By Christina Orlovsky, senior staff writer
Recent Institute of Medicine reports highlighting concerns about the state of emergency care have called attention to the need for caregivers in overcrowded emergency departments—a need that is now being addressed by a handful of advanced practice nursing programs training emergency nurse practitioners.
At Emory University’s Nell Hodgson Woodruff School of Nursing, in Atlanta, Georgia, the 3-year-old emergency nurse practitioner (ENP) program prepares nurses to provide emergency health care—not just in hospital emergency departments, but also in primary care settings.
“There has been a lot of discussion—not just with the recent IOM reports—about cost, emergency department overcrowding and people using the emergency department for primary care,” explained Michelle Mott, RN, MSN, FNP, instructor and program director at the Emory ENP program. “Emergency medicine has tried to address this by diverting people who aren’t emergent to other areas staffed by physician assistants or nurse practitioners. Emory saw the need for emergency nurse practitioners and the need to develop a program to address the situation.”
One of only four such programs in the country, the Emory ENP program has grown exponentially, more than doubling in class size from five students to 12 in the three years since its inception. Mott added that while all the students have a similar interest in emergency medicine, they have expressed varying reasons for their interest in the program.
“I have been impressed with the things they have come up with,” she said. “We have your more traditional students that were ER nurses and that want to go back into the ER as nurse practitioners, but then we have students who want to work in critical shortage areas, including one student who wants to go to Alaska to do primary care work in a remote area. I also had another student with the same interest.”
Because nurses in the ENP program receive training as family nurse practitioners, they are able to treat patients of all ages or, as Mott proclaimed, “from zero to infinity.” This breadth of expertise will allow the ENP professionals to work in varying areas and improve the quality of emergency and primary care patients receive in each of these settings.
“One thing the presence of ENPs will definitely address is lowering the cost of care and increasing access to care,” Mott said.
“It doesn’t cost as much for a hospital to staff a nurse practitioner as it does a physician, so you may be able to have more than one nurse practitioner at a time,” she added. “Another thing besides access is quality of care: You have someone specifically trained to provide both emergency care and primary care and to make appropriate decisions about a patient’s admission, treatment and discharge.”
As the need for emergency-trained professionals increases in EDs and other health care settings nationwide, and as cost continues to be a instrumental factor, Mott expects to see an increase in programs like Emory’s and the other three existing ENP programs, including the ones at the University of Texas campuses in Arlington and Houston.
Vicki Patrick, MS, APRN, ACNP, GEN, FAEN, lead teacher in the ENP program at UT-Arlington, explained that the growing community, regional and statewide needs in Texas led to the creation of her school’s ENP program three years ago. She acknowledged the same concerns addressed by Mott and the IOM: a limited number of providers and an increasing number of uninsured or underinsured patients using the ED for primary care.
The UT program, which accepts roughly 10 students with at least two years of emergency or trauma care experience, has drawn interest from across the country, Patrick explained. It has been designed to prepare students in a growing specialty to work independently, dependently and in a collaborative environment to provide the highest quality, accessible emergency care.
“Our emphasis is to give the ENP the knowledge and skills to provide emergency and urgent health care services to all ages, with an emphasis on acute and chronic care and the stabilization of a patient’s condition,” Patrick said. “We all know about the problems of increasing numbers of patients in emergency departments. We have to have trained providers available to match the provider to the care required.”
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