Over 117 million patients were seen in U.S. emergency departments (EDs) in 2010 (National Health Statistics Reports [NHSR], 2010). Of the patients seen in EDs, fast tracks, and urgent care areas, 87% were seen by physicians, 9% were seen by physician assistants (PAs), and 4% were seen by nurse practitioners (NPs) (NHSR, 2010). In 2010, PAs saw 10.5 million emergency patients while NPs saw nearly 4.7 million patients in emergency care settings. However, no certification exists to validate the knowledge base of NPs practicing in emergency care settings.
WHAT PHYSICIANS ARE SAYING
Physicians can become board certified in emergency medicine and they believe that NPs need certification in emergency care. The American College of Emergency Physicians (American College of Emergency Physicians Resolution 2004) and, more recently, the American Academy of Emergency Medicine requested that NP groups offer an educational program leading to certification for NPs in emergency care.
WHAT NPS AND PAS ARE DOING
The Emergency Nurses Association has developed the Competencies for Nurse Practitioners in Emergency Care (Hoyt et al., 2010). These entry-level competencies are intended for use by NPs in emergency care regardless of setting (e.g., urgent care, fast track, emergency department). The Emergency Nurses Association also has plans to offer a procedural course for emergency nurse practitioners (ENP). Currently, though, there is no plan for this course to be tied to certification.
The American Academy of Nurse Practitioners (AANP) recently conducted a survey of NPs who indicated "emergency" as their area of specialty practice and there was an overwhelming response in favor of an emergency specialty course for NPs. The AANP then announced the development of a specialty course for ENPs to be held in 2012.
The American Academy of Physician Assistants, through its certifying body, the National Certification Commission of Physician Assistants, recently developed Certificates of Added Qualification (CAQs). There is a continuing medical education requirement, an emergency experience requirement, and a procedural skills/case requirement prior to sitting for this specialty examination. Many PAs are successfully using CAQs to obtain ED employment.
WHAT IS CERTIFICATION?
The general term certification is a designation earned by an individual to validate possession of a specific body of knowledge and the qualification to perform a particular skill or behavior. "Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession" (Consensus Model for APRN Regulation, 2008, p. 7). The term certification is also used to specifically describe the granting of a particular title (Family Nurse Practitioner, Board Certified) to a recipient from an approved agency (e.g., American Nurses Credentialing Center [ANCC]). This certification is awarded after the recipient has successfully completed an academic course of study and passed a certification examination (ANCC, 2008).
WHY PROCEED NOW?
Several studies (Sakr et al., 1999; van der Linden, Reijnen, & de Vos, 2010; Wilson, Zwart, Everett, & Kernick, 2009) have validated that ENPs are "on par" with physician outcomes and patient satisfaction in caring for emergency patients. Emergency nurse practitioner certification would be a way to demonstrate competency in the knowledge, skills, and behaviors required for ENP practice. Certification is not always accomplished via an examination. Portfolio review, peer review, and/or CAQs are other potential pathways.
The ANCC states the following:
Certification protects the public by enabling anyone to identify competent people more readily. Simultaneously it aids the profession by encouraging and recognizing professional achievement. Certification also recognizes specialization, enhances professionalism and, in some cases, serves as a criterion for financial reimbursement. It may also foster an enlarged role within the employment setting. Because certification of nursing practice signifies attainment of specific criteria and knowledge, skills, and abilities in a specific specialty field, certified nurses comprise a minority of the professional nurse population. (ANCC, 2008, p. 1)
Moreover, we believe we need to have a non-licensure certification for credibility within our specialty.
THE FUTURE OF NURSING
Nurse practitioners are intimately involved in health care reform. The reforms called for by the Institute of Medicine's (IOM's) Future of Nursing report encompass the recognition and utilization of NPs as primary and urgent care providers (IOM, 2010). The IOM also states that nurses should practice to the full extent of their education and training, achieve higher levels of education and training through an improved education system that promotes seamless academic progression, and be full partners with physicians and other health care professionals in redesigning health care in the United States. The IOM also states that effective workforce planning and policy making require better data collection and an improved information infrastructure (IOM, 2010).
According to the American Association of Colleges of Nursing, there are currently over 140,000 NPs in the United States and nearly 8,000-9,000 NPs graduate annually from colleges and universities throughout the United States AACN (2010) http://www.aacn.nche.edu/research-data/EthnicityTbl.pdf. Many of these new graduates are in family practice and critical care and have an interest in becoming ENPs. The direction of the IOM and the increasing numbers of NPs mean that the time is right to establish a certification mechanism to validate the knowledge and skills of NPs in emergency care. Let's strike while the iron is hot!
-Karen Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP
Emergency Nurse Practitioner
St. Mary Medical Center
Long Beach, CA
-Jean A. Proehl, RN, MN, CEN, CPEN, FAEN
Emergency Clinical Nurse Specialist
Proehl PRN, LLC
Cornish, NH
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