Where Have All the PNPs Gone?

One of my responsibilities as the director of a DNP program is reviewing and evaluating the applications to the program. I cheer when I see an applicant who is either a pediatric nurse practitioner (PNP) or a nurse leader whose specialty is pediatrics.

I have noted that my cheers are few and far between, and I began to wonder why. In a recent conversation with Jan Wyatt, PhD, RN, FAANP, Executive Director of the Institute of Pediatric Nursing, I mentioned the paucity of pediatric nurses in our graduate programs. Alas, I discovered that the scarcity is across the board in the pediatric nursing specialty. And thus began my education on how this has become a national concern among pediatric nurses.

The data are staggering: In the US, there are approximately 74 million children. Of that number, 18% are uninsured and 30% have significant health issues such as asthma, depression, and special care needs.¹ While the Children’s Health Insurance Program (CHIP) has facilitated some reduction in the number of uninsured children, the inequity of their access to care persists. Since 2000, one of the Healthy People initiatives has been to reduce health disparities. The 2020 goals have been broadened to “to achieve health equity, eliminate disparities, and improve the health of all groups.”²  

It has been said that the “future of our world lies in the hands, the hearts, and the minds of our children.” If that is so, then it is incumbent upon us to ensure there are a sufficient number of health care providers who are experts in children’s health and to whom children (and their families) have access. Improving the health and well-being of children not only impacts their future health, but also affects, and can identify, future challenges for the entire health care system.

But sadly enough, with regard to caring for the health of our children, it appears that we are no better off than we were 50 years ago. Recall that the first NP program was a model for public health nurses so they could enhance the care available to children and their families. Just as in the 1960s there was a need for access to pediatric care, so too, today, the services for children border on woefully inadequate. With the passage of the 2010 Patient Protection and Affordable Care Act, and the Future of Nursing report, nurses are well positioned to turn that around.

However, the landscape of nursing is changing, and we are witnessing a decline in the number of nurses who choose pediatrics as their specialty. Today, only 7.3% of the RN workforce, and 8.1% of nurses in advanced practice, specialize in pediatrics.³ In our discussion, Dr. Wyatt noted that in the past 10 to 15 years, the percentage of NP students entering PNP programs has significantly diminished.

Also of note is that pediatrics as content in undergraduate education has often been “integrated,” so BSN recipients have very little pediatric experience—and therefore little confidence in their ability to care for sick children—when they graduate. Moreover, the decrease in pediatric content and clinical experience is worsened by the difficulty in recruiting nurse educators who teach in this area.⁴ And as BSN-prepared nurses consider advanced training as an NP, they are being steered toward the family nurse practitioner (FNP), not PNP, track, despite their desire to focus on pediatrics. 

The pediatric, adult, and women’s health NP roles were established long before the FNP role grew into prominence. In the 1970s, the introduction of the birth control pill probably contributed to the need for more health care providers who specialized in the care of women. These roles were viewed as the pioneers of the NP movement, with the PNP being the first. These programs flourished, albeit the PNP programs less so than the others. That said, in 1998 there were 114 primary care PNP programs, which by 2010 had decreased to 98.⁵ Worse, in some states (Idaho and Wyoming, for example), nurses who want to be a PNP need to leave their homes, as there are no PNP programs there.  

As a result of the disappearance of pediatrics in undergraduate education and the decrease in PNP programs (especially primary care), the Pediatric Nursing Certification Board sponsored the establishment of the Institute of Pediatric Nursing (IPN) in 2011. The IPN is a nonprofit educational organization that brings together leaders from nursing organizations and children’s hospitals to provide a collective voice to advocate for strengthening pediatric nursing education and to advocate for improved health and illness care coordination for kids and families, as well as support for access to safe, quality, evidenced-based care for all children and families.⁶

The IPN, partnering with the American Association of Colleges of Nursing, is currently conducting a national survey of undergraduate nursing programs “to explore the challenges, gaps, and successes within undergraduate pediatric nursing education, including an exploration of the perspectives of nursing faculty regarding the future of pediatric nursing residency programs.”⁷ The results of this survey will be presented at the Third Annual Invitational Forum for Pediatric Nursing in October.

When I was deciding on a career, I knew I wanted to work with children. I became a nurse so I could become a PNP, and my decision was supported by my nursing mentor, who directed me to follow my passion. Just as I was encouraged, we need to encourage nursing and NP students to go where their passion lies. Let them follow their heart—if they want another specialty, OK. But if they love pediatrics, support that passion.

We need to honor our roots and not abandon the pediatric nurse practitioner role. Where would we be without it?

References
1. Kaiser Family Foundation. The uninsured: a primer (2009). www.kff.org/uninsured/7451.cfm. Accessed September 16, 2011.

2. US Department of Health and Human Services. Healthy People 2020. www.healthypeople.gov/ 2020/about/disparitiesAbout.aspx. Accessed September 16, 2011.

3. Health Resources and Services Administration. The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. bhpr.hrsa.gov/healthworkforce/rnsurvey2008 .html. Accessed September 16, 2011.

4. Society of Pediatric Nurses. Position statement on child health content in the undergraduate curriculum (2007).

5. National Association of Pediatric Nurse Practitioners. PNP programs information: pediatric nurse practitioner school list. www.napnap.org/ForStudents/PNPSchoolListing.aspx. Accessed September 16, 2011.

6. Sperhac A, Wyatt JS. Securing the future of children’s health. Pediatric Nursing. 2010;36(1):8-9.

7. Institute of Pediatric Nursing. www.ipedsnursing.org/ptisite/control/index. Accessed September 16, 2011.

One of my responsibilities as the director of a DNP program is reviewing and evaluating the applications to the program. I cheer when I see an applicant who is either a pediatric nurse practitioner (PNP) or a nurse leader whose specialty is pediatrics.

I have noted that my cheers are few and far between, and I began to wonder why. In a recent conversation with Jan Wyatt, PhD, RN, FAANP, Executive Director of the Institute of Pediatric Nursing, I mentioned the paucity of pediatric nurses in our graduate programs. Alas, I discovered that the scarcity is across the board in the pediatric nursing specialty. And thus began my education on how this has become a national concern among pediatric nurses.

The data are staggering: In the US, there are approximately 74 million children. Of that number, 18% are uninsured and 30% have significant health issues such as asthma, depression, and special care needs.¹ While the Children’s Health Insurance Program (CHIP) has facilitated some reduction in the number of uninsured children, the inequity of their access to care persists. Since 2000, one of the Healthy People initiatives has been to reduce health disparities. The 2020 goals have been broadened to “to achieve health equity, eliminate disparities, and improve the health of all groups.”²  

It has been said that the “future of our world lies in the hands, the hearts, and the minds of our children.” If that is so, then it is incumbent upon us to ensure there are a sufficient number of health care providers who are experts in children’s health and to whom children (and their families) have access. Improving the health and well-being of children not only impacts their future health, but also affects, and can identify, future challenges for the entire health care system.

But sadly enough, with regard to caring for the health of our children, it appears that we are no better off than we were 50 years ago. Recall that the first NP program was a model for public health nurses so they could enhance the care available to children and their families. Just as in the 1960s there was a need for access to pediatric care, so too, today, the services for children border on woefully inadequate. With the passage of the 2010 Patient Protection and Affordable Care Act, and the Future of Nursing report, nurses are well positioned to turn that around.

However, the landscape of nursing is changing, and we are witnessing a decline in the number of nurses who choose pediatrics as their specialty. Today, only 7.3% of the RN workforce, and 8.1% of nurses in advanced practice, specialize in pediatrics.³ In our discussion, Dr. Wyatt noted that in the past 10 to 15 years, the percentage of NP students entering PNP programs has significantly diminished.

Also of note is that pediatrics as content in undergraduate education has often been “integrated,” so BSN recipients have very little pediatric experience—and therefore little confidence in their ability to care for sick children—when they graduate. Moreover, the decrease in pediatric content and clinical experience is worsened by the difficulty in recruiting nurse educators who teach in this area.⁴ And as BSN-prepared nurses consider advanced training as an NP, they are being steered toward the family nurse practitioner (FNP), not PNP, track, despite their desire to focus on pediatrics. 

The pediatric, adult, and women’s health NP roles were established long before the FNP role grew into prominence. In the 1970s, the introduction of the birth control pill probably contributed to the need for more health care providers who specialized in the care of women. These roles were viewed as the pioneers of the NP movement, with the PNP being the first. These programs flourished, albeit the PNP programs less so than the others. That said, in 1998 there were 114 primary care PNP programs, which by 2010 had decreased to 98.⁵ Worse, in some states (Idaho and Wyoming, for example), nurses who want to be a PNP need to leave their homes, as there are no PNP programs there.  

As a result of the disappearance of pediatrics in undergraduate education and the decrease in PNP programs (especially primary care), the Pediatric Nursing Certification Board sponsored the establishment of the Institute of Pediatric Nursing (IPN) in 2011. The IPN is a nonprofit educational organization that brings together leaders from nursing organizations and children’s hospitals to provide a collective voice to advocate for strengthening pediatric nursing education and to advocate for improved health and illness care coordination for kids and families, as well as support for access to safe, quality, evidenced-based care for all children and families.⁶

The IPN, partnering with the American Association of Colleges of Nursing, is currently conducting a national survey of undergraduate nursing programs “to explore the challenges, gaps, and successes within undergraduate pediatric nursing education, including an exploration of the perspectives of nursing faculty regarding the future of pediatric nursing residency programs.”⁷ The results of this survey will be presented at the Third Annual Invitational Forum for Pediatric Nursing in October.

When I was deciding on a career, I knew I wanted to work with children. I became a nurse so I could become a PNP, and my decision was supported by my nursing mentor, who directed me to follow my passion. Just as I was encouraged, we need to encourage nursing and NP students to go where their passion lies. Let them follow their heart—if they want another specialty, OK. But if they love pediatrics, support that passion.

We need to honor our roots and not abandon the pediatric nurse practitioner role. Where would we be without it?

References
1. Kaiser Family Foundation. The uninsured: a primer (2009). www.kff.org/uninsured/7451.cfm. Accessed September 16, 2011.

2. US Department of Health and Human Services. Healthy People 2020. www.healthypeople.gov/ 2020/about/disparitiesAbout.aspx. Accessed September 16, 2011.

3. Health Resources and Services Administration. The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. bhpr.hrsa.gov/healthworkforce/rnsurvey2008 .html. Accessed September 16, 2011.

4. Society of Pediatric Nurses. Position statement on child health content in the undergraduate curriculum (2007).

5. National Association of Pediatric Nurse Practitioners. PNP programs information: pediatric nurse practitioner school list. www.napnap.org/ForStudents/PNPSchoolListing.aspx. Accessed September 16, 2011.

6. Sperhac A, Wyatt JS. Securing the future of children’s health. Pediatric Nursing. 2010;36(1):8-9.

7. Institute of Pediatric Nursing. www.ipedsnursing.org/ptisite/control/index. Accessed September 16, 2011.

One of my responsibilities as the director of a DNP program is reviewing and evaluating the applications to the program. I cheer when I see an applicant who is either a pediatric nurse practitioner (PNP) or a nurse leader whose specialty is pediatrics.

I have noted that my cheers are few and far between, and I began to wonder why. In a recent conversation with Jan Wyatt, PhD, RN, FAANP, Executive Director of the Institute of Pediatric Nursing, I mentioned the paucity of pediatric nurses in our graduate programs. Alas, I discovered that the scarcity is across the board in the pediatric nursing specialty. And thus began my education on how this has become a national concern among pediatric nurses.

The data are staggering: In the US, there are approximately 74 million children. Of that number, 18% are uninsured and 30% have significant health issues such as asthma, depression, and special care needs.¹ While the Children’s Health Insurance Program (CHIP) has facilitated some reduction in the number of uninsured children, the inequity of their access to care persists. Since 2000, one of the Healthy People initiatives has been to reduce health disparities. The 2020 goals have been broadened to “to achieve health equity, eliminate disparities, and improve the health of all groups.”²  

It has been said that the “future of our world lies in the hands, the hearts, and the minds of our children.” If that is so, then it is incumbent upon us to ensure there are a sufficient number of health care providers who are experts in children’s health and to whom children (and their families) have access. Improving the health and well-being of children not only impacts their future health, but also affects, and can identify, future challenges for the entire health care system.

But sadly enough, with regard to caring for the health of our children, it appears that we are no better off than we were 50 years ago. Recall that the first NP program was a model for public health nurses so they could enhance the care available to children and their families. Just as in the 1960s there was a need for access to pediatric care, so too, today, the services for children border on woefully inadequate. With the passage of the 2010 Patient Protection and Affordable Care Act, and the Future of Nursing report, nurses are well positioned to turn that around.

However, the landscape of nursing is changing, and we are witnessing a decline in the number of nurses who choose pediatrics as their specialty. Today, only 7.3% of the RN workforce, and 8.1% of nurses in advanced practice, specialize in pediatrics.³ In our discussion, Dr. Wyatt noted that in the past 10 to 15 years, the percentage of NP students entering PNP programs has significantly diminished.

Also of note is that pediatrics as content in undergraduate education has often been “integrated,” so BSN recipients have very little pediatric experience—and therefore little confidence in their ability to care for sick children—when they graduate. Moreover, the decrease in pediatric content and clinical experience is worsened by the difficulty in recruiting nurse educators who teach in this area.⁴ And as BSN-prepared nurses consider advanced training as an NP, they are being steered toward the family nurse practitioner (FNP), not PNP, track, despite their desire to focus on pediatrics. 

The pediatric, adult, and women’s health NP roles were established long before the FNP role grew into prominence. In the 1970s, the introduction of the birth control pill probably contributed to the need for more health care providers who specialized in the care of women. These roles were viewed as the pioneers of the NP movement, with the PNP being the first. These programs flourished, albeit the PNP programs less so than the others. That said, in 1998 there were 114 primary care PNP programs, which by 2010 had decreased to 98.⁵ Worse, in some states (Idaho and Wyoming, for example), nurses who want to be a PNP need to leave their homes, as there are no PNP programs there.  

As a result of the disappearance of pediatrics in undergraduate education and the decrease in PNP programs (especially primary care), the Pediatric Nursing Certification Board sponsored the establishment of the Institute of Pediatric Nursing (IPN) in 2011. The IPN is a nonprofit educational organization that brings together leaders from nursing organizations and children’s hospitals to provide a collective voice to advocate for strengthening pediatric nursing education and to advocate for improved health and illness care coordination for kids and families, as well as support for access to safe, quality, evidenced-based care for all children and families.⁶

The IPN, partnering with the American Association of Colleges of Nursing, is currently conducting a national survey of undergraduate nursing programs “to explore the challenges, gaps, and successes within undergraduate pediatric nursing education, including an exploration of the perspectives of nursing faculty regarding the future of pediatric nursing residency programs.”⁷ The results of this survey will be presented at the Third Annual Invitational Forum for Pediatric Nursing in October.

When I was deciding on a career, I knew I wanted to work with children. I became a nurse so I could become a PNP, and my decision was supported by my nursing mentor, who directed me to follow my passion. Just as I was encouraged, we need to encourage nursing and NP students to go where their passion lies. Let them follow their heart—if they want another specialty, OK. But if they love pediatrics, support that passion.

We need to honor our roots and not abandon the pediatric nurse practitioner role. Where would we be without it?

References
1. Kaiser Family Foundation. The uninsured: a primer (2009). www.kff.org/uninsured/7451.cfm. Accessed September 16, 2011.

2. US Department of Health and Human Services. Healthy People 2020. www.healthypeople.gov/ 2020/about/disparitiesAbout.aspx. Accessed September 16, 2011.

3. Health Resources and Services Administration. The registered nurse population: findings from the 2008 National Sample Survey of Registered Nurses. bhpr.hrsa.gov/healthworkforce/rnsurvey2008 .html. Accessed September 16, 2011.

4. Society of Pediatric Nurses. Position statement on child health content in the undergraduate curriculum (2007).

5. National Association of Pediatric Nurse Practitioners. PNP programs information: pediatric nurse practitioner school list. www.napnap.org/ForStudents/PNPSchoolListing.aspx. Accessed September 16, 2011.

6. Sperhac A, Wyatt JS. Securing the future of children’s health. Pediatric Nursing. 2010;36(1):8-9.

7. Institute of Pediatric Nursing. www.ipedsnursing.org/ptisite/control/index. Accessed September 16, 2011.