The Lack of Consensus Regarding the Scope of Practice for the Academically Prepared Family/Emergency Nurse Practitioner

This discussion with present the current controversies regarding the scope of practice for academically prepared family/emergency nurse practitioners (FNP/ENP).  Utilization of APRNs in emergency departments has increased¹ in response to growing ED volumes² and national ED manpower gaps³ .  APRNs have staffed EDs since the 1970’s, although, specialized academic programs for preparing ENPs did not exist until the 1990’s with some programs adapting Acute Care curricula, others FNP curricula, and others creating dual programs.  There are currently seven ENP programs in the U.S. five preparing FNPs as ENPs and two preparing ENPs with dual certification as FNPs and ACNPs.

 Justification for preparing FNP/ENPs  is based on ED demographic data that shows one third of all ED patients are <25 years of age⁴. Additionally, 80% of EDs nationwide treat patients of all ages as specialized pediatric EDs are limited to large metropolitan areas⁴. Utilization trends over the past decade show APRNs working in EDs are more likely to care for patients with lower acuity conditions. However, the percent of APRNs caring for patients with complex medical problems has increased ¹ consistent with ED patient acuity trends that show a steady rise, 44.6% in 1992⁵ to 54.7% in 2010⁴, in the percent of patients presenting with urgent/emergent conditions.

Entry-level core competencies for ENPs, developed using an evidence- based approach,  were  published in 2008 by the Emergency Nurse’s Association and endorsed by NONPF in 2010⁶. These competencies form the basis for FNP/ENP and ACNP/ENP curricula and clinical requirements.  Academically educated FNP/ENPs are prepared to assess, stabilize and treat ED patients of all ages with complex medical or primary care conditions consistent with the ENP core competencies and scope of practice.

In September 2013, the American Nurses Credentialing Corporation initiated specialty certification for ENPs. Eligibility for certification now poses challenges for the academically prepared FNP/ENP in light of NONPFs position regarding FNP scope of practice in ED settings. These challenges can be mitigated with recognition and acknowledgement of the unique scope of practice of the academically prepared FNP/ENP.