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Michelle Perron Pronsati Editor, ADVANCE for Nurse Practitioners 2900 Horizon Drive, Box 61556 King of Prussia, PA 19406-0956 March 13, 2002 Dear Ms. Pronsati: On behalf of the National Association of Pediatric Nurse Practitioners (NAPNAP), the Association of Faculties for Pediatric Nurse Practitioners (AFPNP), and the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) we would like the opportunity to respond to a recent article titled Outside Your Scope of Practice, published in the February 2002 issue of ADVANCE for Nurse Practitioners, written by Melanie L. Goodman, NP, JD. Our organizations are significantly concerned about the erroneous and misleading information within this article. The information regarding Pediatric Nurse Practitioners (PNPs) and School Nurse Practitioners (PNPs) is inaccurate as well as unsubstantiated. The first area of concern is the author's statement "Pediatric nurse practitioners may see patients age 16 or 18 and beyond." Although the author states "age 18 and beyond," it could be easily misinterpreted to mean that "beyond" is not the norm and the usual standard of practice for a PNP is to see patients up to only 18 years of age. This is incorrect. PNPs have an extensive knowledge base regarding development issues and a unique awareness of some of the pertinent concerns pertaining to adolescent and young adult transitions, especially those pertaining to health care, and are qualified to assist these patients during the transition phase. The NCBPNP/N (2001) examination for PNPs includes items related to the PNPs role in caring for age categories of neonatal (0-30 days) to young adulthood (20-21 years). Establishing exclusive upper age limits to PNPs' practice creates a significant barrier for PNPs and may limit access to health care for this population. The PNP role encompasses providing health care to children up to age 21 years, and in unique situations, such as college health of young adults or transition care of chronically ill children, the PNP may see children older than 21 years of age. The next statement that could create a mistaken interpretation is, "Although they (PNPs) can participate in family planning, any pregnant patient should be referred to a women's health nurse practitioner." We agree that the PNP is not prepared to provide obstetrical health care to women. However, your statement gives the impression that the PNP is legally at risk if she has interactions with pregnant women. Prenatal counseling with a focus on infant health issues is an important aspect of the PNP role. PNPs provide education and support to pregnant women regarding genetic counseling, environmental health, optimal nutrition, and choices in newborn care, as well as preparation for the parenting role to those planning a pregnancy and to expectant parents. Again, the author's restricted statement could easily be misunderstood and could limit the PNP's practice in the above-mentioned counseling situations. Another area of concern is the author's statement "Many school NPs are PNPs with a school nurse credential. Because the formal curriculum for PNPs and SNPs is not the same, a PNP working as a SNP may be practicing outside of her scope of practice." This statement is inaccurate and is based on outdated certification qualifications. The American Nurse Credentialing Center (ANCC) no longer offers initial certification for the SNP role. Those SNPs who were previously certified are granted recertification through continuing education only (http://www.nursingworld.org/ancc/certify/cert/catalogs/2000/cbt/nursprac.htm). Since there is not national certifying examination for SNPs it is not realistic to suggest that PNPs functioning as SNPs are outside of their scope of practice. The National Association of School Nurses adopted in October, 1997 their "Position Statement on The Advanced Practice School Nurse" The statement identifies an advanced practice nurse as a Master's prepared nurse holding national certification. (Available online at: http://www.nasn.org/positions/advan_prac.htm). The specialty area of the certification is not specified. Since PNP certification is the only option offered by ANCC and NCBPNP/N, this certification is considered the most appropriate for the SNP role. Graduates of PNP programs are well prepared to care for children in a school setting by virtue of content of the curriculum, which includes a strong foundation in teaching, counseling, advising, and anticipatory guidance. The NCBPNP/N (2001) PNP certification test blueprint clearly outlines the comprehensive nature of the PNP role (consultation, direct clinical care and teaching) and its focus on health promotion including extensive content on developmental concepts, developmental theories, milestones, socialization, general behavior development, socialization stages, language/speech and other related screening tests, and psychosocial issues including peer relationships, self-esteem, self-care skills. All critical knowledge areas for PNP practice in school health settings. NAPNAP works with the Association of Faculty of Pediatric Nurse Practitioners (AFPNP) and the National Certification Board of Pediatric Nurse Practitioners and Nurses (NCBPNP/N) toward the common goals of ensuring that PNPs are educated and prepared to provide quality health care to children and their families. The organizations collaboratively use an evidence-based approach to ensure congruency among PNP educational programs, national certification standards, and PNP practice. This relationship provides the essential foundation to ensure the highest standards of practice, education, and regulation for PNPs. These core elements and existing congruencies in practice, education, and regulation assure that the PNP has the expertise and qualifications to care for children of all ages through young adulthood, across many settings, including schools. In summary, the scope of practice for a PNP is extensive and as defined by the AFPNP within their Philosophy for the Education of the Pediatric Nurse Practitioner, PNPs are educated to provide "primary child health, which includes the provision of a broad range of services needed to respond to the health care needs of children in their community settings". We look forward to seeing our letter in the May issue of ADVANCE with a response from Ms. Goodman. Sincerely, Julie C. Novak, DNSc, RN, MA, CPNP President, NAPNAP Michelle Beauchesne, DNSc, RN, CPNP President, AFPNP Susan Van Cleve, MSN, CPNP President, NCBPNP/N

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