Pediatric Nurse Practitioners: Issues in Training

Abstract

PEDIATRIC NURSE practitioners can perform routine medical services in a manner which is not only safe for the patient but satisfactory to the child, his mother, and his physician, according to a growing body of literature (1,2). While the evaluation of these services will undoubtedly continue, the question for some health planners now has shifted from one of whether we should train nurse practitioners to how we can best prepare them. The experimental training course described here was developed to provide additional insight regarding the academic preparation for pediatric nurse practitioners. In the fall of 1970, representatives from various Los Angeles health care agencies met to explore the possibility of developing a course to train nurses for expanded roles in the health management of well children and children with minor illness. This group included representatives from the Los Angeles County Health Department, several hospital outpatient departments, Head Start, and two Los Angeles comprehensive health clinics. Consultants from the Schools of Medicine and Nursing, University of California at Los Angeles, also helped with planning the course. Despite efforts to locate adequate funding, substantial financial support was unavailable. Although the Area IV Regional Medical Planning official supplied a classroom, clerical help, a part-time nurse coordinator, and a small cash grant, no money was available to employ an instructional staff. The steering committee, nonetheless, decided to proceed with the course and volunteered to teach. It was important to analyze the problems of curriculum design and to obtain experimental data to facilitate future training programs when money might become available. The course began in May 1971 with 17 nurses enrolled. One issue discussed by the planning committee was length of the course. The original pediatric nurse practitioner curriculum developed by Henry Silver and Loretta Ford at the University of Colorado was a 4-month intensive course with approximately 20 hours of didactic work and 20 hours of clinical practice each week. This course was followed by an unspecified amount of practice in the field (3). Since this was the first and most well-known formal course of its type, it was used as a model, and 4 months became the norm for training nurse practitioners. The joint statement of the American Nurses' Association and the American Academy of Pediatrics (4) also suggested a minimum of 4 months for a course; however, it recommended only 4 hours of lecture and 8 to 12 hours of supervised clinical practice per week and the remaining time for on-the-job experience. Although both courses were 4 months, the ANA-AAP course seemed less intensive than the Colorado one. As patterns other than the familiar 4-month course were studied, it became apparent that the range of possibilities was wide. St. Geme had begun an experimental course in 1967 that was modeled on the medical curriculum. This 21A ll the authors are with the University of California at Los A ngeles. Dr. Bullough is an associate professor in the School of Nursing, Dr. St. Geme is in the Department of Pediatrics, School of Medicine, Harbor General Hospital, and Dr. Neumann is in the Department of Pediatrics, Ambulatory Services, at the School of Medicine. The project was sponsored by pilot grant funds from the Regional Medical Program, Area IV, State of California. Tearsheets requests to Dr. Bonnie Bullough, associate professor, School of Nursing, University of California, Los A ngeles, Calif. 90024.