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

Disclosures

►None

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

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

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

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

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Academic Hospital Fast Track ED Main ED Retail Clinic Urgent Care Other

Setting

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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ENP Role & the Consensus Model

https://www.nap.edu/openbook/12956/xhtml/images/p2001cde1g333001.jpg

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

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

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

http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/

www.bartonassociates.com

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)

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

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

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

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

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

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/ post-graduate 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.

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

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Edu/prof development Journal Access Discounts/Savings Annual Conference Networking Ops Other

Reason for joining AAENP

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

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Practice Issues State

regulations/laws

Credentialing Job opportunities Restrictions Skills Proficiency Other

Top Challenges ENP is facing

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

Photo credit: Vanderbilt School of Nursing, 2016

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

AAENP Accomplished Initiatives

Practice Model for NPs in Emergency Care

Certification Exam(AANPCP, 2017)

Note: Certification by portfolio available through ANCC (2014)

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 post-

resuscitation, critical care patient.

EmergencyCare Specialty

(ANA, 2012)

Scope, Standards & Competencies (ENA,

2008; AANPCP, 2016)

Professional Organization (AAENP, 2013)

Specific

Educational Content(Academic, Fellowship, Continuing Education)

Interprofessional PracticeMD/DO, PA, EMS, Pharmacy,

Respiratory Therapy, etc.

FAMILY NP Population as cornerstone

Not Site SpecificPre-hospital, Critical Access, Emergency

Department, Urgent Care, Telemedicine

Developed Elda Ramirez (2016)

For more information about

Emergency Nurse Practitioners please contact the American Academy of Emergency Nurse

Practitioners

http://aaenp-natl.org