396 DOI: 10.1097/jxx.0000000000000771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Nurse practitioners (NPs) and physician assistants (PAs) have an important role in delivery of care in a tertiary children's hospital emergency department (ED). Most NPs and PAs have not had any formal training to work in a pediatric ED; although our NPs and PAs had no formal ED training, some were acute care certified. We describe a curriculum designed to improve knowledge and skills of NPs and PAs in the pediatric ED. The curriculum consists of three modules, namely, online lecture series, procedural workshops, and case scenarios in a simulated setting. Module 1 consisted of online lecture on 10 common ED diagnoses. The second module consisted of procedural workshops on lumbar puncture, incision and drainage of abscesses, gastrostomy insertion, and laceration repair. The third module included simulation scenarios on ED-specific cases of seizure in an infant, bronchiolitis and ruptured appendicitis with shock. Each module was evaluated by a survey. Participants rated each item on the survey using a Likert scale response (1 = disagree completely to 5 = agree completely). Both NPs and PAs demonstrated increase in knowledge scores in posttest 1 vs pretest (p < .001) and did not show a significant decline in posttest 2 (p = .073). The mean ratings of components of the online lecture series, workshops, and simulation scenarios were 4.5-4.7, 4.4-4.8, and 4.5-4.7, respectively, with positive comments. This novel curriculum meets the educational needs of NPs and PAs at our institution and can be used as a model to train them at other tertiary care pediatric EDs.
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Maymi M, Madden M, Bauer C, Reuter-Rice K. Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis. J Pediatr Health Care 2022; 36:e11-e21. [PMID: 34836734 DOI: 10.1016/j.pedhc.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study informed an update of the Certified Pediatric Nurse Practitioner - Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). RESULTS Respondents were primarily females aged 25 to 34 years (35.4%) and formally educated as AC PNPs (84.2%) and held the CPNP-AC credential (98.9%). Most respondents (83.6%) practiced in urban areas and spent 84% of their time in direct patient care with 74% working in inpatient settings. The majority (87%) worked in subspecialty practice such as critical care (18.5%) and cardiac intensive care (12.3%). DISCUSSION This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.
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Gigli KH, Kahn J, Martsolf G. Availability of Acute Care Pediatric Nurse Practitioner Education in the United States: A Challenge to Growing the Workforce. J Pediatr Health Care 2020; 34:481-489. [PMID: 32173222 PMCID: PMC7483205 DOI: 10.1016/j.pedhc.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
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The Current State of the Pediatric Emergency Medicine Workforce and Innovations to Improve Pediatric Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2018. [DOI: 10.1016/j.cpem.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Bridgemohan C, Bauer NS, Nielsen BA, DeBattista A, Ruch-Ross HS, Paul LB, Roizen N. A Workforce Survey on Developmental-Behavioral Pediatrics. Pediatrics 2018; 141:peds.2017-2164. [PMID: 29453235 DOI: 10.1542/peds.2017-2164] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Developmental-behavioral conditions are common, affecting ∼15% of US children. The prevalence and complexity of these conditions are increasing despite long wait times and a limited pipeline of new providers. We surveyed a convenience sample of the developmental-behavioral pediatric (DBP) workforce to determine current practices, workforce trends, and future needs. METHODS An electronic survey was e-mailed to 1568 members of the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, the Society for Developmental and Behavioral Pediatrics, and the National Association of Pediatric Nurse Practitioners Developmental and Behavioral Mental Health Special Interest Group. RESULTS The response rate was 48%. There were 411 fellowship-trained physicians, 147 nonfellowship-trained physicians, and 125 nurse practitioners; 61% were women, 79% were white, and 5% were Hispanic. Physicians had a mean of 29 years since medical school graduation, and one-third planned to retire in 3 to 5 years. Nurse practitioners were earlier in their careers. Respondents reported long wait times for new appointments, clinician burnout, increased patient complexity and up to 50% additional time spent per visit in nonreimbursed clinical-care activities. Female subspecialists spent more time per visit in billable and nonbillable components of clinical care. CONCLUSIONS The DBP workforce struggles to meet current service demands, with long waits for appointments, increased complexity, and high volumes of nonreimbursed care. Sex-based practice differences must be considered in future planning. The viability of the DBP subspecialty requires strategies to maintain and expand the workforce, improve clinical efficiency, and prevent burnout.
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Affiliation(s)
- Carolyn Bridgemohan
- Department of Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Nerissa S Bauer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Britt A Nielsen
- Department of Psychiatry, MetroHealth Medical Center and Department of Psychiatry, Case Western Reserve School of Medicine
| | - Anne DeBattista
- Department of Developmental-Behavioral Pediatrics, Stanford Children's Health, Palo Alto, California; and
| | | | - Linda B Paul
- American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Nancy Roizen
- Department of Pediatrics, UH/Rainbow Babies and Children's Hospital and Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
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Cohen AR. Workforce data and uncertainty: Uneasy but unavoidable partners. Pediatr Blood Cancer 2018; 65. [PMID: 29068563 DOI: 10.1002/pbc.26862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Alan R Cohen
- Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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DeGuzman PB, Altrui P, Allen M, Deagle CR, Keim-Malpass J. Mapping Geospatial Gaps in Early Identification of Children With Autism Spectrum Disorder. J Pediatr Health Care 2017; 31:663-670. [PMID: 28688939 DOI: 10.1016/j.pedhc.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 11/13/2022]
Abstract
Despite the known developmental benefits of early intervention for autism spectrum disorder (ASD), diagnosis before age 5 years is often not achieved. Research suggests that lack of health insurance and living in rural areas and areas of severe provider shortages contribute significantly to these delays. The purpose of this project was to conduct a geospatial evaluation of potential gaps in early ASD diagnosis of uninsured children in Virginia. A secondary purpose was to show the use of geospatial analysis by pediatric nurse practitioners for policy advocacy. We mapped data from a statewide provider of ASD evaluative services associated with the Virginia Department of Health and found several communities with high numbers of uninsured children where children may not be receiving early diagnostic services. Pediatric nurse practitioners can help address community-level gaps in early identification of ASD for uninsured young children living in rural areas by conducting outreach programs to providers and families within rural communities and concurrently partnering with nurse-scientists to develop visually impactful geospatial analyses to educate legislators and further advocate for policy positions.
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Barnes H, Maier CB, Sarik DA, Germack HD, Aiken LH, McHugh MD. Effects of Regulation and Payment Policies on Nurse Practitioners' Clinical Practices. Med Care Res Rev 2017; 74:431-451. [PMID: 27178092 PMCID: PMC5114168 DOI: 10.1177/1077558716649109] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increasing patient demand following health care reform has led to concerns about provider shortages, particularly in primary care and for Medicaid patients. Nurse practitioners (NPs) represent a potential solution to meeting demand. However, varying state scope of practice regulations and Medicaid reimbursement rates may limit efficient distribution of NPs. Using a national sample of 252,657 ambulatory practices, we examined the effect of state policies on NP employment in primary care and practice Medicaid acceptance. NPs had 13% higher odds of working in primary care in states with full scope of practice; those odds increased to 20% if the state also reimbursed NPs at 100% of the physician Medicaid fee-for-service rate. Furthermore, in states with 100% Medicaid reimbursement, practices with NPs had 23% higher odds of accepting Medicaid than practices without NPs. Removing scope of practice restrictions and increasing Medicaid reimbursement may increase NP participation in primary care and practice Medicaid acceptance.
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Webber E, Serowoky M. Breastfeeding Curricular Content of Family Nurse Practitioner Programs. J Pediatr Health Care 2017; 31:189-195. [PMID: 27553119 DOI: 10.1016/j.pedhc.2016.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Health care provider support is essential for breastfeeding success. Family Nurse Practitioners (FNP) are in a unique position to promote and manage breastfeeding. There is a gap in the literature regarding the amount and type of breastfeeding curricular content in FNP programs. METHOD An online survey of FNP programs was conducted. Data collection included program descriptors, didactic breastfeeding coursework, and clinical breastfeeding opportunities available to students. RESULTS No programs offered courses specific to breastfeeding: 82% of programs devoted 1 to 2 hours of didactic lactation content. More than three quarters of the programs offered students breastfeeding counseling opportunities; no programs, however, identified specific breastfeeding clinical competencies. DISCUSSION FNPs can play an integral role in breastfeeding promotion and counseling. There appears to be a lack of education provided to FNPs regarding breastfeeding management. Creative approaches that incorporate lactation education into FNP programs may increase FNPs' breastfeeding knowledge and enhance their ability to provide support to breastfeeding families.
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Reuter-Rice K, Madden MA, Gutknecht S, Foerster A. Acute Care Pediatric Nurse Practitioner: The 2014 Practice Analysis. J Pediatr Health Care 2016; 30:241-51. [PMID: 26878813 DOI: 10.1016/j.pedhc.2016.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Practice research serves as the certification framework for validating advanced practice roles and updating national qualifying examinations. This national study describes the current practice of the acute care pediatric nurse practitioner (AC PNP) to inform an update of the Certified Pediatric Nurse Practitioner-Acute Care (CPNP-AC) examination content outline. METHOD A descriptive analysis was performed of the responses of 319 pediatric nurse practitioners, practicing in an acute care role, who completed a practice survey in 2014. RESULTS Respondents were primarily White women with a mean age of 40 years; 75% had been formally educated as AC PNPs, compared with 48% in 2009. Regional practice was most heavily concentrated in the Southeast (28%) and Midwest (27%). Most respondents (81%) practiced in urban areas. Respondents reported spending 75% of practice time in inpatient settings. The most frequently cited areas of practice were critical care (36%), followed by emergency department (9%) and subspecialty practices. DISCUSSION This third analysis of AC PNP practice 10 years after initiation of the CPNP-AC certification examination demonstrates changes in clinical practice and educational preparation.
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Schell GJ, Lavieri MS, Li X, Toriello A, Martyn KK, Freed GL. Strategic modeling of the pediatric nurse practitioner workforce. Pediatrics 2015; 135:298-306. [PMID: 25624388 DOI: 10.1542/peds.2014-0967] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess the current pediatric nurse practitioner (PNP) workforce and to investigate the impact of potential policy changes to address forecasted shortages. METHODS We modeled the admission of students into nursing bachelor's programs and followed them through advanced clinical programs. Prediction models were combined with optimal decision-making to determine best-case scenario admission levels. We computed 2 measures: (1) the absolute shortage and (2) the expected number of years until the PNP workforce will be able to fully satisfy PNP demand (ie, self-sufficiency). RESULTS There is a forecasted shortage of PNPs in the workforce over the next 13 years. Under the best-case scenario, it would take at least 13 years for the workforce to fully satisfy demand. Our analysis of potential policy changes revealed that increasing the specialization rate for PNPs by 4% would decrease the number of years required until there are enough PNPs from 13 years to 5 years. Increasing the certification examination passing rate to 96% from the current average of 86.9% would lead to self-sufficiency in 11 years. In addition, increasing the annual growth rate of master's programs to 36% from the current maximum of 10.7% would result in self-sufficiency in 5 years. CONCLUSIONS Current forecasts of demand for PNPs indicate that the current workforce will be incapable of satisfying the growing demand. Policy changes can result in a reduction in the expected shortage and potentially improve access to care for pediatric patients.
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Affiliation(s)
| | | | - Xiang Li
- Department of Industrial and Operations Engineering and
| | - Alejandro Toriello
- School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; and
| | | | - Gary L Freed
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
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Freed GL, Moran LM, Dunham KM, Nantais-Smith L, Martyn KK. Capacity of, and Demand for, Neonatal Nurse Practitioner Educational Programs: A Missing Piece of the Workforce Puzzle. J Prof Nurs 2015. [PMID: 26194963 DOI: 10.1016/j.profnurs.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Studies have demonstrated a dramatic increase in the number of new nurse practitioners (NPs) overall completing NP education each year. However, NPs who provide specialized care to children have not experienced increases in their pipeline at all. This has resulted in shortages of neonatal nurse practitioners (NNPs). PURPOSE The aim of this study was to gain a greater understanding of the NNP pipeline and potential for increasing the number of new NNPs graduating each year. METHODS Telephone survey of all NNP educational programs. DISCUSSION Approximately one fourth of all NNP education programs had closed over the past several years. This is despite a strong job market, planned increases in hiring NNPs, and a seemingly growing shortage of NNPs. CONCLUSION Problems with the NNP pipeline are not due to a lack of capacity of existing programs, but rather to difficulties in increasing the enrollment demand.
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Affiliation(s)
- Gary L Freed
- The Percy and Mary Murphy Professor of Pediatrics and Child Health Delivery, Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; Professor, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Lauren M Moran
- Research Area Specialist, CHEAR Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Kelly M Dunham
- Senior Research Associate, CHEAR Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Leanne Nantais-Smith
- Assistant Clinical Professor, Director MSN and Graduate Certificate Programs, College of Nursing, Wayne State University, Detroit, MI
| | - Kristy K Martyn
- Professor & Assistant Dean for Clinical Advancement, Director, Doctor of Nursing Practice Program, Independence Chair for Nursing, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
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Freed GL, Moran LM, Dunham KM, Hawkins-Walsh E, Martyn KK. Capacity of, and Demand for, Pediatric Nurse Practitioner Educational Programs: A Missing Piece of the Workforce Puzzle. J Prof Nurs 2015. [PMID: 26194962 DOI: 10.1016/j.profnurs.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND In contrast to family nurse practitioners and other adult nurse practitioners, the percentage of new pediatric nurse practitioners (PNPs) graduating each year has not increased. PURPOSE The aim of this study was to determine whether the marginal increase in the pipeline for PNPs is related to a limit in the capacity of educational programs or whether unfilled student openings exist. METHODS Self-administered survey of program directors at all recognized PNP educational programs in the United States. RESULTS Approximately 10% of PNP programs in the United States were either closed, put on hold, or did not have new graduates in the last 3 years. Even with these closures, over 25% of active programs did not fill all available positions for the class entering in 2012. CONCLUSION Despite evidence that demonstrates plans by employers to hire a greater number of PNPs in a variety of clinical venues including pediatric hospitals, primary care and subspecialty pediatric practices, the PNP pipeline has remained relatively stagnant. More than one third of program directors do not believe that their PNP program is currently at capacity, indicating that underutilized capacity to educate PNPs is a hindrance to meeting the current and future demands for these professionals.
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Affiliation(s)
- Gary L Freed
- The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; Professor, Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI.
| | - Lauren M Moran
- The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Kelly M Dunham
- The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, MI; The Percy and Mary Murphy Professor (Freed), Research Area Specialist (Moran), Senior Research Associate (Dunham), Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI
| | - Elizabeth Hawkins-Walsh
- Clinical Associate Professor, Assistant Dean for MSN Programs and Outreach Director, School of Nursing, The Catholic University of America, Washington, DC
| | - Kristy K Martyn
- Professor & Assistant Dean for Clinical Advancement, Director, Doctor of Nursing Practice Program and Independence Chair for Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Freed GL, Dunham KM, Martyn K, Martin J, Moran LM, Spera L. Pediatric nurse practitioners: influences on career choice. J Pediatr Health Care 2014; 28:114-20. [PMID: 23406823 DOI: 10.1016/j.pedhc.2012.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/28/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The demand for hiring pediatric nurse practitioners (PNPs) is strong. However, the number of newly educated PNPs has remained relatively flat during the past several years. Understanding the rationale and timing for the decision to pursue this profession is essential to having a positive impact on increasing the future workforce. METHODS A mail survey of all new PNPs certified between January 2009 and July 2011 (N = 1040) was conducted. RESULTS The response rate was 79.9%. Nearly half of all respondents (45%, N = 314) reported that they work in outpatient general pediatrics, 26% (N = 184) in outpatient subspecialty pediatrics, and 22% (N = 152) in inpatient settings. More than one third (36%, N = 253) spend most of their time in a private practice. Forty percent (N = 307) reported that they decided to pursue education as an advanced practice nurse while in practice as a registered nurse (RN), and 38% (N = 289) made the decision before pursuing RN education. CONCLUSIONS Efforts to increase the PNP pipeline will need to be directed both to students during their RN education and to creating opportunities for current RNs to pursue advanced practice nurse education that is focused on children.
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Martyn KK, Martin J, Gutknecht SM, Faleer HE. The pediatric nurse practitioner workforce: meeting the health care needs of children. J Pediatr Health Care 2013; 27:400-5. [PMID: 23631880 DOI: 10.1016/j.pedhc.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Kristy K Martyn
- Health Promotion and Risk Reduction Programs, The University of Michigan, School of Nursing, Ann Arbor, MI 48109, USA.
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Abstract
The American Academy of Pediatrics (AAP) believes that optimal pediatric health care depends on a team-based approach with supervision by a physician leader, preferably a pediatrician. The pediatrician, here defined to include not only pediatric generalists but all pediatric medical subspecialists, all surgical specialists, and internal medicine/pediatric physicians, is uniquely qualified to manage, coordinate, and supervise the entire spectrum of pediatric care, from diagnosis through all stages of treatment, in all practice settings. The AAP recognizes the valuable contributions of nonphysician clinicians, including nurse practitioners and physician assistants, in delivering optimal pediatric care. However, the expansion of the scope of practice of nonphysician pediatric clinicians raises critical public policy and child health advocacy concerns. Pediatricians should serve as advocates for optimal pediatric care in state legislatures, public policy forums, and the media and should pursue opportunities to resolve scope of practice conflicts outside state legislatures. The AAP affirms the importance of appropriate documentation and standards in pediatric education, training, skills, clinical competencies, examination, regulation, and patient care to ensure safety and quality health care for all infants, children, adolescents, and young adults.
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Brown RF, Willey-Courand DB, George C, McMullen A, Dunitz J, Slovis B, Perkett E. Non-physician providers as clinical providers in cystic fibrosis: survey of U.S. programs. Pediatr Pulmonol 2013; 48:398-404. [PMID: 22715133 PMCID: PMC3449052 DOI: 10.1002/ppul.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 04/04/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND METHODS Non-physician providers (NPPs) including nurse practitioners (NPs) and physician assistants (PAs) are important members of CF care teams, but limited data exist about the extent NPPs are involved in CF care. A subcommittee was established by the CF Foundation to gather information about current involvement of NPPs. Surveys were sent to adult, pediatric and affiliate CF program directors (PDs) and NPPs working in US CF programs. RESULTS Responses were received from 108 PDs (49% pediatric, 34% adult, 17% affiliate). Overall, 53% of the 108 programs had NPPs and 70% had or planned to hire NPPs. Reasons for NPP use included ideal clinical role (75%), expansion of services (72%), and physician shortage (40%). The survey collected 73 responses from NPPs (96% NPs, 4% PAs) who worked in pediatric (49%), adult (29%), affiliate (3%), or multiple programs (19%). Training occurred on the job in 88% and from prior CF experience in 21%. NPPs provided coverage in outpatient clinics (82%), inpatient care (64%), and weekend and/or night call (22%). In addition to clinical roles, NPPs are involved in education (95%), research (81%), and leadership (55%). The major obstacle reported by PDs and NPPs was billing with only 12% of programs reporting NPP salaries covered by billing revenue alone. Salary support included hospital support (67%), billing (39%), center grant (35%), and other grant/contract (25%). NPPs bill for outpatient and inpatient care in 65% and 28% of programs, respectively. CONCLUSIONS NPPs are working with physicians in many centers and have the potential to help meet the increasing clinical workforce demands. Further evaluation of financial issues is indicated to continue the support of NPP jobs in CF. Roles and expectations need to be clearly defined. Initial and ongoing training standards and opportunities should be explored.
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Affiliation(s)
- Rebekah F Brown
- Vanderbilt University Medical Center, Nashville, Tennessee 37232-9500, USA.
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Canon S, Basham K, Canon HL, Purifoy JA, Swearingen C. Alternative Approaches to Expanding Pediatric Urology Services and Productivity. J Urol 2012; 188:1639-42. [PMID: 22971271 DOI: 10.1016/j.juro.2012.03.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen Canon
- Department of Urology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA.
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Freed GL, Dunham KM, Loveland-Cherry C, Martyn KK, Moote MJ. Nurse practitioners and physician assistants employed by general and subspecialty pediatricians. Pediatrics 2011; 128:665-72. [PMID: 21890832 DOI: 10.1542/peds.2011-0329] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is little nationally representative information describing the current manner in which nurse practitioners (NPs) and physician assistants (PAs) work in pediatric practices and their professional activities. To understand better the current NP and PA workforce in pediatric primary and subspecialty care, we conducted a national survey of pediatricians. METHODS A survey study of a random national sample of 498 pediatric generalists and 1696 subspecialists in the United States was performed by using a structured questionnaire administered by mail. The survey focused on practice settings, employment, and scope of work of NPs and PAs. RESULTS Response rates were 72% for generalists and 77% for subspecialists. More than one-half (55%) of generalists reported that they do not currently work with NPs or PAs, compared with only one-third of subspecialists who do not. Many generalists and subspecialists intend to increase the number of NPs and PAs in their practices in the next 5 years. More generalist and subspecialty practices work with NPs than with PAs. There was great variability between generalists and subspecialists and among different subspecialties in the proportions that worked with NPs and PAs. The scope of work of NPs and PAs also varied between generalists and subspecialists. CONCLUSIONS Planned increases in the number of NPs hired and expansion of their scope of work might put subspecialists and general pediatricians in competition with regard to recruitment and hiring of a limited pool of new pediatric NPs. Similar issues might arise with PAs.
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Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research Unit, Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan 48109-0456, USA.
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Vandenbranden SL. The role of the nurse practitioner in the care of children with chronic respiratory disorders. Pediatr Ann 2010; 39:800-4. [PMID: 21162489 DOI: 10.3928/00904481-20101116-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Stacy L Vandenbranden
- Children's Memorial Hospital, Division of Pulmonary Medicine, Chicago, Il 60614, USA.
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Freed GL, Dunham KM, Loveland-Cherry C, Martyn KK. Family nurse practitioners: roles and scope of practice in the care of pediatric patients. Pediatrics 2010; 126:861-4. [PMID: 20956411 DOI: 10.1542/peds.2010-2157] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to characterize the pediatric role and scope of practice of family nurse practitioners (FNPs). METHODS A mail survey of a random national sample of 1000 FNPs, stratified according to states that license nurse practitioners to practice independently, was performed. Frequencies were calculated and bivariate analyses were performed to determine the level of association between practice characteristics and practice state, practice location (urban versus rural), and type of care provided (primary versus specialty). RESULTS The overall response rate was 75.9%. Sixty-six percent of respondents (n = 416) reported that they currently provided care to children, and 18% (n = 110) reported that they had never provided care to children. Fifty-four percent of FNPs who provided care to children (n = 222) reported that children represented ≤ 25% of their current patient populations. Few FNPs (9% [n = 39]) reported that children represented >75% of their total patient populations. CONCLUSIONS Among FNPs who provide care to children, pediatric patients represent only a small fraction of their patient populations. FNPs are unlikely to have a significant impact on the availability of either primary or subspecialty care for children in the near future.
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Affiliation(s)
- Gary L Freed
- University of Michigan, School of Public Health, Child Health Evaluation and Research Unit, 300 North Ingalls Building, Ann Arbor, MI 48109-0456, USA.
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Freed GL, Dunham KM, Lamarand KE, Loveland-Cherry C, Martyn KK. Pediatric nurse practitioners: roles and scope of practice. Pediatrics 2010; 126:846-50. [PMID: 20956419 DOI: 10.1542/peds.2010-1589] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are ∼ 13,000 pediatric nurse practitioners (PNPs) in the United States. PNPs have been suggested as professionals who could provide care to the growing cadre of children with chronic illnesses and expand the pool of subspecialty care providers. Little is known about current roles of PNPs in primary or subspecialty care. OBJECTIVE To gain a better understanding of the roles, focus of practice, professional setting, and professional responsibilities of PNPs. METHODS We conducted a mail survey of a random national sample of 1200 PNPs stratified according to states that license NPs to practice independently. χ(2) statistics were used to assess responses from PNPs in states that allow independent practice versus those that do not and on PNPs in primary versus specialty care. RESULTS The overall response rate was 82.4%. Ninety-six percent (n = 636) of the PNPs were female. More than half of all the respondents (59% [n = 391]) worked in primary care, and almost two-thirds (64% [n = 394]) did not provide care in inpatient settings. Only 11% of the PNPs in states that allow independent practice, practiced independently. CONCLUSIONS The majority of PNPs currently work in primary care, and most do not have any inpatient roles. It does not seem that independent PNP practices are responsible for a significant portion of pediatric visits. For those who posit that PNPs will help alleviate the currently perceived shortage of pediatric subspecialists, our findings indicate that it likely will not occur without a significant change in the PNP workforce distribution.
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Affiliation(s)
- Gary L Freed
- University of Michigan, Child Health Evaluation and Research (CHEAR) Unit, 300 North Ingalls Building, Ann Arbor, MI 48109-0456, USA.
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Loman DG, Clinton P. Where are all the PNPs? Pediatric nurse practitioner practice opportunities and challenges. J Pediatr 2010; 157:526-7. [PMID: 20619855 DOI: 10.1016/j.jpeds.2010.05.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 05/25/2010] [Indexed: 11/15/2022]
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