REGIONAL SURVEY OF PEDIATRIC NP PRACTICE

Ellen Reynolds, MSN, CRNP
Meg Hannan, MSN, CRNP

For years, there have been ongoing discussion and anecdotal reports regarding the various approaches to NP professional issues among local hospitals, facilities and private practices. In early 2004, members of Three Rivers NAPNAP set out to devise an objective method to describe characteristics of PNP practice in our region. Approximately 168 surveys were sent out to all the members of Three Rivers NAPNAP and the Southwest Pennsylvania NP group. Wishing to also include the practice parameters of FNPs and other NPs who care for children, we requested participants to complete the survey only if the practitioner provides regular care to children in their practice. Seventy complete questionnaires were returned. These data have provided a glimpse into the practice of PNPs and FNPs who treat children in western PA.

Education and Background
Respondents are a fairly young group. Their range of experience years ranges from 1 to 34 years, with the mode being 5 years (Fig. 1.)

 

Fig. 1

Respondents were educated all over the country, although the majority (66%) graduated from the PNP program at the University of Pittsburgh. Educational programs delineated were the following:

AGH Univ. of Illinois
Boston College Univ. of Tennessee
Case Western Reserve Univ. SUNY-Buffalo (2)
Clarion Univ. Univ. of Maryland
Emory Univ. Univ. of Pennsylvania (2)
Univ. of Washington Univ. of Virginia
LaRoche College (4) Vanderbilt Univ.
Univ. of Pittsburgh (44) West VA Univ.
SUNY-Stonybrook

Most respondents hold Master’s degrees; several hold certificates or PhDs (Fig. 2).

Fig. 2

More than one-half of respondents are nationally certified as PNPs; of those, 40% are certified by PCNB, and 17% by ANCC. An additional 19% are certified as FNPs. Other certifications held are reflected in Fig. 3

Fig. 3

Areas of practice
Primary care accounts for 43% of the practitioners’ areas of practice, with an equal number (n=14) working in either pediatric or family practice. Thirteen respondents (20%) work in a pediatric subspecialty (Fig. 4). Six respondents hold positions in Emergency Medicine; 4 work in School Health.

Fig. 4

The pediatric subspecialties listed by the respondents include the following areas:

Abuse/foster care continuity Adolescence Adolescent OB/GYN
Anesthesia/Same Day Surgery Anesthesia Cardiology
Child Advocacy Developmental/Behavioral Health Pediatric acute care
Endocrine Gastroenterology Plastic surgery
Hematology/Oncology Internal Medicine
Disability General Surgery
Pulmonology Women’s Health

Practice sites include hospital clinics, other clinics and offices, schools, resident facility (1), and others not specified (Fig. 5).

Fig. 5

Forty-seven practitioners (70%) report working with 1,2,3, or 4 physicians. Interestingly, Fourteen (21%) generally work without a physician present. This includes 4 who work in school nursing.

Respondents view physician colleagues as varying greatly in their knowledge of PNP scope of practice and regulatory issues (Fig. 6).

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Fig. 6

 

Professional Issues
One-half of respondents report being the only NP in their practice group. 26% report that PAs are also employed by the practice. There were not enough valid responses to the question, “Are NP and PA roles handled in the same manner?” to determine a trend.

Just over half of respondents (51%) have prescriptive authority. 33% are credentialed by various insurance companies, as detailed below (Fig. 7).

Almost 50% are credentialed by hospitals. Nearly half of those are credentialed at CHP. Several NPs are credentialed at more than one hospital. The credentialing hospitals listed were as follows:

Alle Kiski
Beaver Med. Center

Somerset
CHP

Southwood
Jefferson Regional

UPMC
MaGee

West Penn
Mon Valley

WPIC
WRH

Seven (13%) of respondents report having a DEA number for prescribing scheduled medications, and report prescribing Category I-V medications..

Most respondents reported considerable autonomy in their day-to-day practice, independently performing patient histories, physical exam, ordering lab work or imaging, ordering medications, and coordinating follow-up. The following invasive procedures are performed with, and without supervision:

Without Supervision	With Supervision
Arterial Blood Draws	Arterial line insertion
GYN Cryosurgery	Joint Aspiration
ET Intubation	Nerve Blocks
Endometrial Biopsy	ET Intubation
I & D	IUD Insertion
Joint Aspiration	Joint Injection
LP	Suturing
Nerve Block
Skin Biopsy
Suturing
Tissue Expansion
Tympanocentesis

70% of respondents have charts cosigned by a physician; 80% see patients alone in the office with a physician available by phone, and 20% see patients alone for the first visit.
Only 14, or 20%, round on their practice’s patients, and one-half (7) of those are able to bill for those visits.

NP SALARIES

The salary range for this group of respondents ranges from < $20/hour to >$40/hour (Fig. 8). Interestingly, salary is not well correlated with years of PNP experience. The salary mean is $28-32/hour, with 75% of respondents earning between $25-$35 per hour.

Fig. 8

This group of NPs is generally quite satisfied with their chosen role. No one reported their role satisfaction to be less than “4” on a scale of 1-10 (1=unsatisfied; 10= very satisfied)(Fig. 9).

Fig. 9

Satisfaction with individual positions varies a bit more: (Fig. 10)

Fig. 10

The 4 aspects of one’s NP position most frequently mentioned as being satisfying were:
-Patient interaction/ongoing relationships with patients/being able to see both positive and negative change in their lives.
-Respect from colleagues.
-Ability to problem solve and have direct impact on positive change/cognitive challenge;
-Interaction and learning from other professionals.

The most commonly noted desired improvements were:
-Recognition by others within and outside of medicine as to the high quality of care we provide and the skill we have;
-Recognition by insurance providers as PCPs/3rd party credentialing;
-Enhanced institutional support to NPs.

Summary/Discussion
NPs who routinely care for children in Western PA are a diverse group. There is a great range of autonomy accorded by institutions and practice groups. Salaries vary widely. Interestingly, some of the barriers to professional practice that we have associated with insurance or other regulations are not barriers for some of the respondents to this survey. Many reported seeing patients for the first visit, not having to have charts co-signed by physicians, prescribing controlled substances with few restrictions, billing for inpatient rounds, and being credentialed by third-party payers.

A limitation of these data is that we did not delineate original NP program focus – i.e., whether respondents were prepared as PNPs, FNPs, or others. We had also included a question regarding numbers of patients seen per day, but this was not included in the results as the numbers varied widely, and we were unable to correlate those numbers with type of practice.

What is clear is that NPs enjoy their practice because of being able to help others, being mentally stimulated and challenged, and being afforded a collegial relationship with physicians and other health care professionals. There is also a consensus that NPs in our area have a number of professional concerns concerning barriers to practice. These have yet to be addressed in order for NPs to actualize the role we were educated to perform.

Thank you to Cathy Campese and Jane Miller for assistance in data entry.