Should All Nurse Practitioner Education Programs be Standardized as General Practice and All Specialty Programs Abolished?

Article Outline

• Support for general education
• Rationale against general education
• Copyright

Laura Cecilia Holland received a MNSc from the University of Arkansas for Medical Sciences as a clinical nurse specialist in 1988 and was employed at the University Hospital of Arkansas as a critical care education specialist. She completed a post-master's gerontological nurse practitioner course in 1997. She has worked for the past 6 years at Ochsner Health System, first in internal medicine as a nurse practitioner in long-term care and hospital-based internal medicine. Most recently she works as a Gerontological NP at PACE of Greater New Orleans. She can be reached at lceciliaholland@cox.net.

Jamie McDonald is a family practice nurse practitioner who has extensive experience in general pediatrics and pediatric intensive care for 7 years, mostly at Ochsner Hospital in New Orleans, LA. Before becoming a nurse practitioner, she also worked as a travel nurse in several large pediatric hospitals around the country, including Children's Hospital of Philadelphia. She chose to become a family nurse practitioner rather than specializing in pediatrics for personal reasons but feels nurse practitioner programs for specialties like pediatrics and pediatric intensive care are warranted and necessary. She can be reached at jmcdonaldrn@yahoo.com.

Historically, the nurse practitioner (NP) role began as a specialty in pediatrics, but it quickly evolved to include multiple specialties, such as family, acute care, neonatal, and gerontologic NPs to name a few. Educational programs and various certification examinations were developed for each specialty, and, in 1990, the National Organization of Nurse Practitioner Faculties (NONPF) released domains and competencies, which identify and describe the scope of practice for each specialty. Some NPs feel that the specialty role greatly restricts the scope of clinical practice. Others feel that the fragmentation of the NP role into various specialties, with multiple educational programs and certification examinations, has made standardization and regulation difficult. In 2006, the National Council of State Boards of Nursing (NCSBN) published a vision paper that recommended all NP educational programs use the generalist approach, essentially abolishing current specialty practice programs. In response to the vision paper, the NONPF wrote a paper that debates many of these proposals of the NCSBN. This debate has raised the question: should all NP educational programs be standardized as general practice?

What do you think? Should all nurse practitioner education programs be standardized as general practice and all speciality programs abolished? To comment on this matter, email section editor Jacqueline Rhoads at JRhoad@lsuhsc.edu.

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Support for general education 

Laura Cecilia Holland

Advanced practice nursing programs are some of the only professional programs that focus on the specialty role as entry into advanced practice. Medical, pharmacy, and physician assistant schools are generalist programs that prepare graduates to care for a broad patient base. Specialty training is usually through postgraduate fellowships or residencies.

In nursing, generalist training is obtained at the baccalaureate level, and advanced practice training was obtained at the master's level specifically for specialty training. Advanced practice training prepares nurses to obtain highly specialized education beyond that obtained at the generalist level.

Currently, the NP profession has many specialty tracts, which are offered in many graduate nursing programs in the country. The type of education an NP receives determines the NP's scope of practice. Limits on the scope of practice for NPs with specialist degrees have created concerns about credentialing and regulation and make mobility within the profession difficult. For instance, as a gerontologic NP, I have been restricted to treating patients older than 50 years. Yet, as an RN, I can perform histories and physicals on younger patients, but I cannot diagnose or write orders as an NP would. If I had been educated in a generalist program, I would be able to treat patients of all ages. A standardized generalist program as entry level into practice would eliminate some of the fragmentation found in nursing. The educational programs would be more consistent, and credentialing would be standardized and better regulated, because all new NPs would be educated and tested the same way. This would help unify the nursing profession and garner more deserved respect from our counterparts in other disciplines.

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Rationale against general education 

Jamie McDonald

The NCSBN has a valid concern for better regulation of standards for the NP profession. However, abolishing all specialty education programs and certifications is not the way to do it.

Many experts feel that generalist nursing education is achieved at the undergraduate level and that graduate programs should focus on a specific specialization. This specialization at the graduate level helps the NP become an expert in the chosen field, whether it is gerontology, neonatology, critical care, pediatrics, and so forth.

According to NCSBN recommendations, once the NP graduates from the generalist program, he or she would specialize by completing “competency” training, which is not clearly defined in its execution or regulation and may cause the same problems with regulation as current specialty certifications. How does this competency training differ from the traditionally trained NP obtaining on-the-job training, completing continuing education, or returning to school to obtain certification in a specialty? Also, needing further competency training to specialize may reduce the marketability of NPs. An NP graduating from a current specialty program is well trained to begin practicing independently with minimal extra training needed for specialty practice. If all NPs were educated as generalist practitioners, many employers in specialty practice may not be interested in spending time, money, or resources for extra training. Specialty programs also help distinguish NPs from physician assistants who are trained in the generalist approach and often require further training.

Finally, mandating a generalist program and making it more difficult to obtain specialty education may deter nurses from becoming NPs. It is a waste of educational resources to force NPs to be educated as generalists, especially when specialty care remains such an important and viable force in medicine. The current family NP program suffices as a generalist program.