March 2015
Pediatric Nurse Practitioner Professional Profile and FAQ
Who We ArePediatric nurse practitioners (PNPs) and other pediatric-focused advanced practice registered nurses (APRNs) are certified, licensed advanced practice nurses who have obtained a master’s degree, postgraduate certificate or clinical practice doctorate from an accredited academic program. PNPs have completed advanced course work in physical/health assessment, pharmacology and pathophysiology. The curriculum content includes health promotion, disease prevention, and differential diagnosis and disease management. The degrees require a minimum of 500 faculty-supervised clinical hours. These advanced course and practice requirements are in addition to a PNP’s initial nursing degree (typically RN baccalaureate) and licensure requirements. Beyond educational requirements, PNPs and APRNs have passed a national certification exam and expanded their knowledge through ongoing continuing education.
Preferred Terminology
All advance practice nurse practitioners object to being referred to as “mid-level health care professionals” because it implies they provide “average” care instead of “high level” care. PNPs and other APRNs are highly qualified and educated, multi-skilled health care professionals.
Patient Population
Children from birth through 21 years of age and their families and caregivers. Based on NAPNAP membership, patient population distribution is:
• general pediatrics—75 percent
• adolescents and young adults—14 percent • neonatal—7 percent
• adults—4 percent Where We Practice
PNPs and other pediatric-focused APRNs treat millions of patients across the country each year. PNPs spend significant one-on-one time with patients and families. Fifty-five percent of National Association of Pediatric Nurse Practitioner (NAPNAP) members report spending 11-20 minutes with patients and 23 percent report spending more than 20 minutes. Based on NAPNAP membership, practice settings include:
• pediatric offices—29 percent • hospitals—45 percent
• school-based health care settings—3 percent
• specialty clinics, public health, faculty, other—23 percent How We Are Regulated
Based on state laws, each state’s regulatory board sets guidelines for APRN licensure, including practice and prescriptive authority. PNPs/APRNs have full practice and prescriptive authority in 19 states and the District of Columbia, which allows them to work independently. The other states have rules ranging from reduced practice to restrictive practice and prescriptive authority. Advanced practice education requirements prepare APRNs to provide high-quality, cost-effective health care to their patients. The Institute of Medicine’s report of The Future of Nursing: Leading Change, Advancing Health recommends that all APRNs be allowed to practice to the fullest extent of their education and training. The IOM report recommends that APRNs in reduced or restrictive states advocate for full practice legislation and regulation.
March 2015 What We Do
In a review of studies comparing the primary care provided by nurse practitioners to primary care provided by physicians, researchers found that patients of both groups had comparable health outcomes. Nurse
practitioners were found to out perform physicians in measures of consultation time, patient follow-up and patient satisfaction (Naylor and Kurtzman 2010). PNPs provide the following services:
• Manage acute, chronic and critical pediatric diseases, including asthma, diabetes and cancer • Provide pediatric health care maintenance, including well child exams
• Diagnose and treat common childhood illnesses such as allergies, otitis and acne • Screen and manage mental health illnesses in children and adolescents
• Perform in-depth physical assessments, including vision, hearing and dental • Perform therapeutic procedures in a variety of settings
• Prescribe medications and medical equipment
• Order and interpret results of laboratory and diagnostic tests
• Provide anticipatory guidance regarding common child health concerns such as nutrition, obesity and weight management
• Provide behavioral counseling in areas such as school failure, ADHD and risk taking behaviors • Coordinate and lead pediatric healthcare homes
• Perform developmental screenings
• Perform school physicals and provide childhood immunizations
• Provide anticipatory guidance on in-home safety, unintentional injuries, sports injuries, motor vehicle and bike safety
Primary Advocacy Issues
• Reauthorization of funding for Children’s Health Insurance Program (CHIP) • Optimal funding for and access to state Medicaid programs
• Funding for nurse practitioner education programs (Title VIII Nurse Workforce Development programs) • Improving Medicare patient access to home health services
• State-by-state full practice authority legislation
• Children should have access to comprehensive, continuous, coordinated, compassionate, culturally sensitive and family-centered health care, including behavioral health services in order to ensure healthy lifestyles.
• We strive to remove barriers that impede access to the care provided by pediatric advanced practice nurses in all practice settings.
• Commitment to national and grassroots advocacy by NAPNAP members is essential and should be supported by providing learning opportunities for members to support their development as advocates. About the National Association of Pediatric Nurse Practitioners
The National Association of Pediatric Nurse Practitioners (NAPNAP) is the nation’s professional association of pediatric nurse practitioners and advanced practice nurses dedicated to improving the quality of health care for infants, children, adolescents and young adults. Representing more than 8,000 healthcare practitioners
nationwide with 17 special interest groups and 49 chapters, NAPNAP has been advocating for children’s health since 1973. NAPNAP was the first nurse practitioner professional society in the U.S.; the nurse practitioner movement was founded in 1965. NAPNAP is based in New York, NY. There are an estimated 16,000 PNPs; there are an estimated 205,000 NPs in the U.S.
Updated 5/2015
National Association of Pediatric Nurse Practitioners
2015 Federal Policy Issues
On behalf of more than 15,000 PNPs and other advanced practice nurses who care for children, the National
Association of Pediatric Nurse Practitioners (NAPNAP) urges members of the 114th Congress to improve access to less costly, more efficient health care for America’s children and their families by addressing the following issues:
• PROTECT THE CHILDREN’S HEALTH INSURANCE PROGRAM
Along with Medicaid, the Children’s Health Insurance Program (CHIP) is a critical component of the health care safety net for our nation’s children. The number of uninsured American children is at a historic low, and CHIP and Medicaid are responsible for covering more than one third of the children in the U.S. As states adjust to changes in health care coverage, PNPs believe it is essential that Congress secure CHIP’s future, so that states will have certainty in continuing to operate their programs without disruption.
NAPNAP applauds Congress for reauthorizing CHIP funding through September 30, 2017, and maintaining all provisions of current law on which states and programs have based their planning and budgets as part of the “Medicare Access and CHIP Reauthorization Act of 2015” (H.R. 2). This critical legislation also removed barriers to NP practice and extended funding for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program for two years. NAPNAP is eager to work with Congress in the next two years to expand and strengthen the benefits, coverage and cost-sharing designed specifically to meet the needs of children in qualified health plans offered through federal and state insurance exchanges by 2017.
• PRESERVE MEDICAID AND CHIP COVERAGE
Medicaid is the backbone of the nation’s health care safety net, covering roughly 68 million low-income families, people with disabilities, and the elderly. Medicaid is also a children’s program – the single largest health insurer for 32 million children from low-income families. PNPs and other APRNs who care for children recognize the
importance of the federal government living within its means, but we also know that many families face challenges in trying to afford adequate health care.
NAPNAP urges Congress to preserve Medicaid and the Children’s Health Insurance program as critical sources of children’s health insurance coverage by:
o Maintaining the federal medical assistance percentage (FMAP) and oppose efforts to convert Medicaid into a block grant program or cap federal funding, shifting the cost of services to states.
o Opposing attempts to repeal requirements that states maintain their current Medicaid and Children’s Health Insurance Program eligibility standards.
o Recognizing PNPs as primary care providers in all Medicaid managed care plans, and enable enrollees to choose PNPs as their primary care provider.
• FY 2016 FUNDING FOR PNP EDUCATION PROGRAMS
The demand for health care providers is increasing as millions of Americans enroll in expanded health insurance coverage, the patient population ages and the healthcare workforce decreases due to retiring providers. PNPs and other APRNs who care for children are increasingly important components of the nation’s health care
infrastructure, yet tens of thousands of nursing positions are unfilled in acute care settings, home healthcare, nursing homes, health departments, community health centers, schools and workplaces. The federal government’s support for Title VIII nurse education program is almost $11 million less in 2015 than it was four years ago. Support for the Advanced Education Nursing Program – the only source of federal funding for pediatric nurse practitioner education programs – totaled less than $63.6 million in 2015 – nearly $500,000 less than in 2011.
Updated 5/2015
NAPNAP urges Congress to keep its commitment to meet the nation’s health workforce needs by providing $244 million in fiscal year 2016 for Title VIII programs to educate PNPs.
• PROTECT CHILDREN FROM NICOTINE POISONING
The unregulated sale of liquid nicotine in easily opened vials and eyedroppers is an urgent public health threat to which federal regulators must respond. The public health risk from nicotine poisoning is growing rapidly – more than 3,800 closed human exposures to e-cigarettes and liquid nicotine in 2014.
NAPNAP urges members of Congress to cosponsor and pass the “Child Nicotine Poisoning Prevention Act” (S. 142/H.R. 1375) to require child-resistant packaging for liquid nicotine.
• IMPROVE CARE FOR KIDS WITH COMPLEX CONDITIONS
Approximately three million children in our country – roughly one in every 25 kids – are afflicted with a complex medical condition, and that group is growing at five percent a year, faster than the pediatric population as a whole. Of that number, about 2 million rely on Medicaid to access case because commercial insurance doesn’t cover all the treatments they need or their parents cannot afford private coverage.
NAPNAP urges members of Congress to cosponsor and pass the “Advancing Care for Exceptional Kids Act,” or “ACE Kids Act” (H.R. 546/S. 298) to create pediatric care networks for children with complex conditions. For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
Updated 3/2015
Protect the Children’s Health Insurance Program
Congress Must Take Action to Reauthorize CHIP Funding
Along with Medicaid, the Children’s Health Insurance Program (CHIP) is a critical component of the health care safety net for our nation’s children. The number of uninsured American children is at a historic low, and CHIP and Medicaid are responsible for covering more than one third of the children in the U.S. To maintain our investment in improving the health of our children, the National Association for Pediatric Nurse Practitioners (NAPNAP) believes it is essential for Congress to take action to continue to provide adequate funding for the CHIP program. Since it was established in 1997, CHIP has become a dependable source of coverage for low-income children in working families whose parents earn too much to qualify for Medicaid but too little to afford private health insurance. In the last 17 years, the number of uninsured children has been cut nearly in half. Nearly 93 percent of America’s children have health coverage today, thanks in large part to the role CHIP has played in covering
millions of children nationwide.
Pediatric nurse practitioners (PNPs) and other advanced practice registered nurses (APRNs) who care for children know first-hand the difference stable, affordable health coverage makes for families and their children in getting the timely health care they need. Practicing in primary care, specialty, and acute care settings, PNPs have provided quality health care to children and families for more than 40 years in an extensive range of community practice settings such as pediatric offices, schools, and hospitals – reaching millions of patients across the country each year. NAPNAP members recognize the critical role that CHIP plays in providing an affordable coverage option that is specifically designed with children’s health needs in mind. CHIP has bipartisan support among governors due in part to the flexibility it provides to states in designing their program and targeting outreach and enrollment efforts to meet the needs of their population.
NAPNAP applauds Congress for reauthorizing CHIP funding through September 30, 2017, and maintaining all provisions of current law on which states and programs have based their planning and budgets as part of the “Medicare Access and CHIP Reauthorization Act of 2015” (H.R. 2). This critical legislation also removed barriers to NP practice and extended funding for the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program for two years. NAPNAP is eager to work with Congress in the next two years to expand and strengthen the benefits, coverage and cost-sharing designed specifically to meet the needs of children in qualified health plans offered through federal and state insurance exchanges by 2017.
For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
Updated 3/2015
Preserve Medicaid and the Children’s Health Insurance Program
Ensure Enrollee Access to Pediatric Nurse Practitioners
Medicaid has become the backbone of this country's health care safety net, providing coverage for more than 68 million low-income Americans, including families, people with disabilities, and the elderly – a figure that will increase significantly in 2014 as health reforms are implemented.
Medicaid is a children’s program, the single largest health insurer for children from low-income families, covering three out of every 10 children and youth – 32 million children nationwide. Many pediatric Medicaid enrollees have working parents who cannot afford private health insurance. While children represent half of all Medicaid enrollees, they account for only 25 percent of program spending. Without Medicaid, most – if not all – of these children would not have health insurance coverage. Pediatric nurse practitioners (PNPs) and other advanced practice registered nurses (APRNs) who care for children are increasingly important providers in meeting the health care needs of enrollees in Medicaid and the Children’s Health Insurance Program (CHIP). Eighty-nine percent of PNPs report treating children covered by Medicaid; 42 percent of all nurse practitioners indicate the majority of their pediatric patients have Medicaid as their primary coverage.
PNPs recognize the importance of our federal government living within its means, reducing the deficit and maintaining control of health care entitlement spending. However, we also know that many families face challenges in trying to afford adequate health care. The National Association of Pediatric Nurse Practitioners (NAPNAP) urges Congress to preserve this critical source of children’s health insurance coverage:
• Funding: Maintain funding for the federal medical assistance percentage (FMAP) sufficient to meet current demand and enable states to prepare for a growing number of enrollees. Reject proposals for “blended” matching rates that would give states less federal funding, shift significant costs to overburdened state budgets and force states to cut coverage for children. Oppose efforts to convert Medicaid into a block grant program or cap federal funding and shift the burden of increasing cost and demand for services to states. • Enrollment and eligibility: Oppose attempts to repeal requirements that states maintain their current
Medicaid and Children’s Health Insurance Program eligibility standards. Eliminating this safeguard would likely result in a sharp increase in the number of uninsured children as some states scale back Medicaid and CHIP eligibility.
• Barriers to PNP practice: Support legislation and regulations that enable PNPs to provide care for children to the full extent of their education and clinical preparation. PNPs should be recognized as primary care
providers in all Medicaid managed care plans, and enrollees should be able to choose PNPs as their primary care provider rather than being required to select a physician.
For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
Updated 3/2015
Support Funding for Pediatric Nurse Practitioner Education Programs
Title VIII Programs Ensure Long-term Access to Health Care Services
As millions of Americans enroll in expanded health insurance coverage in 2015, the nation is facing significantly increased demand for health care providers at a time when many professions are facing shortages and impending retirements. Pediatric nurse practitioners (PNPs) and other advance practice registered nurses (APRNS) who care for children are a critical component of the nation’s health care infrastructure, yet tens of thousands of nursing positions are unfilled in acute care settings, home healthcare, nursing homes, health departments, community health centers, schools and workplaces. Many schools of nursing are facing shortages of qualified faculty to provide advanced education to future generations of nurse practitioners (NPs) in pediatric care.
The American Medical Association has projected a shortage of 91,000 primary care physicians by 2020. Numerous studies have shown that 65 percent to 80 percent of patients’ primary care needs can be managed safely and effectively by nurse practitioners. Funding education of nurse practitioners is an important cost-effective approach to increasing the primary care provider workforce.
PNPs appreciate the need to control the growth of government spending and reduce the federal budget deficit. In doing so, however, legislators must be aware that nurse education programs are facing extreme funding pressure. The federal government’s support for Title VIII nurse education program is almost $11 million less in 2015 than it was four years ago. Support for Advanced Education Nursing in fiscal year 2015 totaled less than $63.6 million – nearly $500,000 less than in 2011 despite increasing needs. This is the only source of federal funding for pediatric nurse practitioner educationprograms since they so not have access to graduate medical education (GME) funds. NAPNAP believes it is essential that Congress preserve funding through the Division of Nursing and Public Health in the Bureau of Health Workforce of the Department of Health and Human Services for nurse practitioners’
educational programs, traineeships and Nurse Managed Health Clinics. Funding for these programs is crucial to finance didactic andclinical preparation to produce the number of highly educated graduates required to meet the increasing need for nurse practitioners.
The National Association of Pediatric Nurse Practitioners (NAPNAP) urges Congress to keep its commitment to meet the nation’s health workforce needs by supporting funding for Title VIII programs at $244 million for fiscal year 2016 and funding the National Institute of Nursing Research at $150 million. Not only must these programs be protected from deeper spending cuts, it is critical that funding for fiscal year 2016 be sufficient to enable these programs to expand current NP education and faculty preparation programs and to fund clinical training programs in nurse managed clinics.
For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
Updated 3/2015
Protect Our Nation’s Children From Nicotine Poisoning
Require Safe, Child-Resistant Packaging For Liquid Nicotine Products
The unregulated sale of liquid nicotine in easily opened vials and eyedroppers is an urgent public health threat to which federal regulators must respond. As little as a single teaspoon of liquid nicotine, whether ingested or absorbed through the skin, could be lethal to a small child, and exposure can easily result in vomiting and seizures. Liquid nicotine is manufactured for use in e-cigarettes and is most often sold in concentrated form in easy-to-open vials bearing bright colors, enticing images and flavors that sound more like candy, such as Peppermint Patty, Frankenberry and Cotton Candy.
As licensed advanced practice registered nurses (APRNs) who have enhanced education in pediatric nursing and health care using evidence based practice guidelines, pediatric nurse practitioners (PNPs) have been providing quality health care for more than 40 years, reaching millions of children and families in an extensive range of practice settings such as pediatric offices, schools, and hospitals. As the principal primary care providers for many children and families, PNPs are acutely aware of the growing problem created by the unregulated sale of highly toxic concentrated liquid nicotine.
The public health risk from nicotine poisoning is growing rapidly – the American Association of Poison Control Centers reported more than 3,800 human exposures to e-cigarettes and liquid nicotine in 2014 – almost two and a half times as many cases as reported in 2013. The tragic death of a one-year-old in Fort Plain, New York, in January of this year from liquid-nicotine poisoning underscored the urgency of addressing this problem as quickly as possible.
The “Child Nicotine Poisoning Prevention Act of 2015” (S. 142/H.R. 1375) was introduced by Senators Bill Nelson (D-FL) and Kelly Ayotte (R-NH) and by Representative Elizabeth Esty (D-CT). The National Association of Pediatric Nurse Practitioners (NAPNAP) is pleased to support this legislation as a critical step in confronting this problem, directing the Consumer Product Safety Commission to issue rules requiring safer, child-resistant packaging for any liquid nicotine sold to consumers. Similar childproof containers are routinely required for products ranging from over-the-counter medication to vitamins and mouthwash. NAPNAP agrees that it is simply common sense to require secure child-resistant packaging and appropriate warnings on any concentrated liquid nicotine products sold to the public.
NAPNAP urges members of Congress to support the “Child Nicotine Poisoning Prevention Act” (S. 142/H.R. 1375) by cosponsoring and passing this legislation to protect our nation’s children.
For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
Updated 3/2015
Improve Coordination of Care for Children With Complex Conditions
Support Creation of Pediatric Care Networks for Children Facing Complex Medical Conditions
Approximately three million children in our country – roughly one in every 25 kids – are afflicted with a complex medical condition, and that group is growing at five percent a year, faster than the pediatric population as a whole. Of that number, about 2 million rely on Medicaid to access care because commercial insurance doesn’t cover all the treatments they need or their parents cannot afford private coverage. Caring for these children is specialized, complicated and expensive – children with complex medical conditions are roughly 6 percent of kids in Medicaid, but account for up to 40 percent of the costs. Yet Medicaid is not structured to coordinate care for children with medically complex conditions because of the individual state-based nature of Medicaid programs and the need for these children to cross state lines to get the specialized care they need.As licensed advanced practice registered nurses (APRNs) who have enhanced education in pediatric nursing and health care using evidence based practice guidelines, pediatric nurse practitioners (PNPs) are acutely aware of the highly acute conditions these children face, often requiring the services of multiple providers and specialists as well as time intensive coordination of care. These complex medical conditions can occur as a result of
prematurity, cancer, heart defects, severe injury and other causes. The specialized care they require often involves providers in more than one state.
PNPs have been providing quality health care for more than 40 years, reaching millions of children and families in an extensive range of practice settings such as pediatric offices, schools, and hospitals. The patient and family-centered nature of nurse practitioner education, which includes consideration of social determinants of health and environmental, family, and cultural factors, prepares PNPs to lead the coordination of comprehensive care for the exceptional children with multiple complex medical conditions.
The “Advancing Care for Exceptional Kids Act of 2015,” also referred to as the “ACE Kids Act” (H.R. 546/S. 298), was introduced by Representatives Joe Barton TX) and Kathy Castor (D-FL) and by Senators Chuck Grassley (R-IA) and Michael Bennet (D-CO). This legislation offers an innovative strategy for creating nationally designated pediatric care networks for children with complex medical conditions. By improving and coordinating the care of these children, this legislation creates a structure to reduce overall utilization of services and decrease the cost of care. The National Association of Pediatric Nurse Practitioners (NAPNAP) is pleased to support this legislation and looks forward to working with sponsors and supporters to further strengthen its provisions by specifically
including the PNPs in the development of quality assurance standards and measures and ensuring that the definition of “nationally designated children’s hospital networks” directly includes representing the interests of PNPs as well as other health care providers.
NAPNAP urges members of Congress to support the “Advancing Care for Exceptional (ACE) Kids Act” (H.R. 546/S. 298) by cosponsoring and passing this legislation to improve the coordinated care available to children with complex medical conditions.
For more information, please contact Michele Stickel at healthpolicy@napnap.org or call the NAPNAP Government Affairs office at (202) 223-2250.
