Thank you for the thought-provoking article in the JAANP October 2018 issue by Wilbeck et al. (2018), "Proposed Standardized Educational Preparation for the Emergency Nurse Practitioner." Standardization of the Emergency Nurse Practitioner (ENP) curricula is essential to assure that Nurse Practitioner (NP) graduates are fully competent to practice in emergency departments (EDs) and make their transition more seamless. However, I am surprised that the authors of the article mentioned very little about urgent care NPs, their competency to practice in urgent care settings, and the ability to be ENP certified.

I am a Family NP who has been practicing in broad-spectrum urgent care settings for the past four years. Most providers that work in our urgent care system are Physicians and Physicians Assistants (PAs). The number of NPs is considerably lower. The feedback I hear from PAs who orient new providers is that NPs have most of their training in chronic condition management and, therefore, are not adequately prepared to manage acute conditions and procedures. Hearing this makes me sad and uncomfortable for my fellow NPs. I believe if ENP programs accept and train prospective urgent care NPs, this will not be the case.

The ENP certification eligibility for urgent care NPs is another important topic that I would like to bring to your attention. According to the American Academy of Nurse Practitioners Certification Board (AANPCB), to meet requirements for the initial ENP certification, Family NPs have to prove that they provided a minimum of 2,000 direct, emergency care clinical practice hours over the past 5 years (AANPCB, 2018). What does "emergency care" mean? Would it include urgent care experience? It sounded vague and unclear. I contacted the AANPCB and received a response that expertise in urgent care settings would meet requirements for the ENP certification, but all applications are reviewed individually to determine eligibility.

Urgent care is a promising, fast-growing, and top-rated industry among patients due to its easy access, convenience, and cost-effectiveness. In the city of Lancaster, Pennsylvania, where I practice, with a population of 59,218, there are five urgent care clinics and one walk-in clinic, not counting two local hospitals with general EDs and fast tracks (World Population Review, 2018). In our urgent care, each provider sees, on average, from 35 to 40 or even more patients during a 12-hour shift. As you can see, the demand for this type of setting is high, and so is the need for providers, including NPs. There are a lot of current discussions regarding the importance of lowering costs in our healthcare system. The authors of the article made an excellent point that the majority of patients that seek medical care in EDs are treated and discharged on the same day. Therefore, most of the patients are not emergent and can be managed in urgent care settings which can provide high-quality and cost-effective care. Competent and skillful NPs can be a part of the solution.

In summary, with the growing number of ENP programs, urgent care competencies should be recognized and included in standardized ENP curricula to assure that ENP graduates are proficient and competent to practice in EDs or urgent care settings if they choose so. The Certification Boards should reexamine ENP certification requirements and make them more specific to prevent excluding NPs that practice in urgent care settings from applying for the ENP certification.

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