Heroism in Nursing Practice: PNP Heroes

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Pediatric nurse practitioners often serve in the communities which have the greatest need. They are known to be loyal service-leaders who not only provide excellent services to children and families but also become advocates for change and improvements for the voices that would otherwise be unheard.
Dr. Anne Derouin, Duke University

According to the American Association of Nurse Practitioners (AANP 2016), there are more than 220,000 nurse practitioners across the country, and 6.4 percent of them are pediatric NPs working in primary care. Adequate access to healthcare is an omnipresent concern across the US, and one way to meet the growing shortage of medical professionals is to empower PNPs to practice to the full extent of their education, clinical training, and credentialing (i.e., grant them full practice authority); unfortunately, a political fight has subsumed the debate for decades and NP practice authority still varies widely among states.

There’s abundant evidence that NPs, including those in the pediatric specialty, provide cost-effective and resource-efficient healthcare with quality patient outcomes. In fact, the National Association of Pediatric Nurse Practitioners (NAPNAP) maintains a trove of position papers about issues such as prescriptive authority, the ability of PNPs to prescribe pharmaceuticals and medical devices to patients. NAPNAP (2016), the Institute of Medicine, the AANP, the VA, and many others advocate for NP full prescriptive authority. Dr. Beth Phoenix, a psychiatric NP and professor at the UCSF, poignantly summarized the problem in a 2017 interview; she revealed that the requirement of physician supervision to prescribe drugs “is currently functioning as a barrier to employing PMHNPs in systems that have long-standing shortages of mental health providers with prescriptive authority, which increases the long wait times for consumers needing these services.” The same is true for PNPs trying to serve children and their families.

The main opponents to granting NPs full practice privileges are physician groups. Notably, a majority of NPs are female and there’s some evidence of sexism in this long fight. By illustration, Dr. Nancy Rudner Lugo, a professor at George Washington University, discovered that states which historically ratified the Equal Rights Amendment (ERA) were more likely to have FPA for NPs (Online Journal of Issues in Nursing 2016). In sum, she stated, “A more egalitarian view of women, as reflected in support for the ERA in the state, was found to be associated with regulations recognizing full practice authority for NPs, CNMs, and CRNAs.” While the conclusion isn’t definitive, it’s a thought-provoking coincidence, especially since a recent Harvard University study found that female doctors have superior patient outcomes to male doctors (JAMA Internal Medicine 2017).

In three exclusive interviews, this piece celebrates the invaluable contributions of PNPs across the country and advances the case for granting full practice authority nationwide.

Interviews with Three Exceptional Pediatric NPs

Three professors from prestigious universities graciously agreed to interviews with NPS. They shared anecdotes about the crucial contributions of PNPs and how granting full practice authority can improve healthcare delivery nationwide.

Advancing the Fight for Full Practice Authority

One of the most significant gaps in healthcare nationally is the availability of primary care providers. PNPs are educated to provide comprehensive, cost-effective, high-quality health care services in diverse settings from birth to 21 years of age. Allowing PNPs to work to the full extent of their education and certification increases patient access to health care.
Dr. Cheri Barber, University of Missouri, Kansas City

This piece aims to draw attention to the invaluable role that pediatric nurse practitioners play in healthcare. By highlighting their contributions to the wellbeing of children and families nationwide, it becomes clearer that denying NPs full practice authority privileges is unfair and compromises the ability of trained professionals to help others.

As of March 2017, there are still 29 states which curtail the power of NPs to practice to the full extent of their education, training, and credentialing; this is unjust in the face of mounting evidence that NPs offer cost-effective, quality medical treatment, expanding access to care across all patient populations. Denying NPs less authority than they deserve by requiring physician oversight for even the most basic aspects of care creates a bureaucratic waste of resources and time.

Above all, there’s a growing movement toward granting NPs the professional privileges they earned through their education and credentialing. Recognizing a projected shortage of primary care healthcare providers in the US, the Institute of Medicine, the VA, the AARP, the NGA, the BPC, and the FTC (among many others) have advocated for granting NPs full practice authority nationwide. In addition to engaging lawmakers, calling representatives, and sending messages, it’s important to convince physicians that NPs aren’t in competition with them, but rather seek to serve as empowered members of the team. With recent victories for NPs in Michigan and a growing awareness of the issue in other states, there’s much hope for progress on into the future.

Jocelyn Blore

Jocelyn Blore

Editor

Jocelyn Blore is the Managing Editor of NursePractitionerSchools.com. After graduating from UC Berkeley, Jocelyn traveled the world for five years as freelance writer and English teacher. After stints in Japan, Brazil, Nepal, and Argentina, she took an 11-month road trip across the US, finally settling into lovely Eugene, OR. When Jocelyn isn’t writing about college programs or interviewing professors, she satirizes global politics and other absurdities at Blore’s Razor (Instagram: @bloresrazor). Thank you for being interested.