There are ∼13 000 pediatric nurse practitioners (PNPs) in the United States. PNPs have been suggested as professionals who could provide care to the growing cadre of children with chronic illnesses and expand the pool of subspecialty care providers. Little is known about current roles of PNPs in primary or subspecialty care.
To gain a better understanding of the roles, focus of practice, professional setting, and professional responsibilities of PNPs.
We conducted a mail survey of a random national sample of 1200 PNPs stratified according to states that license NPs to practice independently. χ2 statistics were used to assess responses from PNPs in states that allow independent practice versus those that do not and on PNPs in primary versus specialty care.
The overall response rate was 82.4%. Ninety-six percent (n = 636) of the PNPs were female. More than half of all the respondents (59% [n = 391]) worked in primary care, and almost two-thirds (64% [n = 394]) did not provide care in inpatient settings. Only 11% of the PNPs in states that allow independent practice, practiced independently.
The majority of PNPs currently work in primary care, and most do not have any inpatient roles. It does not seem that independent PNP practices are responsible for a significant portion of pediatric visits. For those who posit that PNPs will help alleviate the currently perceived shortage of pediatric subspecialists, our findings indicate that it likely will not occur without a significant change in the PNP workforce distribution.
Pediatric nurse practitioner (PNP) workforce distribution has been a significant interest of the National Association of Pediatric Nurse Practitioners (NAPNAP) since its inception in 1974 and goes to its mission of promoting optimal health care of children. We value the work done by this study that focused on the essential PNP role in providing pediatric primary, acute and sub-specialty health care for our nation's children in our reformed health care environments and systems.
We share Freed et al's concern about the decreasing number of PNPs to care for our nation's children and are aware of the shift of NP education toward family and elder care practice. NAPNAP appreciates the investigator's contribution to understanding the distribution and nature of PNPs in current practice in our present health care environment and systems. Assuring quality health care of children also requires adequate pediatric content and experiences in pre-licensure and family nurse practitioner (FNP) education programs, recruitment of diverse ethnic groups and males, and incentives to practice in rural and underserved areas. The Institute for Pediatric Nursing, recently convened by the Pediatric Nursing Certification Board, has begun to prioritize and address issues of national importance to quality healthcare for children and their families.
We believe the recently released evidence based Institute of Medicine report on the Future of Nursing (www.thefutureofnursing.org) provides a framework and call to action to address these workforce issues. Specifically, Recommendation #8 calls for building an infrastructure to collect and analyze health care workforce data. This includes developing minimum data sets across states and professions including nursing, medicine, dentistry and pharmacy. In these times when all are needed to meet our children’s healthcare needs, knowing where health care professionals are employed, in what roles, and what functions they are performing is essential to assure that everyone is being used to the full extent of their education and training.
We welcome new and more dialog and work toward increasing the number of NPs entering pediatric care. In this, we stand united with our colleagues. We believe that through responding to the IOM’s call to action, our membership can make important contributions to the landscape of understanding PNP roles, nature, practice and scope. We welcome the opportunity to continue this effort.
Conflict of Interest:
None declared