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Standards of Practice for Emergency Nurse Practitioners

Campo, Theresa M. DNP, FNP-C, ENP-BC, FAANP; Carman, Margaret J. DNP, ACNP-BC, ENP-BC, FAEN; Evans, Dian PhD, RN, FNP-BC, ENP-BC, FAANP; Hoyt, Karen Sue PhD, FNP-BC, FAEN, FAANP, FAAN; Kincaid, Kyle DNP, ENP, FNP-BC; Ramirez, Elda G. PhD, RN, FNP-BC, FAEN, FAANP; Roberts, Eric DNP, FNP-BC, ENP-BC; Stackhouse, Ken MBA, MSN, RN, FNP-C, ENP-BC; Wilbeck, Jennifer DNP, ACNP-BC, FNP-BC, FAANP; Weltge, Arlo MD, MPH, FACEP

doi: 10.1097/TME.0000000000000127
From the Editors

Co-Director Family Nurse Practitioner, Track and Associate Clinical Professor, Drexel University, Philadelphia, PA; Emergency Nurse Practitioner, Atlanticare Regional Medical Center, Atlantic City, NJ

Assistant Professor, Duke University School of Nursing, Emergency Nurse Practitioner, Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC

Clinical Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Emergency Nurse Practitioner, Emory Healthcare, Atlanta, GA

Clinical Professor, University of San Diego, Hahn School of Nursing and Health Science: Beyster Institute for Nursing Research, San Diego, CA; Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA; Editor, Advanced Emergency Nursing Journal, Wolters Kluwer, Philadelphia, PA

Section NP/PA Director, Schumacher Clinical Partners, Emergency Nurse Practitioner, Citizens Medical Center, Victoria, TX; Clinical Instructor, UTHealth School of Nursing, University of Texas Health Science Center, Houston, Texas

Professor Clinical Nursing and Director Emergency/Trauma NP Concentration, UTHealth School of Nursing, Houston Texas; President/Founder American Academy of Emergency Nurse Practitioners

Assistant Professor, Marcella Niefhoff School of Nursing, Loyola University, Chicago, IL; Emergency Nurse Practitioner, Rush University Medical Center, Chicago, IL

Emergency Nurse Practitioner CHI, St Luke's Memorial San Augustine Hospital, San Augustine, TX; Instructor UTHealth School of Nursing, Houston, TX

Associate Professor & ENP Specialty Director, Vanderbilt University School of Nursing, Nashville, TN

Clinical Professor of Emergency Medicine, Department of Emergency Medicine; UTHealth McGovern School of Medicine, Houston, TX

Disclosure: Standards of Practice for Emergency Nurse Practitioners currently appears on the AAENP website at http://aaenp-natl.org/index.php Permission to publish this text is given by the President/Founder of AAENP.

THIS DOCUMENT provides an over-view of applicable standards and definitions for the emergency nurse practitioner (ENP) role.

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ENP QUALIFICATIONS AND COMPETENCIES

ENPs are specialized licensed practitioners, who possess the necessary clinical competencies to provide optimal care to patients in ambulatory, urgent, and emergent care settings.

ENP specialization builds upon NP entry-into-practice knowledge and skills and requires a minimum of a master's level preparation or specialized preparation at the post-master's or doctoral level.

ENPs demonstrate competencies by applying standardized care guidelines in their clinical practice. Other ways of continuing competencies include participation in maintaining continuing education, quality improvement processes and peer reviews- including the systematic periodic review of records and treatment plans- while maintaining specialty and population-focused certification in compliance with current laws and regulations.

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DEFINITION OF ACUTE CARE IN EMERGENCY PRACTICE

Acute care in emergency practice is not defined by setting or population.

Acute care in emergency practice is defined as the dynamic, short term stabilization of conditions including, but not limited to, treatment of injuries, new onset clinical conditions and exacerbation of chronic co-morbidities.

Acute care in emergency practice is inclusive of resuscitative stabilization and treatment of medical and traumatic clinical presentations for patients across the lifespan within the scope of population-area of NP education and national certification.

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ENP PRIORITIZATION OF CARE

ENPs incorporate evidence-based practice as their framework for managing patient conditions. This process includes the following components: assessment, differential diagnoses/diagnosis, medical decision making, and treatment/management.

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Assessment

ENPs assess and triage a patient's condition by obtaining a focused and pertinent history, identifying risk factors, performing an appropriate focused/complete physical examination, and by ordering and/or providing preventative or diagnostic procedures.

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Differential Diagnoses/Diagnosis

ENPs develop a differential diagnosis and/or diagnosis of life threatening and non-life threatening conditions by utilizing critical thinking while simultaneously synthesizing and analyzing patient data. ENPs establish a differential diagnoses based on the patient's medical history, physical exam findings, interpretation of diagnostic studies, while continually establishing priorities to meet the needs of the patient, their family, and/or the community.

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Medical Decision Making

ENPs utilize critical thinking during medical screenings and diagnostic processes by synthesizing and analyzing the data (i.e., all known diagnoses being treated, undiagnosed conditions being evaluated, treatments implemented, considered or planned) to execute a plan of care including stabilization, resuscitation of unstable conditions and the transfer of care when appropriate.

ENPs provide medical screening evaluations in accordance with EMTALA. This includes: documentation of the chief complaint and pertinent history incorporating health risk factors and physical exam findings; interpretation of diagnostic data including the rationale for the medical necessity of tests; medical decision making with differential diagnoses, adding on-going evaluation of patient progress and response to treatment to determine the plan of care.

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Treatment/Management

ENPs provide individualized, cost-effective, evidence-based plans of care to maximize a patient's well-being. ENPs plan of care consists of: ordering/interpreting diagnostics, ordering/performing therapeutic interventions including non-pharmacologic therapies, prescribing pharmacologic agents, developing patient-specific education plans, and making timely referral/consultations as needed. ENPs also provide acute resuscitation and stabilization of life-threatening conditions and coordinate transfers to critical care providers/facilities as warranted.

Plan Implementation: ENP interventions include established priorities of care that are individualized and based on current evidence-based guidelines.

Follow-up and Evaluation: ENPs determine the effectiveness of a patient's treatment plan by following a systematic process including documentation of patient care outcomes, on-going reassessment, and/or plan modification to optimize a patient's health status within the context of emergency care.

Health Education: An ENPs' practice emphasizes health education including the provision of community resources for patients and their families.

Facilitation of Patient Self-care: ENPs facilitate entry into the health care system and also provide competent care in a safe environment. ENPs promote patient participation by providing the necessary information to promote optimal health and make informed health decisions. The ENP consults with other health care personnel as needed and appropriately utilizes health care resources.

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ENP DOCUMENTATION

ENPs document accurately, legibly and maintain confidential emergency care medical records.

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ENP INTERPROFESSIONAL/COLLABORATIVE RESPONSIBILITIES

ENPs participate as an interprofessional/collaborative member in emergency care, interacting with colleagues to promote comprehensive, quality patient care.

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ENP PATIENT ADVOCATE RESPONSIBILITIES

Ethical and legal standards provide the basis of patient advocacy. As an advocate, ENPs participate in health policy, regulatory and legislative activities. ENPs are able to define their role to patients, families and other professionals.

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PRACTICE-BASED RESEARCH

ENPs promote research by formulating clinical inquiries, by conducting or participating in research and quality improvement studies, and disseminating and incorporating findings into their clinical practice.

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OTHER ROLES

ENPs blend the roles of clinician, mentor, educator, researcher, leader, interdisciplinary team member and consultant.

The American Academy of Emergency Nurse Practitioners (AAENP) supports the following documents:

AANP (2015). Scope of Practice for Nurse Practitioners. See https://www.aanp.org/images/documents/publications/scopeofpractice.pdf

AANP (2015). Standards of Practice for Nurse Practitioners. See https://www.aanp.org/images/documents/publications/standardsofpractice.pdf

Competencies for Nurse Practitioners in Emergency Care (2008). See www.nonpf.org/resource/resmgr/competencies/compsfornpsinemergencycarefinal.pdf

National Association of Nurse Practitioner Faculties Population-Focused Nurse Practitioner Competencies. See http://www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

The Emergency Nurses Association Standards of Practice for APRNs (2015). See https://www.ena.org/practice-research/Practice/Pages/AdvPractice.aspx

The American Nurses Association Code of Ethics (2015). See http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics-2015-Part-1.pdf

The Emergency Nurses Association Code of Ethics (2015). See https://www.ena.org/about/Documents/CodeofEthics.pdf

Thank you to the following individuals of the IENAP Advisory Council who reviewed this document:

Karen Reilly Follin, MSN, RN, ACNP, CNS, CEN, ACNP-BC, CCNS, SANE (Chairperson)

Carla Brim, MN, RN, CNS, CEN, PHCNS-BC

Timothy Pruitt, MSN, RN, APRN, FNP-BC

Amy Rettig, MSN, MA, RN, NP, CNS, ACNS-BC, PMHNP-BC

Amanda Shrout, MSN, RN, CNS, CEN, CCNS

Diane K. Fuller Switzer, DNP, RN, ARNP, CEN, CCRN, ENP-BC, FNP-BC

Darleen Williams, DNP, CNS, EMT-P, CEN, CCNS

Matthew Dunn, MSN, BSN, BS, RN, CRNP, ACNP-BC

Justin S. Fulkerson, MS, BSN, RN, ACNP, CEN, ACNP-BC

Cindy Kumar, MSN, RN, ACNP-BC, FNP-BC

Jean Proehl, RN, MN, CEN, CPEN, TCRN, FAEN (Board Liaison)

Authors

Theresa M Campo, DNP, FNP-C, ENP-BC, FAANP, Co-Director Family Nurse Practitioner, Track and Associate Clinical Professor, Drexel University, Philadelphia, PA; Emergency Nurse Practitioner, Atlanticare Regional Medical Center, Atlantic City, NJ

Margaret J. Carman, DNP, ACNP-BC, ENP-BC, FAEN, Assistant Professor, Duke University School of Nursing, Emergency Nurse Practitioner, Department of Emergency Medicine, University of North Carolina, Chapel Hill, NC

Dian Evans, PhD, RN, FNP-BC, ENP-BC, FAANP, Clinical Associate Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA; Emergency Nurse Practitioner, Emory Healthcare, Atlanta, GA

Karen Sue Hoyt, PhD, FNP-BC, FAEN, FAANP, FAAN, Clinical Professor, University of San Diego, Hahn School of Nursing and Health Science: Beyster Institute for Nursing Research, San Diego, CA; Emergency Nurse Practitioner, St. Mary Medical Center, Long Beach, CA; Editor, Advanced Emergency Nursing Journal, Wolters Kluwer, Philadelphia, PA

Kyle Kincaid, DNP, ENP, FNP-BC, Section NP/PA Director, Schumacher Clinical Partners, Emergency Nurse Practitioner, Citizens Medical Center, Victoria, TX; Clinical Instructor, UTHealth School of Nursing, University of Texas Health Science Center, Houston, Texas

Elda G. Ramirez, PhD, RN, FNP-BC, FAEN, FAANP, Professor Clinical Nursing and Director Emergency/Trauma NP Concentration, UTHealth School of Nursing, Houston Texas; President/Founder American Academy of Emergency Nurse Practitioners

Eric Roberts, DNP, FNP-BC, ENP-BC, Assistant Professor, Marcella Niefhoff School of Nursing, Loyola University, Chicago, IL; Emergency Nurse Practitioner, Rush University Medical Center, Chicago, IL

Ken Stackhouse MBA, MSN, RN, FNP-C, ENP-BC, Emergency Nurse Practitioner CHI, St Luke's Memorial San Augustine Hospital, San Augustine, TX; Instructor UTHealth School of Nursing, Houston, TX

Jennifer Wilbeck, DNP, ACNP-BC, FNP-BC, FAANP, Associate Professor & ENP Specialty Director, Vanderbilt University School of Nursing, Nashville, TN

Arlo Weltge, MD, MPH, FACEP, Clinical Professor of Emergency Medicine, Department of Emergency Medicine; UTHealth McGovern School of Medicine, Houston, TX

Developed and approved by the American Academy of Emergency Nurse Practitioners Board of Directors © August, 2016.

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