Over the last 3 years, there has been a significant increase in nurse practitioners (NPs) working in emergency care settings. In 2022, more than 27,000 NPs were practicing in emergency care, representing a 50% increase over the last 3 years (American Association of Nurse Practitioners [AANP], 2019,2022). Based on Centers for Disease Control and Prevention (2014,2020) statistics, between 2014 and 2020, the number of patients who received emergency care from an NP nearly doubled. This acceleration in the number of NPs providing emergency care and the increased number of patients receiving emergency care from an NP has implications for advanced practice registered nurse (APRN) licensing, accreditation, certification, and education.

Currently, the emergency nurse practitioner (ENP) is considered a specialty for the family nurse practitioner. According to the Consensus Model for APRN Regulation (Consensus Model), state boards of nursing should not regulate specialty practice (APRN Joint Dialogue Workgroup, 2008). Despite the Consensus Model's purpose of standardizing APRN regulation, many states have not adopted its recommendations. In contrast, others have only adopted certain elements of the model for APRN regulation (National Council for State Boards of Nursing, 2023). Recent evidence suggests that this lack of uniformity in APRN regulation across state lines has created barriers to using ENPs within the emergency care workforce and reimbursement of NPs working in emergency care settings (Wilbeck, Schumann, Comer, & Davis, 2022).

CRITERIA FOR A POPULATION

According to the Consensus Model (APRN Joint Dialogue Workgroup, 2008), an APRN population must meet essential elements to be recognized, including nationally recognized competencies, education standards, and practice standards. In addition, the new APRN population must not be entirely subsumed within another population. Since the publication of the Consensus Model in 2008, the ENP specialty has evolved to meet the model's criteria for a population.

NATIONALLY RECOGNIZED COMPETENCIES

The first set of ENP competencies was derived through a national Delphi process and published by the Emergency Nurses Association [ENA] in 2008. An ENA taskforce revised and updated this first set of competencies in 2019 using a consensus process. In 2016, the American Academy of Emergency Nurse Practitioners (AAENP) delineated ENP practice standards from an American Academy of Nurse Practitioners Certification Board (AANPCB) practice analysis that validated the elements of the ENP role (Tyler et al., 2017). In response to a 2020 call for collaboration among ENP stakeholders (Davis, Evans, & Wilbeck, 2020), a group of ENP content experts from diverse practice settings and geographic areas was appointed by AAENP and ENA to a joint workgroup that merged the 2018 AAENP Practice Standards and ENA's 2019 ENP competencies producing one nationally recognized set of ENP competencies. The resulting 2021 ENP competencies (Davis & Guillote, 2022) support competency-based education and are aligned with the American Association of Colleges of Nursing (AACN) Essentials (AACN, 2021) and the National Organization of Nurse Practitioner Faculties (NONPF, 2022) core NP competencies. The 2021 ENP competencies are endorsed by NONPF.

NATIONALLY RECOGNIZED EDUCATION STANDARDS AND PROGRAMS

In 2014, the AAENP Validation Committee implemented a process to validate specialty academic ENP programs. With the growth in academic ENP programs nationwide, the AAENP validation program was expanded and formalized in 2020 (AAENP 2020; Davis, Gibbons Hallman, & Wilbeck, 2023). The AAENP validation program reviews academic ENP programs for alignment with the ENP competencies and certification examination blueprint. Using a crosswalk methodology, the AAENP validation program ensures that graduates of ENP academic programs have the appropriate education to qualify for the certification examination and practice in emergency care settings. Currently, 13 colleges and universities in the United States have demonstrated alignment of their ENP educational program with the ENP competencies, certification, and practice and have been granted validation by AAENP (AAENP, 2023a,2023b). Accreditation of APRN programs differs from ENP program validation and is required at the population level (APRN Joint Dialogue Workgroup, 2008).

PROFESSIONAL NURSING CERTIFICATION EXAMINATION

Through a national practice analysis, AANPCB delineated the knowledge, skills, and abilities required to perform the ENP job (Tyler et al., 2017). The data from this analysis linked the content of the ENP certification examination to current ENP practice (Tyler et al., 2017). In January 2017, AANPCB launched the first ENP certification examination. The AANPCB ENP certification program is accredited by the Accreditation Board for Specialty Nursing Certification and the National Commission for Certifying Agencies (AANPCB, 2023). The AANPCB ENP certification examination meets the Consensus Model recommendation, “...professional nursing certification program that is psychometrically sound, legally defensible, and which meets nationally recognized accreditation standards for certification programs” (APRN Joint Dialogue Workgroup, 2008).

DISTINCT POPULATION FOCI

A recent national-level analysis comparing the competencies of the current NP population foci with the ENP competencies demonstrates that the knowledge, skills, and abilities required of the ENP are not subsumed within one of the existing NP populations. In addition, the ENP certification examination blueprint was compared with other NP population foci blueprints. Although there was similarity in the competencies and elements of the examination blueprints, many of the elements lacked the across-the-life span coverage required of the ENP. None of the NP populations contained competencies or examination blueprint items, such as Emergency Medical Treatment and Labor Act medical screening examinations and other professional and legal elements related to emergency care, indicating that many ENP competencies are unique.

RESPONDING TO EVOLVING PATIENT NEEDS

The education, certification, and licensure of nurses are influenced by changes in society, evolving patient needs, and technological advances. Compared with 2010, the acuity of patients seeking emergency care has increased and patients have more medically complex problems (Mafi et al., 2022). Thirty states and U.S. territories have adopted full practice authority for APRNs, giving ENPs the ability to practice to the full extent of their education and certification (AANP, 2022). Furthermore, ENPs have transitioned to working in nontraditional emergency care settings, including emergency medical services and interfacility transport (Davis & Guillote, 2022). As the landscape of emergency health care advances, the ENP specialty has evolved to meet the escalating complexity of patient needs. This evolution highlights the importance of updating regulatory measures (see Table 1) to ensure safe patient care.

Table 1. - ENP specialty versus population regulatory standards ENP as a specialty ENP as a population Licensure Boards of nursing do not regulate specialty practice. APRNs cannot be licensed solely in a specialty area. Boards of nursing grant authority to practice at the APRN role/population level. ENPs would be eligible for licensure. Accreditation Accreditation is not required for APRN specialty academic and fellowship programs. APRN programs granting degrees and postgraduate certificates must be accredited. Graduates must be eligible for certification and state licensure. Certification Since the ENP is a specialty for the FNP population, FNP certification is an eligibility criterion for ENP certification. Certification is optional. FNP certification will not be an eligibility criterion for ENP certification. Certification will be required for licensure. Education Specialty-level education may be obtained by continuing education, academic preparation, or fellowship training. Graduate or postgraduate education that meets the population-level Consensus Model recommendations for education will be required for licensure.

Note. APRN = advanced practice registered nurse; ENP = emergency nurse practitioner; FNP = family nurse practitioner.

CONCLUSION

Following the Consensus Model recommendations, ENP experts have aligned ENP academic education programs and certification with ENP practice. The existing alignment of ENP education, certification, and practice provides an opportunity for a logical transition to a population. Recognizing that the ENP now meets the criteria for population-level recognition per the Consensus Model (APRN Joint Dialogue Workgroup, 2008), AAENP released a position statement calling for national collaboration to develop the ENP population (AAENP, 2020). AAENP reaffirmed and updated this position statement in 2023. Moving the ENP specialty to a population will facilitate the licensure of ENPs and accreditation of ENP academic programs, ensuring congruence of education, certification, and licensure with the APRN role and population.

—Wesley D. Davis, DNP, ENP-C, FNP-C,
AGACNP-BC, CEN, FAANP, FAEN
Family & Emergency Nurse Practitioner
Program Coordinator & Associate Professor
College of Nursing
University of South Alabama
Mobile, Alabama
—Melanie Gibbons Hallman, DNP,
CRNP, CNS, FAEN, FAANP, FAAN
Associate Professor
Emergency Nurse Practitioner
Subspeciality Pathway Co-Coordinator
The University of Alabama at
Birmingham School of Nursing
Birmingham, Alabama

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