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Barriers to Role Expansion
NPs are well-suited to practice in the ED. Although the role and employment of NPs have been rapidly growing since the 1990s, there is insufficient research on the NP functions within the ED.4
Use of NPs in the ED can depend on the contracted physician group that provides staffing. Some groups cite uncertainty of the role and having never worked with NPs and physician assistants as reasons for not hiring NPs.12
Scope of practice and role autonomy differ from state to state, which increases uncertainty for this evolving role.17 Physician attitudes toward NPs practicing in the ED is another area that requires further research. Physician acceptance of the role may be a barrier. Confusion over role boundaries and the ambiguity within the diverse education and training may pose additional barriers.15
Emergency department nurse practitioners necessitate specialized ED training. Specific knowledge relating to unambiguous ED protocols, policies and procedures is necessary. The standard for emergency health care requires an emergency care provider to be in the specialty of emergency care. NP providers in the ED should have defined professional competencies and accountabilities.18
Nurse practitioners within specialties have recognized core competences and a national certification exam. There are no specific core competencies or national certification examination for the emergency NP specialty. The Emergency Nurses Association scope of practice recommends certification in Basic Life Support, Advance Cardiac Life Support, Trauma Nursing Core Course, and Emergency Nurse Pediatric Course.17 It would be useful to identify the core competencies and skills required of an NP in the ED in order to provide role clarity and to further develop the role.
Conclusion
Nurse practitioners practicing in the ED would likely benefit from specialized training, and clarification of the role and responsibilities of NPs in the ED would enhance acceptance among other providers.1,12,17 Unless the role is examined and clarified, use of this important health care provider will remain theoretical and speculative. It is crucial to validate this role to ensure continued high quality care.4
For continued growth in the profession, NPs should work to establish competencies, training and standardization of education and to develop protocols before regulatory agencies, or other groups or professions mandate them. Having other groups or professions establish NPs' competencies, training and standardization of education could negatively affect the gains already made in the role.
Michele Corker and Denise Kellepourey are family nurse practitioner graduates from the University of Detroit Mercy. Corker works in the ED and Kellepourey is a house supervisor at Oakwood Southshore Medical Center in Trenton, Mich.
References
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