Nurse Practitioner Job Analysis

The American Academy of Pediatrics conducted a survey in 2010 which established that there were only 13,000 Pediatrics Nurse Practitioners in practice at the time. It was noted in the same survey that the majority of that number work in primary care settings. In order to establish role delineation for Nurse Practitioners, The American Nurses Credentialing Center (ANCC), a subsidiary of American Nurses Association (ANA), conducted a national level job analysis survey. The purpose of the survey was to describe practice expectations and map out performance requirements and environments that Nurse Practitioners must meet to in order to practice. It is the goal of The American Nurses Credentialing Center (ANCC) to conduct this study every three
years. The demographic background of this survey indicated that approximately 97% of the respondents were female and more than 90% were reported to be white. Approximately 70% of the overall sample fell into the group of 45-64 years of age. Approximately 73% of the Pediatric Nurse Practitioners indicated that they held a Masters in Nursing as one of their highest degree. 15% indicated they held a Post-Master Certificate. 3% of the respondents had doctorate degrees of Nursing Practice. 8% of the respondents indicated they held a degree other than what was listed as their highest level of education. The average number of years of experience the pediatric nurse practitioner respondents had as a Registered Nurse (RN) was over 25 years. The respondents also reported on average 17 years of experience as a nurse practitioner (Journal of Clinical Nursing, 2005). A board certification examination for Pediatric Nurse Practitioners is administered by The American Nurses Credentialing Center (ANCC). It is competency based and reliably assess entry level clinical knowledge and skills. This certification aligns with the Consensus Model for Advanced Practice Registered Nurses (APRN) Regulation, Licensure, Accreditation, Certification and Education. Following successful completion of this examination, a Nurse Practitioner becomes board certified to practice as a Pediatric Nurse Practitioner. This credential is renewable every five years and according to American Nurses Credentialing Center, one must continually meet renewal requirements at the time of certification renewal. Some states allow Nurse Practitioners of all specialties to practice and write prescriptions of certain medications independently and have more autonomy in how they provide care. There is however a need for growing emphasis focusing on in-depth knowledge in primary health care with advanced knowledge in well child care, prevention and management of common conditions. Pediatric Nurse Practitioners' focus is to provide evidence-based care to children and enhance optimal health regardless of the environment and circumstances that the children may be in, whether it is in a community, family or environmental setting. Their primary goal in providing that evidence-based care to children from birth to young adult life is by assessing, screening, evaluating and finding a treatable diagnoses. Pediatrics Nurse Practitioners, like other practitioners, have an opportunity to develop a patient-nurse relationship which allows them to provide and incorporate non-pharmacological therapies like teaching the patient and other family members education to support the prescribed treatments, managing and negotiating through the health care systems maze. As they provide family centered care, they are better equipped and have an opportunity to develop a rapport with their patients in their professional role, they learn and demonstrate cultural competency through this interraction. Pediatrics Nurse Practitioners continually monitor patient outcomes by ensuring that the quality of care given to each patient is in line with their scope of practice. They exhibit this sense of connectedness with their patients whether they practice in patients' home, emergency departments, intensive care units or in subspecialty outpatient clinics. As mentioned elsewhere, the first Nurse Practitioner program has its inception in 1965 and while both men and women in the program have experienced great successes, there are those who have also presented heated opposition. Top on the list of those who oppose are Physician organizations who claim that the disparity in education, between the physicians and nurse practitioners render them unsafe and unqualified to provide primary care to patients independently without a physician overseeing them. According to the American Association of Nurse Practitioners, 21 states which include the District of Columbia, Connecticut and Colorado are among those with full practice status. The remaining states continue to hold reduced or restricted practice regulations for Nurse Practitioners. While the practice guidelines for each of these levels is slightly different depending on location, they all require that Nurse Practitioners have either a signed collaboration agreement with a physician or direct oversight of a physician. The scope of practice guidelines for Nurse Practitioners with 'full practice' status varies by state. Nurse Practitioners who operate in these areas are also free to establish their own independent practices in the same way physicians do. A list of states where Nurse Practitioners have full practice status can be found on the American Association of Nurse Practitioners page. While the debate on Nurse Practitioners' scope of practice, who they practice with and which states recognizes them as professionals equipped with the necessary academic achievement and skilled training, they are undoubtedly a growing work force ready to take on full practicing autonomy and have the necessary qualifications to work within different health care specialties.
In a 2010 Federal Prevention Initiates report it is noted that one third (1/3) of all Primary Care doctors are likely to retire over the next decade giving rise to the need for Nurse Practitioners in all specialties to step into those shoes and continue providing care with more autonomy. This is a trend that is likely to gain momentum and with greater number of insured patients, insurance companies as stakeholders in the ACA initiatives are likely to encourage patients being seen by a Nurse Practitioner from a billing stand
point. In an article in The Wall Street Journal titled ' Should Nurse Practitioners Be Able to Treat Patients Without Physician Oversight?', arguments are presented for and against. In support for autonomy for Nurse Practitioners, Dr. Angela Golden, President American Association of Nurse Practitioners (AANP), responds by saying that Nurse Practitioners 'Skillfully fill a gap that is large and growing'. Golden argues that it is time for other states that have not done so already, to recognize and give autonomy to Practicing Nurse Practitioners. She points out that NP are at the forefront of patient care and are best suited to diagnose and treat the growing numbers of patients who come through the door, most with chronic conditions. As Nurse Practitioners spend large amounts of time with and get to know their patients well, they are likely to achieve better outcomes and patient compliance with treatments. Gold points out that 'researchers have repeatedly found equal or higher satisfaction rates among patients who received primary care from Nurse Practitioners, compared with patients treated by physicians' ((Wall Street Journal, 2013) In the same article in The Wall Street Journal, Reid Blackwelder, a Family Physician and President-elect; American Academy of Family Physicians , unequivocally says no to the idea of Nurse Practitioners in all specialties having autonomy to practice. He argues that they do have the necessary clinical experience and training and as a result, they do not qualify and should not treat patients without a physician's oversight. Blackwelder notes that while studies may show a higher patient appreciation of the Nurse Practitioners, they (NP) do not achieve the same clinical outcomes as the physicians. In conclusion, whether the remaining states in the US grant Nurse Practitioners autonomy to practice, the question is how soon. With the advent of Affordable Care Act (ACA) which has expanded accessibility to health insurance and the inevitable increase of a largely aging population, the demand for Nurse Practitioners in all specialties is bound to rise over the next five years. The federal agency Health Resources and Services Administration (HRSA), whose focus is on strengthening and improving access to care for the health care work force, projects that in 2020 there will be a shortage of 20,400 primary care physicians. In a similar survey conducted by the Kaiser Family Foundation titled 'Tapping Nurse Practitioners to Meet Rising Demand for Primary Care', the report focuses on the need and how to tap Advanced Practice Nurse Practitioners as an answer to increasing access to primary care. I see Nurse Practitioners in all specialties in the very near future coming to a place where they are recognized, along side the primary care professionals as care providers.
If we take the focus from 'turf protection' where physicians and legislatures see Nurse Practitioners as encroaching on their territory, and put the focus on the well being of patients. In returning to school, my long term goal is to progress to a Family Nurse Practitioner (FN) and can see that day when a group of Nurse Practitioners from different specialties (Pediatrics, Sports Medicine) come together and combine our experiences and education to put together a practice just like a group of physicians do. I remember years ago when the first generic medications came on the market and the resistance they were met with by both patients and other drug
manufacturers. Today, there are are programs and incentives that encourage patients to choose the generics over brand names. There has also been a lot of patient education on the potency and quality of the generics - I see the field of Nurse Practitioners in all specialties going the same way.