Dissemination of research findings is essential to the scientific process and helps fill knowledge gaps, inform future research, and change clinical practice. To support the translation of research into practice, researchers have an ethical obligation to present results completely, transparently, and accurately, whereas publishers and editors must adhere to the highest standards in publication ethics to uphold the integrity of the scientific record (Committee on Publication Ethics [COPE], 2017,2022; Wager & Kleinert, 2011). Misrepresentation of data and research misconduct undermine these processes, and the repercussions can be extensive and damaging to the profession and to patient care.

Research misconduct may take various forms, including the fabrication of data, falsification of research materials, equipment, or processes, and misrepresentation of results (National Science Foundation, 2023). Intentionally misleading readers by omitting data, presenting data known to be erroneous, or deliberately leaving out important facts to distort the outcome are matters of gross misconduct and ethical violations. Misinterpreting statistical data and selectively reporting certain findings favorable to the researcher's agenda are also unethical acts (Wager & Kleinert, 2011).

Researchers and authors may misrepresent data to distort research findings (Boutron & Ravaud, 2018). Data misrepresentation is defined as “communicating honestly reported data in a deceptive manner” and may include presenting unsubstantiated inferences to support the author's opinion rather than fact, use of deceptive tables or figures, and using persuasive language for rhetorical effect (Boutron & Ravaud, 2018; Resnik, 2015, section 5.3). Researchers have “numerous opportunities to misrepresent data” when using statistical analyses (Resnik, 2015, section 5.3) within studies.

It is essential to draw attention to the issues of data misrepresentation and research misconduct because many of the errors and biases in professional literature are the consequence of these violations. As members of the health care team, expert clinicians have a professional obligation (American Nurses Association, 2015) to ensure that any evidence used to shape, impact, or direct practice is accurate. Specific to nurse practitioner (NP) practice in emergency care, recent publications within nursing literature warrant clarification. This article addresses an example of gross misrepresentation of data and discusses the adverse consequences that have followed including restricted access to care and failure to attain full practice authority in a largely rural state.

EMERGENCY NURSE PRACTITIONER EDUCATION

Within the context of NP education, a recent article by Lavin et al. (2022) provides an example of an inaccurate representation of emergency specialty NP education, leading to negative outcomes. The authors attempt to describe emergency nurse practitioners' (ENPs') educational preparation, credentialing, and scope of practice; yet, none of the authors are ENP educators, certifiers, or institutional credentialing experts. Although cited as research, the article is essentially a limited literature review published in a journal with limited circulation. The authors provided no conflict-of-interest statements and do not cite funding sources of this work. In addition, a number of typographical and citation errors in this publication are evidence that the article did not receive proper oversight and review before acceptance for publication.

The authors' self-generated Social Justice in Nursing and Public Health Preparedness: Human-Centered Structured Analytic Approach was the framework for the methods employed (Lavin et al., 2022). Despite a previous publication demonstrating the Strong Model of Advanced Practice Nursing (Ackerman, Norsen, Martin, Wiedrich, & Kitzman, 1996) as the most applicable theoretical model to ENP practice (Ramirez et al., 2018), these authors have opted to take their work from another specialty area and retrofit it into a domain where it does not align. Unlike the Strong Model, the authors' model is not validated in the scientific literature.

Furthermore, the authors did not follow the Social Justice in Nursing and Public Health Preparedness model cited as the framework for the research analysis. The model defines the evidence base as in-depth discussion, expert interviews, and stakeholder meetings (Lavin et al., 2022). Deliberate decisions to avoid communication with experts working in emergency care and not adhering to the research model demonstrate flaws in the logic and methodology used by the authors, biasing study conclusions. Had the authors adhered to the theoretical model listed as the framework, they would have uncovered substantive data that would have led to a well-informed conclusion.

As an example, the Standards for emergency Nurse Practitioner Academic Program Validation handbook was published in 2020 and made publicly available on the American Academy of Emergency Nurse Practitioners' (AAENP, 2020) website. The AAENP academic validation program represents the collective work of experts in emergency care and education to establish standards and criteria for specialty ENP academic programs to ensure ENP education, certification, and practice alignment. In addition, had they queried any academic ENP program leaders, another omission in the methodological framework, the authors would have been aware of the Standards document and validation process. The authors' omission of the Standards from the literature selected to review and analyze leads to significant study limitations.

An even more concerning omission from the work is the lack of data describing patient outcomes and the quality of care provided by NPs working in emergency care settings. The literature included, instead, represents only a tiny subset of the available evidence. In fact, no data demonstrate a link between ENP education and the quality of care provided by NPs in the emergency care areas. Thus, the authors' statements, recommendations, and conclusions about the impact of NP education and care are not based on scientific evidence.

In addition, although the supporting references are severely limited with a notable lack of literature from ENP experts, the authors' own prior work is repeatedly cited. Conclusions drawn from faulty, biased, and/or incomplete research are false and potentially dangerous to patients in need of access to emergency services. Unfortunately, the unsubstantiated claims from this publication have been used by states to limit NP practice (Mississippi Legislature, 2022). In Mississippi, this article was specifically cited by a physician giving testimony to a legislative committee in opposition to NP full practice authority in the state. In the recorded legislative session cited here, this testimony begins approximately 35 min into the video. As of 2023, NPs still do not have full practice authority in Mississippi.

NURSE PRACTITIONER BILLING

The same authors have additionally attempted to “characterize NP practice in the ED [emergency department] by examining NP independent billing by the level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality” (Veenema, Zare, Lavin, & Schneider-Firestone, 2022, p. 78).

Within the study, NPs in emergency care are characterized on the basis of data representing payment and service utilization. Because claims data serve only to support billing and reimbursement, there are inherent threats to data quality from converting medical chart information to claims data (Konrad, Zhang, Bjarndóttir, & Proaño, 2019). Data quality assessments have demonstrated discrepancies between the medical record and the data obtained from payer claims (Konrad et al., 2019). Although Veenema et al. (2022) recognized the limitations of their data set, they make a faulty generalization from an unrepresentative data sample. The data used do not reflect the care quality (Centers for Medicare & Medicaid Services, 2019) provided by NPs and has nothing to do with the utilization of NPs in emergency care, as the authors have misleadingly concluded.

Although the data, within its limitations, indicate that “NPs are increasingly managing higher acuity patients,” the authors erroneously conclude that “current employment of NPs in the ED may not be fulfilling its original vision to care for the lower acuity patients ... and to increase the services for underserved populations in rural areas, those over age 65, and those with limited English language proficiency” (Veenema et al., 2022, p. 85). The climate at the inception of the NP role nearly 60 years ago remains similar to today in that “political, professional, and social environments were turbulent and chaotic and provided a perfect opportunity to innovate” (Ford, 2015, p. 294). Contrary to the deduction of Veenema et al. (2022), Ford's conceptualization of an expanded advanced nurse role to improve access to care has ultimately been realized in ways grander than initial visions could dream (Ford, 2015).

CONCLUSION

Research misconduct and data misrepresentation have significant consequences. Beyond ethical violations, false or misrepresented data can negatively affect patient trust in providers, patient care funding, scope of practice, provider well-being, and retention of essential care providers. Those reporting data within specialized areas of health care must understand the nuances of care to grasp the implications of unclear variables on outcomes reported. It is essential that practicing clinicians and experts within emergency care are integrated into research teams to provide guidance on the nuances that impact studies exploring such a unique sector of today's health care delivery. Rather than offering unsubstantiated claims from the sidelines of emergency care, researchers should partner with the interdisciplinary team of providers who possess the expertise to both render and explain the true processes of emergency care. Doing so invites researchers and the public alike to propel emergency care forward.

—Wesley D. Davis, DNP, ENP-C, FNP-C,
AGACNP-BC, CEN, FAANP, FAEN
Family and Emergency Nurse
Practitioner Track Coordinator and
Assistant Professor
College of Nursing
University of South Alabama
Mobile, Alabama
—Lorna Schumann, PhD, FNP-C,
ACNS-BC, ENP-C, FAAN, FAANP
Commission Chair
American Academy of Nurse
Practitioners Certification Board
Austin, Texas
—Dian Dowling Evans, PhD, FNP-BC,
ENP-C, FAANP, FAAN
Professor Emeritus
Emergency Nurse Practitioner Program
Emory University Nell Hodgson Woodruff
School of Nursing
Atlanta, Georgia
—Elda Ramirez, PhD, RN, FNP-BC,
ENP-C, FAEN, FAANP, FAAN
Professor of Clinical Nursing
Cizik School of Nursing & UT Health,
Houston, Texas
—Jennifer Wilbeck, DNP, RN, FNP-BC,
ACNP-BC, ENP-C, FAANP, FAAN
Emergency Nurse Practitioner Program
Director and Professor
Vanderbilt University School of Nursing
Nashville, Tennessee
Guest Editors

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