Background/Purpose:

Due to the shortage of subspecialty physicians there is an increasing  need of adding mid-level practitioners to specialty practices (Solomon, Bitton, et.al., 2014).  However there is little guidance as to best practices and standards for training a nurse practitioner (NP) or physician assistant (PA) in specialty practice. In this study we investigated the scope of practice and training for NPs in pediatric rheumatology in the United States by a nationwide survey. 

Methods:                                                          

The Pediatric Nurse ListServe in the United States has an over 100 NP members and currently no known PA’s. We developed an 18 question survey focused on the education, background, training and practice of Nurse Practitioners in Pediatric Rheumatology Practices. Survey monkey was utilized and sent to both the Pediatric Rheumatology and Pediatric Rheumatology Nursing List Serves. Questions included state of employment, years working a nurse prior to and as a nurse practitioner, length of training with the Rheumatologist staffing patients, focused education in the specialty, scope of practice, length of appointments, volume of clinics per week, billing practices and research engagement. The survey was sent out as an e-mail blast with two follow up reminders to practitioners.

Results:

33 NP’s from 17 States in the United States responded. Response rates were evenly distributed across the country. 67.7% had a background in acute care settings as RN’s with anywhere from less than 2 to over 20 years of experience prior to becoming a NP. 57% had prior experience as an NP in primary care or other specialty setting. Training with a Rheumatologist ranged from <6 months=31.0%, 6 month=31.0% and 1 year=27.6% and 10% 1-2 years. Subsequent to this, 93.7% reported seeing patients in follow up independently with an MD available, while 28.1% see the patients together with an MD; 53.1% report seeing new patients with an MD, 36.5% with a MD available.  Most common diagnosis being followed: Juvenile Idiopathic Arthritis 97%, uveitis 90.9%, systemic lupus 84.8%, dermatomyositis 84.8% and linear/morphea scleroderma 81.8%. Respondents reported a broad range of acuity. 93.9% followed patients on infusion therapy. 60.6% participated in research trials although 90.6% had no protected research time. Rheumatology education of the respondents was obtained as follows: 87% within their own department, 51.5% through attending ACR/ARHP PRYSM, 54.5% by attending the ACR/ARHP Annual Meeting, 33.3% by taking the ARHP Advanced Rheumatology Course, and 9.1% through the Rheumatology Nurses Society. 78.8% of the respondents were billing under their own name. The average job profile was 5 days a week with 43.7% averaging 3-5 half day clinics and 37.5% averaging 6-8 half day.  72.4% of the respondents had 30 minute follow up visits.

Conclusion:

Nurse Practitioner’s entering pediatric sub specialty practice have a wide range of clinical background frequently with limited experience as a NP. The scope of practice and job profile appears to be broad with an average work load ranging from 3 to 8 half day clinics. There does not appear to be consistency between programs regarding length of training and educational plan. A formalized clinical training for NP’s going into specialty practices is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/utilization-and-education-of-nurse-practitioners-in-pediatric-rheumatology/