Update on ENP Practice & Certification

Transcription

1 Update on ENP Practice & Certification Michael D. Gooch, DNP, ENP Instructor in Nursing Vanderbilt University Emergency Nurse Practitioner TeamHealth TN State Representative American Academy of Emergency Nurse Practitioners

2 Disclosures None

3 Session Objectives At the conclusion of this session, learners will be able to: Describe the ideal educational preparation for an Emergency Nurse Practitioner (ENP) Identify ongoing efforts to further define and support ENP practice

4 Landscape of ENP Practice NPs of all specialties have been in EDs since the 1980 s First programs preparing ENPs specifically not until the 1990s Increased use of EDs as a primary source of healthcare, & overall sicker patients presenting to the ED (Centers for Disease Control and Prevention, 2015) Increasing physician shortages (AAMC, 2013; Tucker and Bernard, 2015) IOM supports NP practice to their full educational ability & removing barriers to practice (IOM, 2010) Increasing numbers of specialized programs to meet current needs Graduate level (8 academic programs) Post-graduate (11 clinical fellowships) level

5 2016 ENP Facts 222,000 NPs practicing in the U.S. (AANP, 2016) 13,320 are working in EDs (American Association of Nurse Practitioners, 2016; Emergency Nurse s Association, 2013) 93% of NPs in EDs are FNPs (AAENP, 2016) ENPs must be prepared to provide primary care, acute resuscitation, as well as manage complex, unstable conditions in patients of all ages

6 Where ENPs work High acuity Emergency Departments Urgent care settings Observation medicine Fast Track/Rapid Treatment Areas Trauma care Triage/Medical screening Disaster preparedness Administrative and/or teaching roles Rural/Critical Access facilities

7 Setting Academic Hospital Fast Track ED Main ED Retail Clinic Urgent Care Other Counts/frequency: Academic Hospital/Tertiary Care (27, 22.7%), Fast track (42, 35.3%), Main ED (93, 78.2%), Retail Clinic (2, 1.7%), Urgent Care (18, 15.1%), Other (11) Data from: American Academy of Emergency Nurse Practitioners (2016). Academy of Emergency Nurse Practitioners 2015 Membership Survey. Houston, TX

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9 ENP Role & the Consensus Model ENP Family Population* NP Role * While the Family population is the most direct & common route, emergency care expertise & competencies may be demonstrated among NPs with other population foci

10 Licensure of ENPs Nurse Practitioners are independently licensed, professional healthcare providers who have completed advanced nursing education & clinical training in order to evaluate, diagnose and treat specific populations of patients State BON vs. BOM Nurse Practitioners minimally hold a Master s degree and may additionally hold a Doctoral Degree

11 State Practices Significant variance in state practice acts, licensure, & recognition Licensure to practice in most states also requires national board certification in a population foci Inconsistency regarding certification type needed results in competent ENPs being removed from their current positions

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13 Paths to the ENP Specialty ENPs are educated in advanced emergency care skills (e.g., advanced airway skills and resuscitation) and procedures (e.g., ultrasound and lumbar puncture) Current graduate ENP educational programs build upon FNP education to provide specialty knowledge across the lifespan Graduate level (8 academic programs) Post-graduate fellowships are available to provide additional educational opportunities for ENPs who have not received specialty knowledge in their graduate nursing programs. Post-graduate level (11 clinical fellowships)

14 Scope & Role of the ENP ENP scope of practice is based on educational preparation, state regulation and licensure, and institutional credentialing. The ENP practices within his or her scope of practice and consults with other providers for situations requiring a higher level of care or additional medical expertise in some settings. Scopes of Practice, Standards of Care & Competencies support ENP practice Competencies initially delineated in 2008 are currently being updated Scopes & Standards have been published by AAENP in October, 2016

15 Competencies Specialty-level competencies & certification are determined by specialty organizations Evaluation of ENP Competencies may be assessed in several ways: Successful completion of academic ENP program or post-graduate fellowship education in emergency care Organizational orientation, skill acquisition, and evaluation based on location and organization standards Completion of emergency specific continuing education Individual portfolio documentation of skills, training and/or procedure log

16 Certification Certification for ENPs recognizes an individual s specialty knowledge Two Options for Certification Currently only based on competency validation by completion of an expert portfolio through the American Nurses Credentialing Corporation (ANCC) Exam to be offered beginning January 2017 by AANPCP

17 Certification by Portfolio American Nurses Credentialing Center (ANCC) has offered Emergency NP Certification by Portfolio since 2013 Applicants submit self & peer evaluations with a written exemplar showing expertise as an emergency care clinician Available to NPs certified in a population foci (FNP, AGNP, PNP, ACNP) who also have: Two years or 2000 hours of emergency clinical practice in the past 3 years Completion of 30 hours of continuing education in emergency care Exemplary performance in 2 of 5 professional development & leadership aress Awards the credentials ENP-BC

18 Certification by Exam A new certification exam offered by the American Academy of Nurse Practitioners Certification Program (AANPCP) Available for Family NPs ENP Specialty Certification Handbook & applications available online currently Testing slated to January 2017 Awards the credentials ENP-C

19 ENP-C Eligibility Criteria Due to the lifespan scope of the ENP examination, eligibility to take the Emergency NP certification examination is limited to applicants meeting eligibility criteria for one of the following three options: OPTION 1: - Minimum of 2,000 direct, emergency care clinical practice hours as a Family NP in the past five (5) years; - Evidence of 100 hours of continuing emergency care education; and a - Minimum of 30 continuing emergency care education hours in emergency care procedural skills within those 5 years. OPTION 2: - Completion of an academic emergency care graduate/ postgraduate NP program from an accredited nursing program, or - Completion of a dual FNP/ENP graduate/post-graduate certificate program from an accredited nursing program. OPTION 3: - Completion of an approved emergency fellowship program.

20 American Academy of Emergency Nurse Practitioners Established in 2014 by group of core NP leaders in emergency care The mission of AAENP is to "promote high quality, evidence based practice for NPs providing emergency care for patients of all ages and acuities in collaboration with an interdisciplinary team". Since establishment, AAENP members are collaborating with other groups to improve emergency patient care within the United States American College of Osteopathic Emergency Physicians American College of Emergency Physicians Physician assistant colleagues Nursing Organizations

21 100 Reason for joining AAENP Edu/prof development Journal Access Discounts/Savings Annual Conference Networking Ops Other Counts/frequency: Continuing education/professional development (79, 68.7%), Journal access (4, 3.5%), Discount/savings (1, 0.9%), Annual conference with skills lab (11, 9.6%), Regional meetings/networking opportunities (20, 17.4%), Other (21) Data from: American Academy of Emergency Nurse Practitioners (2016). Academy of Emergency Nurse Practitioners 2015 Membership Survey. Houston, TX

22 Top Challenges ENP is facing Practice Issues State regulations/laws Credentialing Job opportunities Restrictions Skills Proficiency Other Counts/frequency: Practice issues (60, 54.1%), State regulations/laws (62, 55.9%), Credentialing (21, 18.9%), Job opportunities (18, 16.2%), Restrictions (42, 37.8%), Skills Proficiency (64, 57.7%), Other (2) Data from: American Academy of Emergency Nurse Practitioners (2016). Academy of Emergency Nurse Practitioners 2015 Membership Survey. Houston, TX

23 AAENP Initiatives Facilitate broad & clear understanding of the ENP role by those hiring ENPs by regulatory agencies (e.g., NCSBN) by educational accreditation bodies by graduate NP educational organizations (e.g., NONPF) Standardize educational curricula Updating Core Competencies Further ENP science Photo credit: Vanderbilt School of Nursing, 2016

24 AAENP Accomplished Initiatives

25 Practice Model for NPs in Emergency Care FAMILY NP Population as cornerstone Emergency Care Specialty (ANA, 2012) Scope, Standards & Competencies (ENA, 2008; AANPCP, 2016) Professional Organization (AAENP, 2013) Not Site Specific Pre-hospital, Critical Access, Emergency Department, Urgent Care, Telemedicine Developed Elda Ramirez (2016) Specific Educational Content (Academic, Fellowship, Continuing Education) Certification Exam (AANPCP, 2017) Note: Certification by portfolio available through ANCC (2014) Interprofessional Practice MD/DO, PA, EMS, Pharmacy, Respiratory Therapy, etc. Emergency NP (ENP) competencies include the ability to manage patients of all ages and acuities, to perform procedures and to make dispositions of any patient requiring expeditious medical, surgical, or psychiatric care (as defined by the specialty of emergency care). The ENP does not provide ongoing management of the postresuscitation, critical care patient.

26 For more information about Emergency Nurse Practitioners please contact the American Academy of Emergency Nurse Practitioners