The Acute Care Pediatric Nurse Practitioner

The Acute Care Pediatric Nurse Practitioner (PNP) is a professional role that provides cost-effective, quality care for acutely, critically, and chronically ill children in a variety of settings. For many decades, PNPs, in acute and critical care settings, have been responsible for the management of children with illnesses characterized by impending or established organ system instability and failure. More recently, the recognition of the unique competencies and the important contributions of the Acute Care PNP to continuity of care has contributed to the role’s expansion (Brady and Neal 2000, Derengowski et al 2000, Jackson et al 2001, Sperhac and Strodtbeck 2001).

The scope of practice of PNPs includes providing direct patient care management such as performing in-depth physical assessments, interpreting results of laboratory and diagnostic tests, ordering medications, and performing therapeutic treatments in a variety of settings (NAPNAP, 2004). In 2004, the National Association of Pediatric Nurse Practitioners (NAPNAP) expanded their PNP Scope of Practice to reflect the role of the PNP in providing care to children who are acutely, chronically, and critically ill.

NAPNAP defines the Acute Care PNP as a registered nurse with a graduate degree in nursing who is prepared for advanced practice in pediatric acute care. This practice includes using a collaborative model to provide direct services to pediatric patients who are acutely or critically ill. The Acute Care PNP role is one “designed to meet the specialized physiologic and psychological needs of children with complex acute and chronic health conditions” (PNCB, 2003). Diagnostic reasoning, advanced therapeutic interventions, and advanced education are key elements in the direct provision of care by the Acute Care PNP. The foundation of advanced practice nursing as an Acute Care PNP incorporates the general role expectations of advancing nursing preparation that includes experience in direct patient care, education, leadership, and research.

Specific components of the Acute Care PNP role vary depending on the practice setting and patient population. Acute Care PNPs’ practice includes independent and interdependent decision-making and direct accountability for clinical judgment. Practice components differ depending on the type of employment arrangement and the practice setting. Many Acute Care PNPs possess additional educational preparation to perform specialized procedures.

Gaining practice privileges may be a requirement for Acute Care PNPs in some settings. The process for becoming credentialed and obtaining practice privileges varies and is based on institutional policy (NAPNAP Position Statement on Credentialing and Privileging, 2003).

The Acute Care PNP meets the specialized physiologic and psychological needs of infants, children, adolescents, and young adults with complex acute, critical, and chronic health conditions. Focus of care includes complex monitoring and ongoing management of intensive therapies in a variety of settings, including but not limited to, inpatient and outpatient hospital settings, emergency departments, and home care settings. Specialty areas of practice are varied and continue to emerge (Christensen and Akcasu 1999, Delametter 1999, Kelly et al 2001, Martin 1999, Pelosi 2000). Collaboration with physician colleagues, other PNPs, and various disciplines is essential for the Acute Care PNP role.

Acute Care PNPs are Master’s-prepared and have received education and training in acute care that includes didactic and mentored clinical experience in pediatric acute, critical, and chronic illness settings. In addition, Acute Care PNPs must possess the equivalent of one year of pediatric acute care work experience prior to their final year of clinical course work in an Accredited PNP program. These programs adhere to curricular standards set by the Commission on Collegiate Nursing Education (CCNE) and the National Organization of Nurse Practitioner Faculties (NONPF).

NAPNAP advocates for:

The Acute Care PNP focuses on the management of children with complex acute and chronic health conditions. The practice strategies for this role include providing direct patient care to children with life threatening illnesses and organ dysfunction or failure, negotiating health care delivery systems, monitoring and ensuring the quality of health care practice, providing family-centered care, and demonstrating cultural competency.