The needs and demands of our nursing profession are many, and in dermatology, this is no different. Accreditation, recognition of dermatology as a specialty of nursing, competencies, scope of practice, standards of care, and proficiency examinations all contribute to the integrity of our profession. Dermatology nursing has been in existence for more than 30 years and has only intermittently addressed some of these criteria.
A coalition is defined by Merriam-Webster (2018) as "a temporary alliance of distinct parties, persons or states for joint action." The Dermatology Nurse Practitioner Coalition (DNPC) was formed in April 2015 to accomplish all of these goals. It is composed of three dermatology nursing organizations: the American Association of Nurse Practitioners' Dermatology Specialty Practice Group (AANP DSPG), the Dermatology Nurses' Association Nurse Practitioner Society (DNA NPS), and the Dermatology Nursing Certification Board (DNCB). Although other specialty dermatology nursing organizations exist, these three have extraordinary skills to collaborate on a project of this magnitude.
Monthly conference calls were used to develop a list of projects, assign responsibility, and develop a timeline for completion. The goals of the DNPC task force were determined to be the following:
1. Update the dermatology nurse and nurse practitioner scope of practice and standards of care through the American Nurses Association (ANA, 2018) and achieve formal recognition as a dermatology nursing specialty;
2. Obtain accreditation of the Dermatology Certified Nurse Practitioner (DCNP) examination through the Accreditation Board for Specialty Nursing Certification (ABSNC, 2017);
3. Develop dermatology nurse practitioner competencies for practice;
4. Provide supportive resources and consensus documents for dermatology nurse practitioners in examination preparation, workplace competencies, policy making, and public comments.
The "Dermatology Scope of Practice, Standards of Care, and Professional Practice" for both registered nurses and advanced practice nurses is an approximately 45-page document in its final stages of development. It answers the important questions of who, what, when, where, and why we do what we do. In addition, it defines the nursing process and professional practice standards of care to our colleagues (ANA, 2018) and will enable us to meet the criteria as a dermatology specialty interest group in nursing from the ANA. This project subgroup is spearheaded by DNA's Heather Onoday and Kelley Jimenez and addresses the ANA's requirements for becoming recognized as a dermatology specialty in nursing (ANA, 2018).
The DCNP examination was established in 2007 (Bermann, 2017). Having certification as a DCNP is seen as the gold standard for dermatology nurse practitioners. To become eligible to take the examination, one must have 3,000 hours of recent dermatology practice (Bermann, 2017). The DNCB is undergoing an application for accreditation of the DCNP examination under the ABSNC 2016 guidelines. DNCB's President Paula Bermann and the DNCB Board of Directors are guiding this effort. This rigorous process addresses 18 different standards (ABSNC, 2017), some of which include definition of scope of practice, standards of care and professional practice, recognition by the ANA as a specialty group in nursing, research-based body of knowledge, eligibility, validity, development, reliability, administration, security, testing psychometrics, and recertification. This tremendous undertaking requires all subgroups to supply information for the application to achieve the goal of submission for accreditation approval through the ABSNC.
AANP's Margaret Bobonich and Mary Nolen initiated the development of the dermatology nurse practitioner competencies for practice. They are expert authors of the Dermatology for Advanced Practice Clinicians (Bobonich & Nolen, 2014) using research (Bobonich & Cooper, 2012) as the basis for defining competencies and a core curriculum. A nationwide validation panel of clinical dermatology nurse practitioners, as well as leaders from professional nursing organizations, were able to reach a consensus on dermatology specialty competencies. The intent is to use these as standards for those who identify themselves as dermatology nurse practitioner specialists.
The DNPC's additional role is to provide supportive resources for education and consensus statements for nurse practitioners, policy makers, and public comments. An example of a supportive project includes the development of the DCNP Certification Review Course. This was led by the DNA NPS co-chairs Theresa Coyner and Katrina Masterson. This review course is complete and the slide deck is being converted for online access through the DNA NPS Web site in 2018. The DNPC has collaborated in response to publications that unfairly misrepresent the professional role of dermatology nurse practitioners. For example, a rebuttal letter to the editor was submitted to the NY Times in response to the article titled "Skin Cancers Rise. Along with Questionable Treatment," authored by Katie Hafner and Griffin Palmer, published on November 20, 2017.
The DNPC worked together to reach a consensus to establish a formal "definition of the dermatology nurse practitioner":
A dermatology nurse practitioner is an advanced practice registered nurse licensed as a nurse practitioner that specializes in the assessment, diagnoses, management and advocacy of individuals and communities with health and illness of the hair, skin, and nails.
The "Dermatology NP Competencies, Dermatology Scope of Practice, and Standards of Care" is undergoing editorial review for publication at the time of this print. The goals are encompassing, volunteers have been many, coordination immense, and the costs to achieve this effort have been substantial. Each aspect of this project has been vetted with expert nurse practitioners nationwide and should be viewed as a worthy achievement by all involved. Together, these organizations offer a voice of experience and knowledge with the vision to move the dermatology nurse practitioner profession forward with integrity for the betterment of quality patient outcomes.
The DNPC would like to extend a special thank you to the staff at the DNA, especially Linda Markham, Executive Director of the DNA, and Elaine Van Vliet, for their participation in support of our efforts.
Members and Affiliations:
Lakshi Aldredge, RN, MSN, ANP-BC, DCNP
Co-Chair, AANP DSPG, Austin, TX, USA
Paula Bermann, RN, MSN, APRN-BC, DCNP
DNCB, Mount Laurel, NJ, USA
Margaret Bobonich, RN, DNP, FNP-C, DCNP, FAANP
AANP DSPG, Austin, TX, USA
Theresa Coyner, RN, MSN, ANP-BC, DCNP
DNA NPS, Southern Pines, NC, USA
Virginia Hanchett, RN, MS, APRN-BC, DCNP, COCN, CWCN
DNA NPS, Southern Pines, NC, USA
Katrina Masterson, RN, DNP, FNP-BC, DCNP
DNA NPS, Southern Pines, NC, USA
Heather Onoday, RN, MN, FNP-C
DNA NPS, Southern Pines, NC, USA
Mary Nolen, RN, MS, ANP-BC, DCNP
AANP DSPG, Austin, TX, USA
Margaret Vernon, RN, MA, CPNP, DCNP, FAANP
Co-Chair, AANP DSPG, Austin, TX, USA
REFERENCES