Graduate education: the perioperative nurse practitioner

As the surgical experience becomes increasingly complex, the need for nurses who are experienced and educated in the management of surgical problems becomes critical. This article discusses the development of a perioperative nurse practitioner program designed to prepare perioperative nurses to assume the complex and exciting role of caring for a diverse population of surgical patients.     

The changing face of critical care medicine: nurse practitioners in the pediatric intensive care unit

Over the last 50 years, healthcare has undergone countless changes. Some of the important changes in recent years have been budget cuts, decreased resident work hours, and increased patient acuity. The need for additional clinical expertise at the bedside has resulted in nurse practitioners becoming an integral part of the healthcare delivery team. To date, little has been published regarding the role of the nurse practitioners in intensive care units. This article outlines how one pediatric hospital has successfully utilized nurse practitioners in the intensive care unit.     

The pediatric nurse practitioner: origins and challenges.

During the past decade, a new health professional has evolved--the pediatric nurse practitioner (PNP). Responding to warnings of a shortage of primary care physicians, the American Academy of Pediatrics helped encourage programs to train PNPs who would provide well-child care, working under a physician's supervision. Simultaneously, in response to changing attitudes by and toward nurses, the American Nurses' Association expressed support for the expanded role of nurses in direct patient care functions--an expansion that would supplement other new academic programs in advancing the status of nursing as an interdependent, rather than subsidiary, health profession. Although mutually aiming at improvements in health care, both professions thus acted with different motivations and goals that have produced ongoing conflicts. These conflicts have been intensified by the absence of long-range planning in federal programs that have supported training for nurse practitioners. This paper summarizes the history of the PNP movement and the unresolved problems created by this new health professional.     

Consortium approach for nurse practitioner education

In 1995, a 10-university consortium approach to deliver a post-baccalaureate primary care nurse practitioner programme funded by the Ontario Ministry of Health was launched throughout Ontario, Canada. A combination of traditional and distance teaching methods, in English and French, were used. A 5-year research project was initiated to evaluate the entire programme, the effect of nurse practitioners on patient and health-care system outcomes and examine practice patterns. Participants included deans and directors (n = 10), regional co-ordinators (n = 5) and course developers, some of whom were also course professors (n = 8). This article is a report of the evaluation of the consortium programme after the first year from the perspective of groups involved in implementation and delivery. Results of qualitative analyses of participant perceptions from researcher-led focus groups and asynchronous electronic interviews provided the framework for the evaluation, and revealed the rationale for the consortium method, strengths, limitations and recommendations. Sharing ideas, resources and delivery and increased student access in remote areas were perceived as positive outcomes. Limitations included the short time period to develop programme content, identify and plan for distance education resources, and too little communication between universities and students. Researchers concluded that the consortium approach was effective for nurse practitioner education. Key factors identified for programme planning were communication, resources, curriculum and workload. Included among the recommendations was to allow sufficient time for role and course development before beginning a similar programme.     

Li-Fraumeni syndrome and the role of the pediatric nurse practitioner

Li-Fraumeni syndrome (LFS) is an inherited cancer syndrome that affects a small percentage of the population worldwide. LFS is characterized by multiple cancers in affected family members and is devastating to all diagnosed patients and their relatives. A link has been identified between LFS and mutations in the tumor-suppressor gene that encodes for the P53 protein, and much research has been done on the effect of this mutation in tumorigenesis. However, the natural history of the disease has no definitive pathway, and additional research is under way. LFS is rare, can present in many ways, requires complex management, and has tumors that often first present in childhood. Therefore, pediatric nurse practitioners should be aware of LFS as a potential differential diagnosis in patients with multiple tumors, certain rare tumors, or most importantly, a family history notable for multiple early-onset cancers.     

Integrating evidence-based practice in nurse practitioner education

This column normally focuses on a specific clinical practice guideline (CPG). This month's column deviates from that practice to demonstrate how evidence-based practice (EBP) was integrated into the nurse practitioner (NP) curriculum at the University of Texas at Austin School of Nursing. Processes of EBP were linked to student clinical assignments across core NP clinical courses, culminating in a student-published CPG. When students research and analyze available scientific evidence for a CPG, they learn to critically evaluate and logically organize knowledge for use in clinical practice, and those critical-thinking skills can lead to improved clinical reasoning and decision making.     

Acute care pediatric nurse practitioner: a vital role in pediatric cardiothoracic surgery

The changing health care environment and provider shortage have required acute care pediatric nurse practitioners (AC PNPs) to play a vital role in hospital-based, subspecialty surgical services. The AC PNP is part of a multidisciplinary team providing care for children with congenital heart disease after heart surgery. The AC PNP provides high-quality, cost-effective care to acute and critically ill children, optimizing hospital throughput while ensuring patient safety. This article focuses on the history and emerging role of the AC PNP in the context of the Magnet component of transformational leadership, the physician/nurse practitioner collaborative practice, and the development of the AC PNP role in cardiothoracic surgery at the Children's Hospital Los Angeles.     

Emerging role of the pediatric nurse practitioner in acute care

The pediatric nurse practitioner role in the tertiary setting is one of several emerging roles gaining recognition in the various groups of advanced practice nursing programs today. The advanced practice nurse (APN) who is a pediatric nurse practitioner (PNP) in an acute care setting helps to provide cost-effective, quality patient care for critically and chronically ill children who are in these settings. The foundation of advanced practice nursing in this role incorporates the general role expectations of advanced nursing preparation, including case management, clinical pathway development, consultation and education, research, and collaboration, with the specific knowledge and skills of the pediatric nurse practitioner to function effectively with sick children in the acute care areas.     

Reconceptualizing the core of nurse practitioner education and practice

Purpose: The movement to the doctor of nursing practice (DNP) is progressing rapidly with new programs emerging and curricular documents being developed. We argue that the implementation of the DNP is a good move for nursing, provided that we use the opportunity to reconceptualize the core of advanced practice nursing, especially nurse practitioner (NP) practice.
Data sources: Theory and research articles from nursing focused on advanced practice nursing, NPs, and doctoral education.
Conclusions: The foundation of NP education is currently based essentially on borrowed or shared content in assessment, pharmacology, and pathophysiology. We argue that the heart and soul of nursing is in health promotion, both in healthy persons and in those dealing with chronic illness. Current master's programs do not prepare NPs to assume high-level practice focused on health promotion and disease management using the latest theoretical developments in health behavior change, behavioral sciences, exercise physiology, nutrition, and medical anthropology. Although these are touched upon in most NP programs, they do not represent the core science of NP education and need to be a critical part of any DNP program.
Implications for practice: Ultimately, our vision is for NP care to be consistently "different," yet just as essential as physician care, leading to positive outcomes in health promotion and disease management.