A Cause to Embrace – PNPs a part of the cure.

The growing shortage of pediatric primary care providers combined with an acute nursing shortage, is putting children’s access to quality healthcare and the health of all children at risk. The uninsured and underserved populations including minorities and those living in rural areas and the inner cities are at greatest risk.

The impact of Pediatric Nurse Practitioners (PNPs) providing primary care to meet the needs of underserved children over the last forty years has been significant.  It is imperative for children’s health and well being to increase the number of PNPs to meet  present and future needs.

The nurse practitioner (NP) role originated in 1965, when Loretta Ford, R.N., EdD, and Henry Silver, MD, a pediatrician, developed a program at the University of Colorado to prepare registered nurses for an expanded role.  The need for NPs at that time arose from a shortage of pediatricians in urban and rural communities.  Over the next 40 years, the PNP became an integral part of cost-effective, quality pediatric and family care.

PNPs – Integral to Children’s Health

PNPs are  an integral part of pediatric health care.  More than 12,000 PNPs today serve children and families in an extensive range of practice settings including primary care in urban and rural pediatric offices and clinics, school based health centers, and mental health centers, as well as acute and chronic care in hospitals, surgical centers and specialty care settings.

A PNP is an advanced-practice registered nurse who provides health care to children from birth through 21 years of age and, in very unique situations, to young adults older than 21 years.  The PNP completes a formal masters or doctoral level educational program specializing in pediatric health care and complies with the state Board of Nursing regulations governing advanced practice nursing.

Key components of the PNP role include assessing, diagnosing, and treating children with acute and chronic illnesses in collaboration with physicians and other health care providers. PNPs perform comprehensive physical, developmental, and neurologic examinations; order and interpret diagnostic tests; prescribe medications; and manage a variety of health conditions. Additionally, PNPs assist in the coordination of care for children with special health care needs who are particularly vulnerable and may not currently be receiving coordinated health care services.

Child and family education, including anticipatory guidance, is a vital part of the PNP's role.  PNPs assess the child's and family’s health habits and focus on preventive measures.  They extend education into the community by offering outreach programs on such topics as immunizations, safety, violence prevention, and parenting. 

About 80% of healthcare issues seen in a primary care pediatric office can be managed by a PNP. Research has repeatedly shown no significant differences in quality of primary care between PNPs and physicians. Growing shortages of primary care and pediatric subspecialty providers combined with efforts to contain costs and expand children’s access to quality health care has continued to find many of the nation’s 12,000 PNPs filling critical pediatric health care gaps, particularly in rural and medically underserved communities.   

Meeting the Needs of Children:

Access to quality care is one of the most important determinants of the health and well-being of America’s children.  Timely access to a regular source of health care is closely associated with higher quality care and better health outcomes.  PNPs increase access to care, provide a healthcare home for children and their families, and provide the comprehensive health care children need.  Many primary care PNPs  see over 5,000 children per year! 

Recent studies confirm that access to health care, particularly for children, has sharply deteriorated.  The number and proportion of families reporting that one or more children went without or experienced a delay in needed health care increased significantly from 2003 to 2007. Those reporting access problems increasingly cited cost for healthcare services and treatments as an obstacle to needed care, along with rising rates of health plan coverage for included children, and health system barriers.

Inadequate access to health care has contributed to disparities in the health of children amongst low-income, homeless, minority, non-English speaking, and uninsured children.  Children in rural and inner-city areas are at particular risk of inadequate health care services due to a lack of health care clinicians.  Children with special health care needs are particularly at risk for fragmented primary care and limited access to specialized health care services. PNPs have historically provided health care to these underserved populations, providing a healthcare home to those most in need.

 
PNPs improve the lifelong health of children and youth by increasing their access to health care.  Increased access to health care results in:

• Reduced fragmentation of health care services.
• Reduced disparities in health between populations.
• Increased early screening, diagnosis and treatment.
• Increased disease prevention.
• Increased healthy eating and activity habits.
• Increase mental health screening.
• Improved growth and development.
• Increased school attendance and thus ability to learn.
• Decreased emergency department utilization.
• Decreased inappropriate and costly treatments.
• Decreased number of inappropriate hospitalizations.
• Decreased healthcare burden for society.

 PNPs, as primary and acute care providers, augment the pediatric health care workforce to address the many unmet needs of well, acutely ill, chronically ill, and children with special health care needs.

 
Costs to Educate PNPs

PNPs are at the forefront of keeping our nation's children emotionally and physically healthy.  To become a PNP, baccalaureate prepared registered nurses must enroll in a 2 to 3 year accredited college of nursing graduate program.  Nursing graduate level PNP programs range from $30,000 to $60,000 for tuition with an additional $41,000 or more for living expenses and other student related expenses.  Financial aid for highly qualified students is critical to the goal of increasing the number of PNPs available to care for children and youth. The average debt of PNPs graduating at one university was recently noted to be as much as $80,000 to $100,000.

Research Conducted by PNPs

PNPs conduct  many studies aimed at increasing the evidence and improving  the health care of children.  Nurse researchers constantly seek funding to support their work that will ultimately result in more cost effective, efficient, and innovative care.  Evidenced-based care is the goal of all working PNPs.  Nurse researchers provide the evidence. 

NAPNAP Foundation

Through advancement of pediatric nurse practitioner (PNP) clinical practice, education, and nursing research, the NAPNAP Foundation improves the health and the quality of life for children and their families.  Established in 1978, the NAPNAP Foundation has awarded funds and administered scholarships and grants to help highly qualified PNP students prepare for advanced careers in delivery of pediatric primary.

Mission:   The mission of NAPNAP Foundation is to support the improvement in the quality of life for children and their families by awarding and administering funds for advanced practice pediatric nursing research, education, clinical projects, and special initiatives.

PNP Facts

·PNPs are qualified and capable health care providers with advanced degrees and credentials who are dedicated to promoting optimal health for all children.

·Studies have shown there are no significant differences between physicians and nurse practitioners with regard to patient outcomes, process of care, and resource use.

  Journal of Pediatric Health Care

2005

·PNPs are an appropriate coordinator of the child’s pediatric healthcare/ medical home.

·PNPs provide cost effective health care, i.e., each physician visit costs on average, $13.31 more than a visit to a PNP.

Bureau of Primary Health Care,

U.S. Dept. HHS,

 1996-2000

·Pediatric nurse practitioners can manage 80-90% of the care provided by primary care physicians.

— M. Mundinger, New England

Journal of Medicine

1994

·PNPs score higher in reports of continuity of care and disease prevention.

Houston Law Review

 1996

·PNPs tend to provide longer consultations, provide more health advice and achieve higher levels of patient satisfaction compared with doctors.

Cochrane Database of

Systematic Reviews, Issue 4

2004

·PNPs have a greater propensity to care for underserved populations than do primary care physicians in pediatric  specialties.

Annals of Family Medicine

2003

 Children Facts

·6.9 million – the number of children and youth who did not have an annual preventive health care visit at recommended ages.

·18.4 million – the number of young children who were not up to date on all recommended doses of key vaccines.

The Commonwealth Fund
2004

·14.7 million – the number of U.S. children medically underserved.

Association of American Medical Colleges, 2006

·79% of children and adolescents with mental health problems severe enough to indicate a clinical need for mental health who did not receive a mental health evaluation or treatment in the past year.

The Commonwealth Fund,

 2004

·8.3 million – the number of U.S. children uninsured.

US Census Bureau

2006

Among Uninsured Children:

·More than one in four (27%) did not have a regular source of health care.

·16% delayed care because of cost (health care/medical care home).

·13% did not get needed health care because of cost.

The Commonwealth Fund

 2004

Provider Facts:

·500,000 - the projected shortfall of registered nurses by 2025.

Health Affairs

2006

·150,000 - the projected physician shortfall by 2030. 

Association of

American Medical Colleges

2007

·40,285 – the number of qualified applicants for nursing programs turned away in 2007 due to the shortage of nursing faculty.

American Association of

Colleges of Nursing

    2008

·With growing pressure to balance quality and cost, health planners are relying increasingly on nurse practitioners as the providers of choice for a range of front-line health services, such as primary and preventive care.

·Mounting studies show that the quality of NP care is equal to, and at times better than, comparable services by physicians, and often lower cost.

American Association of

Colleges of Nursing

    2008