Advanced Practice Registered Nurses in the Emergency Care Setting

APRNs have existed for more than 50 years and are established members of emergency care teams throughout the United States (US) and in many countries worldwide.2-6 Nearly a decade ago, the Institute of Medicine identified APRNs as necessary for the future of health care delivery in the US.7,8 Since...

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Published in:	Journal of emergency nursing Vol. 46; no. 2; pp. 205 - 209
Main Authors:	Winger, Justin, Brim, Carla B., Dakin, Cynthia L., Gentry, Judith Carol, Killian, Marylou, Leaver, Sue L., Papa, AnnMarie R., Proud, Matthew Edward, Riwitis, Cheryl Lynn, Salentiny-Wrobleski, Diane M., Stone, Elizabeth L., Uhlenbrock, Jennifer Schieferle, Zaleski, Mary Ellen, Lee Gillespie, Gordon, Kolbuk, Monica Escalante, Oliver, Nycole, Carman, Margaret, Kraus, Ron, Breuer, G.J., Dakin, Cynthia, Johnson, Kimberly, Leviner, Sherry, Riwitis, Cheryl, Snow, Sally K., Stone, Elizabeth, Salentiny-Wrobleski, Diane, Encapera, Ellen, Brim, Carla, Campbell, Denise, Nickerson, Michael, Roberts, Eric, Fuller Switzer, Diane K., Zielinski, Tresa, Dunn, Matthew, Folin, Karen Reilly, Kumar, Cindy, Newberry, Brittany, Rettig, Amy, Williams, Darleen, Proehl, Jean
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-03-2020 Elsevier Limited
Subjects:	Accreditation Acute services Adults Advanced practice nurses Advanced Practice Nursing Advocacy Cardiology Certification Chronic illnesses Clinical experience Clinical nursing Collaboration Education Emergency medical care Emergency Nursing Emergency services Gerontology Graduate studies Health status Hospitals Humans Interdisciplinary aspects Licensing Life threatening Medical conditions Medical personnel Nurse practitioners Nurse specialists Nurse's Role Nursing Nursing licensure Oncology Patients Pediatrics Primary care Scope of practice United States United States United States > US
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Summary:	APRNs have existed for more than 50 years and are established members of emergency care teams throughout the United States (US) and in many countries worldwide.2-6 Nearly a decade ago, the Institute of Medicine identified APRNs as necessary for the future of health care delivery in the US.7,8 Since then emergency departments (EDs) in the US and abroad have become increasingly overcrowded, in part due to their status as a health care safety net for those who cannot access a primary care provider.9,10 It is estimated that EDs provide more than 47% of all hospital-associated health care in the US.9 As a result, there is currently a substantial mismatch between the need for emergency services and the available resources to provide that care.10 APRNs have been identified as particularly important for bridging this gap in both urban and rural settings.11-14 The regulatory landscape for APRNs in the US continues to evolve, and APRNs who work in the emergency care setting face a few unique licensing and certification challenges. The Consensus Model’s licensing paradigm could create barriers to APRN practice in the emergency care setting because it would require APRNs who treat the full population of the emergency care setting to complete three courses of graduate study and to obtain and maintain three certifications (eg, Family Nurse Practitioner, Adult-Gerontological Acute Care Nurse Practitioner, and Pediatric Acute Care Nurse Practitioner).1,17 CNSs, for whom there are fewer courses of study than for NPs, would be required to have and maintain 2 licenses (Adult-Gerontology CNS and Pediatric CNS), but they would be restricted to either primary or acute care.18ENA Position The following are the positions of the Emergency Nurses Association (ENA): APRNs are established members of the emergency care team and are critical to the future of quality health care across the US and worldwide. Background The emergency care setting is unique when compared to most other practice settings in that its patient population consists of all ages and all combinations of medical history and chief complaint, rather than a narrow subset of them, as is the case with most other specialties (eg, pediatric oncology, adult cardiology, etc).19 Although some APRNs only treat a subset of the patients in the emergency care setting, for example, only pediatric patients or only adults with urgent or chronic needs, other APRNs are called upon to treat all patients and conditions, from nonemergent, episodic chronic care to acute, complex, life-threatening traumatic and medical conditions.2,20-23 APRNs are licensed and regulated by state law, and reciprocity across state lines is determined by each state. The Consensus Model’s proposal that US states license APRNs as “primary care” or “acute care” APRNs, along with its stipulation that an APRN only be allowed to expand his or her scope of practice by completing another graduate program of study, stands in contrast to how APRNs are currently licensed and regulated today.24-29 In nearly all states, APRNs are licensed at the role level, and the scope of practice is determined not only by formal education and national certification but by clinical experience as well.30 Degree-granting programs are designed to prepare APRNs for entry-level competency, and postgraduate training after one’s formal course of education confers clinical expertise.6,29,31-34 It is, therefore, no surprise that APRNs who are currently providing safe and effective primary and acute care across the country are certified as family nurse practitioners (FNPs), acute care nurse practitioners (ACNPs), Adult NPs, Pediatric NPs, Adult-Gerontological NPs, Adult-Gerontological CNSs, and Pediatric CNSs, among others.15,21,35,36 The Consensus Model has been a powerful force for raising the quality of APRN education and training in the US and has successfully championed full practice authority for APRNs in all states.15 Regardless of the outcome of these and future discussions over whether and how to implement the Consensus Model’s definitions of primary care, acute care, and scope of practice, APRNs will continue their long tradition of providing safe, effective care in the emergency care setting, and ENA will remain committed to interprofessional collaboration and advocacy on their behalf.Resources Advanced Practice Registered Nursing Consensus Work Group, The National Council of State Boards of Nursing APRN Advisory Committee.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Instructional Material/Guideline-2 ObjectType-Feature-3 content type line 23
ISSN:	0099-1767 1527-2966
DOI:	10.1016/j.jen.2019.12.011