Analysis of Nurse Practitioners’ Education Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments

I work with a team of nurse researchers that want to see the quality of nursing education improved and especially in areas that are associated with emergency preparedness. We began our work with a systematic review of the literature that examined the evidence to support nurse practitioner (NP) education and training and whether they align with current practices in the emergency department. We then explored the current alignment of nurse practitioner education and training, licensure, and certification with the scope of practice in U.S. emergency departments (EDs). Next we will be looking at types of services provided by nurse practitioners in the emergency department.

The evidence is leading us down a path that is not what I expected. The first paper revealed evidences that:

  • The use of NPs cuts the wait time in EDs by as much as half.
  • The presence of NPs reduced the number of people that left without being seen.

What we did not find were studies that compared NPs with advanced emergency training to those that were trained in primary care. Consequently, we took a deeper dive into educational preparation, certification and scope of practice of NPs working in the ED. This is where I didn’t find what I expected. There has been substantial growth in number of NPs used in EDs, but there are only 14 programs that educate NPs as Emergency NPs. Like everything else in NP education the programs range from postgraduate certificates to doctoral degrees and the specialty courses begin as low as only 10 credit hours and 158 additional clinical hours. To be clear 158 clinical hours is less than 4 weeks of full time work. The surprising findings:

  • There is no clear consensus on what is required for education, training, and certification to practice as an NP in the ED.
  • The use of NPs in the ED is not consistent with the Consensus Model.
  • There are multiple paths to certification and they vary greatly from 100 hours of continuing education over 5 years to a postgraduate program to a fellowship.
  • There is a misalignment between education preparation and training with the practice parameters for NPs working in the ED.

How do we justify unsupervised practice in settings where we lack the appropriate certification? Why is it that we still do not have any significant standardization of training and education requirements for entry into practice in specialty areas? I think nursing education needs reform that focuses on the evidence and sadly we do too little to find the evidence.