Alignment of Pediatric Nurse Practitioner Licensure,Accreditation, Certification,and Education for Employers

Advanced practice registered nurses (APRNs) are a critical member of the health care team, providing essential frontline care to patients and families. Given the evolution of the use of pediatric-focused APRNs in more acute and critical care settings, it is essential to understand the APRN consensus model. Understanding the APRN consensus document and its relationship to selecting the pediatric nurse practitioner who is appropriately qualified for the population of interest is crucial. Compliance with regulatory guidelines during the credentialing and privileging processes, along with organized clinical onboarding after hire, can optimize outcomes for employers and providers alike.     

Advanced Practice Nursing Organizational Leadership Model

Advanced practice registered nurses (APRNs) have been used by organizations to meet the needs of their patients. However, there is a lack of organizational structure in place for appropriate APRN supervision. Oftentimes, there are non-APRN supervisors who lack understanding of APRNs, leading to poorly defined roles, credentialing, understanding of scope of practice, and lack of shared governance. With an advanced practice nursing organizational leadership model, there is evidence for improved job satisfaction, retention, and accountability for APRNs. The proposed model includes use of a chief of advanced practice officer and APRN supervisors.     

Hospital Regulation of Pediatric-Focused Nurse Practitioners: A Multistate Survey

The growing need for pediatric-focused providers remains unmatched by patient demands in acute care settings. Additional organizational restrictions above and beyond state scope of practice laws further limit the ability of nurse practitioners (NPs) to practice to the fullest extent of their training and education. Knowledge of scope of practice is essential for NPs, physicians, and hospital leadership to efficiently use NPs, decrease turnover, and promote access to care. This original research sought to describe hospital-level practice regulation and credentialing patterns across the southeastern United States and inform effective use of NPs at the organizational level.     

Credentialing and privileging of advanced practice nurses

Credentialing and privileging are increasingly common administrative processes that advanced practice nurses must complete. With the intention of assuring the public of safe health care provided by qualified personnel, several federal and state organizations have developed criteria that licensed practitioners must meet. Managed care organizations are also creating credentialing and privileging guidelines for practitioners who are applying to their provider panels. Understanding the requirements of these processes is essential to advanced practice nurses establishing themselves in practice. This article explains the guidelines from federal, state, and institutional agencies and offers recommendations to practitioners as they prepare for the credentialing process. Also included are sample forms for establishing a practice agreement and a privilege-delineation request.     

Impact of new regulatory standards on advanced practice registered nursing: the APRN Consensus Model and LACE

Advanced practice registered nurses (APRNs) represent a crucial resource to meeting growing health care needs. Such resources must be used to the full extent and in the most effective way possible. Through the development of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (LACE), nursing is assuming a leadership role within the health care system and participating as an equal partner in redesigning health care. When fully implemented, the Consensus Model will allow APRNs to practice to the full scope of their education and more easily move from one state to another, increasing access to quality health care for all populations.     

The role of the nurse executive in fostering and empowering the advanced practice registered nurse

The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders.     

COVID-19 and Advanced Practice Registered Nurses: Frontline Update

Coronavirus disease 2019 (COVID-19) emerged in 2019 and rapidly became a global pandemic, infecting millions and killing hundreds of thousands. The disease altered the practices of hospitals, clinics, and patients. These changes have implications for advanced practice registered nurses (APRNs). APRNs must remain current on best practices for treatment and diagnosis of COVID-19 while being cognizant of changes to their scope of practice. As the pandemic continues, APRNs will remain on the front lines treating patients with COVID-19 while also caring for vulnerable populations within the community. To provide high-quality care, APRNs must use a multifaceted approach that heeds ongoing updates to evidence-based practice.     

Credentialing and Privileging: A Primer for Nurse Practitioners

To understand credentialing and privileging, it is helpful to first look at the genesis of such requirements and examine how laws, regulations, agency policies, and common law affect whether or not a nurse practitioner is able to practice in a specific setting and under what conditions. This article provides a brief overview of federal, state, and local laws that impact nurse practitioner credentialing and privileging as well as a glossary of important terms. The process of obtaining credentials and privileges is then addressed. Finally, case examples centering on credentialing and privileging are considered.     

A Review of Procedural Skills Performed by Advanced Practice Providers in Emergency Department and Critical Care Settings

Advanced practice providers (physician assistants and nurse practitioners) are part of the interdisciplinary teams integral to successful care and improved outcomes for acutely ill patients in intensive care units and emergency departments. Between physician shortage and increased complexity of patients with often rapidly deteriorating conditions, the addition of advanced practice providers and expansion of acute care provider roles result in positive outcomes including decreased hospital length of stay, improved continuity of care, decreased hospital costs and increase inpatient, physician and staff nurses job satisfaction. This article attempts to examine the role that advanced practice providers (APPs) play in performing diagnostic and therapeutic procedures in acute care settings, education provided in physician assistant (PA) and nurse practitioner (NP) programs, and post-graduate training required to achieve competency and comfort in performing procedures. PA and NP training and credentialing often vary at the state level and by practice site. This article aims to collect information on how these roles compare as well as which procedures are actually being performed by advanced practice providers in the emergency department and critical care settings. Considering the healthcare system move towards team-based care, procedures performed by APPs align with the needs of the patient population served and correspond to the procedures done within the teams by physician providers. Independently billing under national provider identifier is cost effective but can be influenced by the current physician reimbursement system or lack of understanding of APP billing process by health care systems. Though there is limited research in this area, this article serves as a starting point to examining the current utilization and utility of APPs performing procedures in the emergency department and critical care settings.     

Addressing the Texas Health Care Crisis: Effective Use of Advanced Practice Registered Nurses

Texas is experiencing an unprecedented health care crisis, including a shortage of primary care providers. The current site-based delegation practice model for advanced practice registered nurses (APRNs) restricts public access to qualified providers. APRNs are equipped to immediately address the crisis in Texas by providing accessible, affordable, high-quality care if they are permitted to practice to the full extent of their education and training. Texas APRN organizations are working with stakeholders to propose a new collaborative practice model during the 2013 legislative session. Using APRNs is projected to increase economic output to $26 billion and create 177,200 jobs by 2040.     

Survey of advanced practice registered nurses disciplinary action

The nursing profession continues to struggle to find the most appropriate approach to credentialing Advanced Practice Registered Nurses (APRNs). One early step in addressing this struggle is determining the incidence of APRN disciplinary actions by boards of nursing. This article presents data from 2003 and 2004 describing the incidence of APRN disciplinary actions by United States boards of nursing. Fifty-one boards of nursing, all members of the National Council of State Boards of Nursing, were asked to report the numbers of APRN discipline cases for 2003 and 2004 which had been resolved, using a tool that differentiated disciplinary cases into four data categories: chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients. Thirty-eight (74.5%) of 51 boards of nursing reported discipline data for a total of 125,882 APRNs showing 688 disciplinary actions were taken during 2003 and 2004. This indicates that APRNs experience a low incidence of discipline related to chemical impairment, exceeding scope of practice, unprofessional conduct, and safety or abuse of patients.     

The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses

Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations.     

Do State Restrictions on Advanced Practice Registered Nurses Impact Patient Outcomes for Hypertension and Diabetes Control?

The Institute of Medicine recommends that nurses practice to the full extent of their education and training, yet, state regulations continue to limit the scope of practice for advanced practice registered nurses (APRNs). One reason is the unproven belief that patient outcomes will be inferior if APRNs practice without regulations. This study examined whether the absence of restrictions on APRNs results in inferior outcomes for patients with hypertension or diabetes. We used publicly available data for patients seen in Federally Qualified Community Health Centers during 2013 in 6 states with the most restrictions and in 10 states with the least restrictions.     

A continuing education program for nurse practitioners in ambulatory care

Continuing education should be an integral part of all health care providers' practice. This article discusses the recognition of this need by a group of nurse practitioners in an acute ambulatory care center. The process undertaken in developing the program of continuing education is described. The program outline can serve as a model for other NPs in similar settings.     

Attention-deficit/hyperactivity disorder: diagnostic assessment methods used by advanced practice registered nurses

BACKGROUND: Children presenting with symptoms of attention-deficit/hyperactivity disorder (ADHD) have become highly prevalent in primary care practice; however, advanced practice registered nurses (APRNs) diagnostic methods used to identify and diagnose this disorder are greatly understudied. AIM: This study aimed to identify APRNs recognition and diagnostic practices of children who were suspected of having an ADHD diagnosis. It also addressed APRNs comfort levels with treating and diagnosing ADHD, along with certain diagnostic methods and their perceived accuracy of these methods. METHODS: This nonexperimental exploratory research study used a self-administered questionnaire to gather information about diagnostic methods used by APRNs who diagnose children with ADHD, treat the disorder, or did both. RESULTS AND DISCUSSION: The questionnaires identified that the APRNs were following the American Academy of Pediatrics diagnostic guidelines for diagnosing ADHD in children more closely than other health care providers (pediatricians and family physicians). The results of this study also indicated that most APRNs were very comfortable to comfortable making an ADHD diagnosis (52.5%), and 64.4% reported the same level of comfort with treating ADHD. These findings indicate that the majority of APRNs surveyed who works with children are comfortable with diagnosing and treating ADHD.     

Enrolled nurse trainees in acute care

Enrolled nurses (ENs) play a pivotal role in the health workforce in Australia and the role is expanding in many practice settings. An EN traineeship was introduced in an acute medical/surgical setting at St Vincents & Mercy Private Hospital (STVMPH) a large metropolitan private hospital in Victoria, in 2005. Since then there has been a significant increase in the EN workforce across all clinical areas within the organisation. With consideration of skill mix the current percentage of 18.3% of the nursing workforce is ENs. This review shows the viability of such a program in relation to workforce planning and recruitment. Enrolled nurses are a valuable source in the health care environment. The latest figures indicate there are 230,192 registered nurses (RNs) and 52, 895 ENs (Australian Institute of Health and Welfare, 2010). Enrolled nurses account for approximately 23% of the nursing workforce. The common setting for education (clinical placement) and employment for ENs is aged care. Education and employment of ENs in acute hospital settings is necessary to broaden the skill mix of nursing staff in an acute environment. The acute medical setting encourages ENs to develop and advance their clinical skills to practice acute nursing care within their scope of practice.     

Adult-Gerontology Nurse Practitioners: A Discussion of Scope and Expertise

Adult-gerontology primary care nurse practitioners (NPs) deliver longitudinal primary care in outpatient settings from adolescence to older adulthood, and adult-gerontology acute care NPs provide care to critically ill adults and older adults. Family NP programs vastly outnumber adult-gerontology NP programs nationwide, despite a rapidly aging population. This report discusses the differences in education and scope of practice of adult-gerontology primary care NPs, adult-gerontology acute care NPs, and family NPs and highlights the crucial and unique assets adult-gerontology NPs bring to any health care system or practice. Differences in competencies, certification examinations, and practice settings are discussed in depth.     

Credentialing: The need for a national research agenda

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.