Role Of Pediatric Nurse Practitioners Research Articles

Acute Care Pediatric Nurse Practitioner: The 2018 Practice Analysis.

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. A descriptive analysis of a survey completed in 2018 by 373 pediatric nurse practitioners (PNP) practicing as an acute care role (AC). 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%). This is the fourth practice analysis of the AC PNP role that demonstrates continuous evolution in clinical practice, educational preparation, and subspecialty practice distribution.

International perspectives on the pediatric nurse practitioner role.

Advanced pediatric nurse practitioners (APNPs) working in acute settings are represented in pediatric hospitals, clinics, and wards around the world. They work independently and autonomously. The aim of this study was to compare the role of APNPs in four different countries to gain knowledge on the qualifications and experience of the practitioners and their impact on pediatric patients and families. A qualitative design with semistructured keyinformant interviews with four nurses from Sweden, Norway, England, and the United States was conducted. Analyses were performed using thematic analysis. Three themes were identified: 1) Qualification and Competencies, illustrated parallels within the four educations and daily practice. 2) Responsibility and Autonomy, highlighted differences. The informants experienced a mutual understanding of the concepts of advanced practice. Interprofessional collaboration with aphysician was crucial to ensure best practice. 3) Holistic Nurse Perspective highlighted the importance of APNPs having competencies to make holistic and family-centered decisions at a higher level. From the perspective of four APNPs, advanced pediatric nursing practice is beneficial to the patient, family, and professionals. The formal education varies in the countries studied, but the basic tenets of practice are the same. Family-centered practice and holism are basic to the APNP role.

Evolving role of pediatric nurse practitioners.

To report and interpret findings from national pediatric nurse practitioner (PNP) job analysis surveys reflecting the changes in the knowledge and skills required for advanced practice. National role delineation studies (RDS) conducted by American Nurses Credentialing Center (ANCC) in 2003, 2008, and 2011. Since the first nurse practitioner (NP) program was established in 1965 to train pediatric nurses for advanced practice, the role of the PNP has continued to develop. The RDS results demonstrate the increased autonomy of PNP's prescription of medication as the top work activity category identified, followed by the reporting of suspected abuse, exploitation, and/or neglect and immunizing based on current recommendations. Analysis of the changes in role or work activities, tied to the knowledge and skills required to perform those activities, can provide content for educators updating curriculum, for clinicians to remain current in their practice and impact healthcare policy. The current PNP role has evolved to meet the workforce demands of providing primary care to the pediatric population with increasing complex social and healthcare needs. Role analysis is important as NPs move forward to practice to the full extent of their education and training.

Nurse and Physician Attitudes Toward the Development of a Critical Care Pediatric Nurse Practitioner Role

Nurse and Physician Attitudes Toward the Development of a Critical Care Pediatric Nurse Practitioner Role

Pediatric Nurse Practitioners in the United States: Current Distribution and Recent Trends in Training

To assess the current distribution and training patterns of pediatric nurse practitioners (PNPs). Secondary data analysis from the National Association of Pediatric Nurse Practitioners and the 2008 US Census Bureau were used to estimate the distribution of PNPs per 100,000 children. Data on nurse practitioner (NP) graduation and specialty education programs were obtained from the American Association of Colleges of Nursing. PNPs have the greatest concentration in the New England and mid-Atlantic regions and a narrow band of Midwestern states. States that allow PNPs to practice or prescribe independently do not consistently have a higher density of PNPs per child population. There has been a slight decrease in the proportion of programs that offer PNP training. In the last decade, the proportion of NP graduates pursuing family nurse practitioner education has increased, and the proportion pursuing PNP education has decreased. Workforce planning for the health care of children will require improved methods of assessment of the role of PNPs and the volume of care they provide. Increased use of PNPs in pediatrics will likely require greater effort at recruitment of NPs into the PNP specialty.

Role of Pediatric Nurse Practitioners in Oral Health Care

Dental caries remain the most prevalent unmet health need in US children. Access to care is particularly problematic for poor children and is compounded by the shortage of dentists to meet the needs of this patient population. Expanding the roles of pediatricians, family physicians, and pediatric nurse practitioners (PNPs) who provide primary care services to children may be a strategy to address in this issue. Enhancements in current PNP education and certification processes are needed to support the expansion of oral health-related clinical responsibilities. Although oral health is included in the published curriculum for PNPs and certification exams require specific oral health knowledge, gaps in postgraduate training persist and few data document the extent to which current oral health-related educational goals are being achieved. We recommend enhancements in oral health education and research to evaluate curriculum innovations, the development of partnerships between stakeholder groups to leverage existing resources, and ongoing surveillance of oral health-related practice patterns among PNPs. Leadership at the national level is needed to develop policies that support curriculum changes and the implementation of oral health practice guidelines for PNPs that will improve access and reduce health disparities.

The Mental Health Needs of Children and Adolescents

THE MENTAL HEALTH needs of children and adolescents cannot be met by any one discipline or specialty. As we examine the National Association of Pediatric Nurse Practitioners (NAPNAP) position statement, it becomes clear that there is a vision shared by both advanced practice psychiatric nurses and pediatric nurse practitioners. The synergism between these two specialties holds the potential for increasing networks and resources; enhancing knowledge and skills; and having more innovation in clinical practice, research, and education related to the mental health of children and adolescents. Everyone gains in such a collaborative relationship —pediatric nurse practitioners, advanced practice psychiatric nurses, and most importantly, our clients. Pediatric nurse practitioners (PNPs) have provided care for children and their families for more than 40 years, especially in underserved communities. The PNP's role includes providing care with a holistic approach to children and their families,with emphasis in areas such as anticipatory guidance; growth and development; immunizations; early intervention; screening; prevention; and treatment of physical, mental, behavioral, and emotional disorders. In the last several years, particular attention has been given to the child and adolescent mental and behavioral health areas. As national chair of the Keep your Child Safe and Secure Program, Bernadette

The Pediatric Nurse Practitioner's Role in Reducing Oral Health Disparities in Homeless Children

Dental caries is the most common infectious disease of children. The majority of children in the United States who experience dental decay are from low-income, minority families. Many low- income, minority families are at risk for homelessness and, indeed, mothers with children are the fastest growing homeless group. Once homeless, families end up in shelters. Shelters are a unique source for the provision of health care; however, the provision of dental care to mothers and children in shelters is limited. At a shelter-based clinic, of a total number of children assessed in a 24-month period (n = 264), 22.7% (n = 60) had obvious gross dental cavities. The school-aged children (6-12 years) (n = 41) had the highest prevalence of dental cavities (34%). Consistent with the literature, dental caries was the most prevalent condition of homeless children and the most difficult for which to obtain treatment. Follow-up was difficult because of the transient nature of homeless families.

Evaluation of the Role of the Pediatric Nurse Practitioner in an Inpatient Asthma Program

Introduction In 1994, pediatric nurse practitioners (PNPs) at St. Louis Children's Hospital developed a program to improve the care of children admitted with asthma. In the Asthma Intervention Model, PNPs directly manage the care of children hospitalized with asthma and are instrumental in hospital-wide education. An evaluation study was conducted to measure effectiveness of this inpatient PNP role. Methods Attending physicians, interns, nurses, and families were surveyed regarding their perceptions of the PNPs as care manager and educator. A 16-item asthma knowledge test was administered to interns at the start and conclusion of their intern year. Length of stay, readmission rate, and cost were evaluated. Results PNPs were found to be effective in the inpatient asthma role by all participants. Significant gains were noted in intern knowledge and confidence in caring for asthma. Interns identified the PNPs as important contributors to their education. No significant differences occurred between interns and PNPs in length of stay, cost, readmissions, or severity of the condition of the asthma patients. Discussion PNPs in the inpatient asthma setting are effective care managers and educators.

The Evolving Responsibilities of the Pediatric Nurse Practitioner

The role of the pediatric nurse practitioner (PNP) is continuing to evolve and expand to meet the increasingly complex health care demands of the pediatric population. Although the PNP role initially was developed to provide pediatric primary care, PNPs now practice in a variety of settings: private practices, school clinics, hospital clinics, inpatient care settings, including intensive care units, and emergency departments. Most of these settings now involve secondary and tertiary care (Neale, 1999).

Spiritual development and the dying child: the pediatric nurse practitioner's role.

Dying children require special consideration when it comes to spiritual development. Pediatric nurse practitioners (PNPs) can be a pivotal influence in the manner in which a child progresses from sick child to dying child and an influence on the family at large during the process. The primary care PNP is uniquely positioned to have a premorbid knowledge of the spiritual development and needs of the child and family. The tertiary care PNP has a responsibility to provide continuing spiritual assessment and follow-up with referrals to appropriate professional staff and community resources for spiritual care. Childhood spiritual development within the context of the PNP's role in assessing and meeting the spiritual needs of the dying child is discussed.

Spiritual development and the dying child: the pediatric nurse practitioner's role

Dying children require special consideration when it comes to spiritual development. Pediatric nurse practitioners (PNPs) can be a pivotal influence in the manner in which a child progresses from sick child to dying child and an influence on the family at large during the process. The primary care PNP is uniquely positioned to have a premorbid knowledge of the spiritual development and needs of the child and family. The tertiary care PNP has a responsibility to provide continuing spiritual assessment and follow-up with referrals to appropriate professional staff and community resources for spiritual care. Childhood spiritual development within the context of the PNP's role in assessing and meeting the spiritual needs of the dying child is discussed.

Spiritual development and the dying child: the pediatric nurse practitioner's role

Dying children require special consideration when it comes to spiritual development. Pediatric nurse practitioners (PNPs) can be a pivotal influence in the manner in which a child progresses from sick child to dying child and an influence on the family at large during the process. The primary care PNP is uniquely positioned to have a premorbid knowledge of the spiritual development and needs of the child and family. The tertiary care PNP has a responsibility to provide continuing spiritual assessment and follow-up with referrals to appropriate professional staff and community resources for spiritual care. Childhood spiritual development within the context of the PNP's role in assessing and meeting the spiritual needs of the dying child is discussed.

PNP Roles and interventions with children with special needs and their families

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families. J Pediatr Health Care. (2001). 15, 138-143.

PNP Roles and interventions with children with special needs and their families

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families. J Pediatr Health Care. (2001). 15, 138-143.

Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions

Introduction: This study explored the current practice responsibilities of pediatric nurse practitioners (PNPs) from a national perspective. Educational preparation, geographic region of practice, years of employment as a PNP, type of employment setting, and full-time versus parttime employment were examined. Method: From a randomly selected sample (N = 997), a total of 387 respondents returned their questionnaire, resulting in 325 usable questionnaires. Results: Years of experience as a PNP, setting of employment, geographic region, prescriptive authority, and subspecialty practice were significantly related to various health supervision and illness-focused activities performed by PNPs, as well as level of management responsibility. Anticipatory guidance supervision continues to be an integral part of the PNP role. PNPs report that they assume major responsibility for the health assessment and management of children with common pediatric illnesses as well as chronic illnesses and conditions. Discussion: The ability to prescribe prescription medications produced the greatest overall effect on PNP role activities and level of management responsibility. Years of experience exerted an interesting effect on role functions related to the overall health supervision and illness-focused activities in which PNPs engaged. Implications for the educational preparation of PNPs, the updating of national certification examinations, and planning for adequate numbers in the workforce to replace the cohort of retiring PNPs in the next 20 years are discussed. J Pediatr Health Care. (2000). 14, 149–159.

Role delineation study of pediatric nurse practitioners: A national study of practice responsibilities and trends in role functions

Introduction: This study explored the current practice responsibilities of pediatric nurse practitioners (PNPs) from a national perspective. Educational preparation, geographic region of practice, years of employment as a PNP, type of employment setting, and full-time versus parttime employment were examined. Method: From a randomly selected sample (N = 997), a total of 387 respondents returned their questionnaire, resulting in 325 usable questionnaires. Results: Years of experience as a PNP, setting of employment, geographic region, prescriptive authority, and subspecialty practice were significantly related to various health supervision and illness-focused activities performed by PNPs, as well as level of management responsibility. Anticipatory guidance supervision continues to be an integral part of the PNP role. PNPs report that they assume major responsibility for the health assessment and management of children with common pediatric illnesses as well as chronic illnesses and conditions. Discussion: The ability to prescribe prescription medications produced the greatest overall effect on PNP role activities and level of management responsibility. Years of experience exerted an interesting effect on role functions related to the overall health supervision and illness-focused activities in which PNPs engaged. Implications for the educational preparation of PNPs, the updating of national certification examinations, and planning for adequate numbers in the workforce to replace the cohort of retiring PNPs in the next 20 years are discussed. J Pediatr Health Care. (2000). 14, 149–159.

Response to Dr Stone

Dr Elsa Stone, in her usual organized and lucid fashion, has presented the case for inclusion of pediatric nurse practitioners (PNPs) in private pediatric practices. She bases her conclusions on her nearly 10 years of positive experience with a PNP in her own practice in Connecticut. Dr Stone describes the PNP population and demography, describes the training curriculum of PNPs, and discusses the scope of work of these individuals. She concludes that "there is substantial evidence that PNPs provide quality health care and that collaborative teams of pediatricians and PNPs can provide high-quality, cost-effective care to a broader spectrum of children than can be served by either profession alone." The American Academy of Pediatrics (AAP) has insisted for several years that there is a shortage of pediatricians to meet the expanding needs of the children of the United States. Furthermore, pediatricians—because of system changes—will be expected increasingly to provide a variety of time-intensive services. Dr Stone believes that many of these services can be well provided by PNPs. Within the AAP, there have been some concerns about the role of PNPs. Of particular worry seems to be the possibility that PNPs might decide to practice independently, leading to a lower quality of care for their patients. Less often stated, but clearly an issue, is that PNPs are viewed by some pediatricians as potential competitors. Dr Stone's demographic analysis of what PNPs are currently doing is relevant to these concerns. One third of PNPs work in private pediatric practices or health maintenance organizations.

Experience with a nurse practitioner program in the surgical department of a children's hospital

Manpower limitations are occurring in residency programs because of fewer residency positions and increasing governmental regulations. This limitation prompted the development of a program to utilize pediatric nurse practitioners (PNPs) in our Department of Surgery. Two began in September 1989. Their role was similar to that of the junior resident and included collaborative management of patients, admission evaluations, discharges, and a variety of procedures. The impact of this program was evaluated by questionnaire to attending surgeons, house staff, and parents. There were 123 surveys mailed (12 attending surgeons, 46 residents, 65 parents). The overall response rate was 51% (100% attending surgeons, 57% residents, and 38% parents). Only two of the attending surgeons had previous experience working with a PNP. All attending surgeons were enthusiastic about the PNP role in managing their patients and felt the PNP had decreased the workload of the resident. Eighty-three percent did not feel the PNP interfered with resident learning; 17% were undecided. Eleven of 12 felt the PNP had helped communication between them and their patients; one was undecided. The resident responses were assessed by level of training. Among senior residents, 82% felt the PNP had decreased the workload of the junior resident and 91% viewed the PNP as a valuable resource, whereas 87% of the junior residents felt the PNP decreased their workload and 100% felt the PNP was a valuable resource. None of the residents felt the PNP interfered with their learning and 73% of the junior residents and 55% of the senior residents felt the PNP contributed to their learning. Forty-seven percent of the junior residents felt the PNPs' availability provided them with more time in the operating suite. Of the parents surveyed, 40% had previous experience with a PNP. Ninety-six percent were pleased with the involvement of the PNP in their child's care and the PNPs' knowledge base; 4% were undecided. Eighty-four percent of parents felt the PNP facilitated communication with their surgeon and 92% felt the PNP kept them well informed about their child's progress. All of the parents felt the PNP was easily accessible to answer their questions. In conclusion, the implementation of the PNP role has been well received by attending staff, resident staff, and parents. The new PNP program has achieved its goals, decreasing resident workload while providing safe, efficient care. The program has been expanded to 4 PNPs and has proven to be an effective measure to improve care of pediatric surgical patients.

Hair loss in children and adolescents

No other body system is more exposed to the public eye than the skin and the hair. Pediatric nurse practitioners (PNPs) frequently encounter patients in their practice settings with the complaint of “hair loss.” The most often diagnosed causes of hair loss include tinea capitis, alopecia areata, traction alopecia, and trichotillomania. This article defines these conditions, explores the causes for them, and describes the incidences. Emphasis is placed on the PNP's role on making a differential diagnosis based on the presenting clinical manifestations, patient history, and laboratory testing. Treatment for these conditions as well as nursing goals and PNP interventions for management and family education also are discussed.