1. Edmunds, Marilyn NP, PhD, Advocacy In Practice Editor

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The dust has not yet settled regarding the Scope of Practice Policy Paper issued by the American Academy of Pediatrics (AAP). 1 The AAP paper focuses on the organization's perceived concern arising from the increase of nonphysician pediatric clinicians and their expanding scopes of practice.


In provocative language long-abandoned by other physician groups, and rarely spoken by pediatricians in particular, the AAP describes "critical public policy and child health advocacy concerns" arising from nonphysician pediatric care because "optimal pediatric health care depends on a team-based approach with coordination by a physician leader, preferably a pediatrician."


While the AAP "recognizes the valuable contributions of nonphysician clinicians" and gives a nod to the supportive literature, it maintains, "until well-controlled studies demonstrate comparable outcomes for care rendered by all such clinicians, the AAP opposes independent practice, independent prescriptive authority, and reimbursement parity for these nonphysician clinicians."


Forging Camaraderie

Carol Berkowitz of the University of California, Los Angeles, recently elected president of the AAP, chaired the Committee on Pediatric Workforce that issued this highly inflammatory AAP policy statement. Despite many member complaints, she continues to stand firmly behind this policy.


In the AAP elections, Berkowitz defeated Francis Rushton, a community practitioner and past AAP chapter president from Beaufort, SC, who has long worked with NPs. Rushton reportedly had written to the former president asking to have the statement revisited in favor of NP/physician collegiality and collaboration saying, "Repairing the rift caused by the present statement will go a long way toward really advocating for children."


The NP Voice

While NPs didn't have a vote, they surely have a voice. One NP who always has a clear and concise message is Loretta Ford, founder of the NP role. She wrote the letter printed here and has given permission to reproduce parts of it in this column.


Dear Dr. Berkowitz:


As the co-founder [with 2 physicians] of the Pediatric Nurse Practitioner program...I am shocked and dismayed by the proposed AAP policy on "nonphysicians". What has happened to the AAP leadership over the years? The colleague relationship that pediatricians and nurse practitioners enjoyed apparently has deteriorated into a turf battle that shows no respect for the integrity of the nursing discipline, no recognition of the 37 years of data that has accumulated on the quality of care, improved access, economic value and patient satisfaction provided by pediatric nurse practitioners...


"Surely, the AAP's attention and intentions are misguided and misplaced in proposing the establishment of controls on a profession other than its own. Additionally, the lofty goal to "improve the health of all children" will never be achieved by such a recalcitrant and myopic policy...The AAP has been highly respected by nurses and I believe this...policy will not only tarnish that reputation, but label it as just another medical organization trying to control all of health care, create a monopoly in access, deny patient choices and services, protect its own turf and its resources all in the name of assuring "quality", for which there is no scientific evidence. To the contrary, the evidence for quality care, increased access, controlling costs, and willingness to serve weighs in favor of nurse practitioners. I suggest the AAP recognize these facts.




Loretta C. Ford, RN, PNP, EdD, FAAN, FAANP



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1. American Academy of Pediatrics, Committee on Pediatric Workforce: Scope of practice issues in the delivery of pediatric health care. Pediatrics 2003; 111( 2): 426-435. [Context Link]