Understanding Advanced Practice Registered Nurse Distribution in Urban and Rural Areas of the United States Using National Provider Identifier Data, WWAMI Rural Health Research Center, University of Washington, American Academy of Pediatrics Committee on Pediatric Workforce. Furthermore, the AAP maintains that to ensure safe and effective care, all members of the health care team must be required to demonstrate adequate education, training, skills, and competencies in pediatric health within their scope of practice, and all members of the health care team must provide care that is consistent with their education, training, and licensure. In comparison, with 4 years of medical school and 3 years of pediatric residency at a minimum, the pediatrician has invested between 12 000 and 14 000 clinical hours at the completion of basic pediatric training alone. In an evergrowing and more complicated health care delivery system, patients and families need to know what services these clinicians are licensed and trained to provide and understand the differences in education and skills among them. As leader of the pediatric health care team, the physician oversees the delivery of care and, when appropriate, delegates patient care responsibilities to nurse practitioners (NPs), physician assistants (PAs), and other valued members of the heath care team. Or Sign In to Email Alerts with your Email Address, Scope of Practice Issues in the Delivery of Pediatric Health Care, Role of the School Nurse in Providing School Health Services, DOI: https://doi.org/10.1542/peds.2013-0943. Available at: Enter multiple addresses on separate lines or separate them with commas. The AAP specifically acknowledges the key role that family physicians have played in providing care to children and the importance of their continuing collaboration with pediatricians. The Nursing Scope and Standards of Practicedescribe the “who,” “what,” “where,” “when,” “why,” and “how” of nursing practice: 1. Who:Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) comprise the “who” constituency and have been educated, titled, and maintain active licensure to practice nursing. When delegating authority to nonphysician clinicians, physicians should consider the proper method of delegation and their oversight responsibilities for the delegated duties. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Christopher E. Harris, MD – Section Forum Management Committee, Gail A. McGuinness, MD – American Board of Pediatrics. Some have called for an expansion of retail-based clinics as a means to increase the provision of care for children in underserved areas. NPs can play an important role in the inpatient setting, but the AAP believes that a pediatrician should lead the health care team that is providing pediatric inpatient care. The Pediatric Nurse Practitioner - Primary Care (PNPPC) is an advanced practice nurse specializing in pediatric health care. Also, a recent study of more than 900 retail clinics throughout the United States found that “retail clinics are currently located in more advantaged neighborhoods, which may make them less accessible for those most in need.”14 In light of its commitment to comprehensive team-based care, the AAP does not support the use of retail-based clinics for the medical care of infants, children, and adolescents.15 Because retail-based clinics are not founded on a medical home model, use of these clinics as a source of care for children poses a significant risk for fragmentation of care, limited follow-up, missed diagnoses, and decreased quality of care overall. Similarly, training of pediatricians should include collaborative learning experiences in team care. Learning to work in teams should begin in pediatric residency training, where collaborative learning with nonphysician clinicians can expose future pediatricians to the benefits of team-based care. The AAP endorses this collaborative and structured relationship and believes this choice reflects both a shared commitment to patient safety and the positive nature of current pediatrician–NP relationships in US health care. The Committee acknowledges the contributions of Ethan Alexander Jewett, MA, a former member of the AAP Division of Workforce & Medical Education Policy, to the development of this policy statement. Rather, the AAP recommends incentives for physician relocation, including loan forgiveness, payment reform, and expanded health insurance coverage for children.13. Pediatric nurse practitioners in the United States: current distribution and recent trends in training. If your organization uses OpenAthens, you can log in using your OpenAthens username and password. Grumbach K, Grundy P. Patient-Centered Primary Care Collaborative. Enter multiple addresses on separate lines or separate them with commas. Chicago, IL: American Medical Association; 2012, American Board of Pediatrics Research Advisory Committee. AAP chapters should encourage, recruit, and train their members to serve as advocates of optimal pediatric health care in state-level policy initiatives concerning nonphysician scope of practice. Moreover, health care entities, such as hospitals or managed care organizations, may not authorize the delegation of more authority than is permitted by state statutes or regulations, but they may impose limitations on the delegation of authority that are more restrictive than state laws. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. For many years, pediatricians have worked closely with physicians in disciplines across the field of medicine to optimize the care of children. The AAP supports safe, quality care for all children and their families and believes that any health care professional who wishes to actively participate in the care of children must demonstrate appropriate education, training, skills, and ongoing competencies in pediatric health within his or her scope of practice to ensure the highest standards of care. Pediatricians should serve as advocates for optimal pediatric care in state legislatures, public policy forums, and the media and should pursue opportunities to resolve scope of practice conflicts outside state legislatures. You do not have access to the full text of this article, the first page of the PDF of this article appears above. Pediatric dentistry is also an special branch of Pediatrics. We do not capture any email address. Pediatricians must assume responsibility for educating patients, families, health care purchasers, policy makers, the media, and the public about scope of practice issues. To this end, optimal pediatric care is best delivered in a team-based approach that is led by a primary physician, ideally a pediatrician, who assumes responsibility for managing the patient’s care. Support for such transparency is increasing and resulting in requirements that medical and health professionals be required to display or advertise their degrees, credential(s), or licenses according to a standard that is easier for consumers to understand. Available at: Cronenwett L, Dzau V. In: Culliton B, Russell S, eds. Assessing scope of practice in health care delivery: critical questions in assuring public access and safety. Pediatricians should serve as advocates for optimal pediatric care in state legislatures, public policy forums, and the media and should pursue opportunities to resolve scope of practice conflicts outside state legislatures. Policy makers must ensure that all practitioners are prepared, by virtue of education and training, to provide the services authorized in their scope of practice in a safe, effective, and economical manner.”. Variations, taking into account individual circumstances, may be appropriate. Because a greater supply of NPs in a state does not necessarily lead to an equitable distribution to areas that are underserved, the AAP does not support changes in scope of practice for NPs in these areas and believes it is ill-advised to create a system of care based on independent practice without any supervision or oversight by a physician.
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