Letter to the Editor
Article Outline
DEAR EDITOR:
This letter is in response to the article by Reider-Demer, Widecan, Jones, and Goodhue (2006) on the evolving responsibilities of the pediatric nurse practitioner in the July/August edition of the Journal of Pediatric Health Care. While it contained useful information pertaining to credentialing and privileging for the acute care pediatric nurse practitioner (AC-PNP) practicing in hospital-based settings, it also contained distressing statements in regards to AC-PNPs. First, we were alarmed that a statement was made regarding pediatric intensive care unit staff nurses’ refusal to implement orders written by an AC-PNP without a physician co-signature, resulting in a delay in treatment, was presented without any evidence. As legislation varies state to state regarding co-signature requirements, evidence of problematic implementation of the AC-PNP role would assist in developing programs for successful implementation. Without effective programs for implementation, we propose that difficulties associated with staff nurses not carrying out orders written by AC-PNPs is a failure of education of staff regarding the appropriate scope of practice of AC-PNPs within that state and institution. Many studies have documented the outcomes of AC-PNPs. In these studies, AC-PNPs have demonstrated excellence in management skills and staff satisfaction. One study by Shebesta et al. (2006) evaluated pediatric trauma nurse practitioners and found that involvement of the PNP leads to higher nursing satisfaction scores when compared with residents while providing equivalent care for pediatric trauma victims. Another study by Fanta et al. (2006) demonstrated that PNPs provide equivalent care for injured pediatric patients with a significantly shorter length of stay and significantly higher patient satisfaction scores when compared to resident physicians with regards to communication.
The second comment that was disconcerting was one stating that AC-PNPs are often asked to perform procedures that they are not qualified to perform, placing the community at risk for harm. Again, this statement was offered without any evidence of impact on patient care outcome and the community. Statements made without presentation of the evidence add to urban legend and it becomes unclear what is actually accurate. As you well know, AC-PNPs are often facile at many invasive procedures that have been the sole responsibility of physicians in the past. AC-PNPs acquire their skills in AC-PNP programs and while in the clinical setting of their role under the supervision of either experienced nurse practitioners or physicians. As published by Molitor-Kirsch et al. (2005), approved invasive procedures for critical care pediatric nurse practitioners are wide and varied, often including arterial line placement, central venous line placement, chest tube placement/thoracentesis, endotracheal intubation, lumbar puncture, suturing, and suprapubic bladder aspiration. These procedures are safely performed and there are no data in the literature to support a statement suggesting that AC-PNPs are putting patients at risk by performing invasive procedures. One survey by Verger et al. (2005) evaluated 74 nurse practitioners practicing in pediatric critical care. The survey addressed the skill level and need for supervision skills for the majority of technical procedures. Survey respondents described expert or proficient skills for the majority of technical procedures they perform (e.g., lumbar puncture, central line placement).
AC-PNP roles continue to evolve and expand as they consistently demonstrate exceptional management practices. As a profession, we must continue to conduct outcome studies to document the outstanding care delivered to patients and to be receptive to supporting the continually evolving role of the AC-PNP.
References
- . Pediatric trauma nurse practitioners increase bedside nurses’ satisfaction with pediatric trauma patient care. Journal of Trauma Nursing. 2006;13:66–69
- . Pediatric trauma nurse practitioners provide excellent care with superior patient satisfaction for injured children. Journal of Pediatric Surgery. 2006;41:277–281
- . The changing face of critical care medicine. AACN Clinical Issues. 2005;16:172–177
- . The evolving responsibilities of the pediatric nurse practitioner. Journal of Pediatric Health Care. 2006;20:280–283
- . Nurse practitioners in pediatric critical care: results of a national survey. AACN Clinical Issues. 2005;16:396–408
PII: S0891-5245(06)00736-X
doi:10.1016/j.pedhc.2006.12.004
© 2007 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
