Nurse Practitioner - Paediatrics

Heather Whittle RN (EC) NP - Adult, MScN, and Sheeva Woznuk RN (EC) NP - Pediatrics, MHSc, NCC and Giulia Marchesan RN (EC) NP - Pediatrics, MHSc, NCC on behalf of Nurse Practitioners’ Association of Ontario Interest Group

A day in the life

For a Pediatric Nurse Practitioner in the neonatal intensive care unit (NICU), your day is busy, caring for medically fragile, premature infants. It begins with the team making rounds on all of the babies in the unit. The team may consist of registered nurses, other NPs, neonatologists and neonatal fellows, a pharmacist, a dietitian, and a social worker. Together, you devise a plan of care for the day for each infant.

As the day progresses, you will assess, order lab tests, follow up on test results, and prescribe medications. Depending on the needs of the infants, you may also need to insert an endotracheal tube to help a baby to breathe, perhaps administer a surfactant, or insert a central venous catheter to optimize a baby’s condition.

An important aspect of the NP’s day is to also care for the parents and family members of the infants. A priority is to keep them informed of their baby’s condition, and include them in the development of the plan of care. Length of stay in the NICU may be three to four months at times, making it vital that parents are prepared for each stage in the process. As a Pediatric NP, you will continue to work with the parents and family right up to the day of discharge, so that they will be comfortable with the care needs of their baby at home.

Pediatric NPs in the NICU make a difference in the care of premature infants every day. It is challenging work, but also very rewarding. At the end of the day, it is gratifying to hear sincere ‘Thank you’ from a baby’s parents.

Background

In 1965, education programs were developed in the United States, focusing on NP practice in remote or underserviced areas. In the 1970’s, several educational programs were developed in Canada. In Ontario, the role declined due to lack of funding and legislative support. Political interest in the role in primary care resurfaced in the early 1990’s. Education programs for NPs in primary care were introduced. The “Expanded Nursing Services for Patients Act” was proclaimed in 1998. This established College of Nurses of Ontario (CNO) category of “Registered Nurse in the Extended Class” RN (EC). In 1999 Post-Masters Acute Care Nurse Practitioner (ACNP) courses were established at the University of Toronto and the University of Western Ontario in response to an identified need for the role in teaching hospitals. In 2006, the College of Nurses of Ontario moved to protect the title of Nurse Practitioner. Since then advanced practice nurses in acute care have been required to write a certification examination in order to be registered in the extended class as an NP – Paediatrics.

Specialty Education

The NP – Paediatric preparation is at the Masters level. The required education focuses on areas of practice such as advanced clinical knowledge, research, and leadership.

Scope of Practice

The scope of practice of the NP – Paediatrics includes independent authority for the controlled acts authorized to nurses registered in the general class: performing prescribed procedures below the dermis/mucous membrane, administering substances by injection or inhalation and inserting an instrument, hand or finger into a natural or artificial body orifice.

In addition Bill 127 authorized additional controlled acts to NPs – Paediatrics: communicating a diagnosis, ordering a form of energy (such as ultrasounds), prescribing a drug, ordering specified x-rays, and ordering specified lab tests.

Bill 179 will authorize three additional controlled acts to NPs: (1) dispensing, compounding, or selling a drug in accordance with regulations, (2) applying a prescribed form of energy, and (3) setting or casting a fracture of a bone or dislocation of a joint. As well, additional authorities will include broadly prescribing drugs in accordance with the regulations (removal of drug lists) and removal of restrictions on certain types of x-rays to order. Bill 179 will enable NPs – Paediatrics to practice to their full scope, and is awaiting proclamation.

Currently the Public Hospitals Act does not permit NPs to practice to their full scope in inpatient settings, and medical directives are required for NPs to treat inpatients. Proposed changes to Regulation 965 of the Act will allow NPs to treat and discharge inpatients beginning July 1, 2011, and to admit and treat inpatients beginning July 1, 2012.

Proposed revisions to the Controlled Drugs and Substances Act would allow NPs to prescribe controlled drugs and substances with only a few exceptions.

Practice Environment

Most NPs-Paediatrics work in acute care settings. The role is well-established in neonatal intensive care units. NPs-Paediatrics also provide care to patients in outpatient clinics as well as on inpatient units. These roles tend to be more specialized, for example in paediatric nephrology, neurology, oncology, and palliative care.

Liability Protection

Nurse Practitioners who are RNAO members are automatically eligible for liability protection through Canadian Nurses’ Protective Society (CNPS).

Current Status

To date, there are about 175 NPs – Paediatrics registered in the Extended Class of the College of Nurses of Ontario (CNO). CNO also has the authority to register NPs – Anaesthesia. The University of Toronto offers a program to prepare NPs in Anaesthesia. To date no NPs – Anaesthesia are registered with CNO.

Links

Nurse Practitioners’ Association of Ontario: www.npao.org
Canadian Association of Advanced Practice Nurses: www.caapn.com

References

1 www.npao.org
2 www.cno.org