Today's complex and evolving healthcare environment has provided the opportunity for the advanced practice nurse to emerge as a vital player. It is to our advantage for all nurses to assume an active role in this process. The recent attempts to blend the roles of a clinical nurse specialist (CNS) and a nurse practitioner (NP) have occurred owing to downsizing of middle management staff and the need for patients to have greater access to primary care. This may have been avoided with more organized efforts to demonstrate the benefits of the varied positions.
An example of a creative addition to the advanced practice family is the role of a pediatric gastroenterology NP who specializes in caring for those with often chronic gastrointestinal (GI) issues that may ultimately impact children's growth and development. This role often melds the responsibilities of a clinician/caregiver, an educator, and a researcher. These children are often comanaged in cooperation with a pediatric gastroenterologist who is needed more for the diagnostic role of performing endoscopic procedures.
Pediatric gastroenterology NPs function in both inpatient and outpatient settings. On the inpatient level, a pediatric GI NP makes rounds and daily notes on the pediatric GI patients, provides much needed instruction to both the family and the nursing staff, and facilitates coordination of outpatient care if required by the situation. Many NPs work on the outpatient level to see patients with common problems such as constipation, encopresis, gastroesophageal reflux disease, and recurrent abdominal pain. These conditions rarely require endoscopic procedures, but these patients are greatly benefited by counseling, teaching, and ongoing encouragement provided by the NP.
It is imperative to create a foundation and environment for the continued development and evolution of new advanced specialty roles such as the pediatric GI NP to fill unmet needs in the healthcare system. Currently, most of those in these positions have been trained as primary care or pediatric NPs and subsequently receive on-the-job training in the specialty area. There has been a lack of graduate programs to address specialty care practice; however, more colleges are considering ways to standardize and implement these educational programs. Advanced practice nurses with advanced specialty training ultimately should seek to be certified or licensed and credentialed to appropriately reflect their intended practices. Without this, these roles have the potential to weaken our professional accountability to the public.
Current trends of the increased numbers of nurses in these roles suggest that the established categories of advanced practice nurses such as NPs, CNSs, certified nurse midwives (CNMs), and certified registered nurseanesthetists will remain relatively unchanged. Primary care provided by NPs and CNMs is a reasonably straightforward concept to explain to health policy makers and enhance economical access to care for a great majority of citizens. While primary care NPs will compete with physician assistants and physicians for positions, other specialty NPs will continue to create new positions within the healthcare arena. They will face unique challenges when interpreting their practice and expertise, and future employers will require the demonstration of the benefits of these roles to sustain their existence.
We live in an exciting yet challenging period. We must act quickly to unite and establish our role in the healthcare arena as a true profession requiring baccalaureate degree education for entrance into practice. The opportunities for the advance practice nurse in pediatric GI and other specialty areas are broad and have the potential to significantly impact the healthcare of our citizens. Advance practice nurses must work together to establish standards to ensure necessary education and training to continue to provide access to care in both primary care and specialty practice areas. The advanced practice nurses in the specialty of pediatric gastroenterology are a well-educated and cohesive group that has the potential to provide guidance and direction to legislators and educators in the arena of establishing the vital role of a specialty care NP. The future challenges must instill in all of us an urgency to get involved at the local, state, or national level to bring forth these changes in an efficient and expeditious process.
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