Pediatric nurse practitioners
include family in treatment

Pat Clinton, associate clinical professor of nursing, demonstrates how pediatric nurse practitioners diagnose and treat ear infections with the help of volunteer Jack Berg, son of Mary Berg, assistant clinical professor of nursing. Clinton directs the Pediatric Nurse Practitioner (PNP) Program, which recently celebrated its 30th anniversary. An increasing number of her students, she says, enter the graduate program because they had positive childhood experiences as patients of PNPs. Photo by Tim Schoon.

According to the American Medical Association, two out of three children suffer at least one ear infection by their third birthday. Treatment often consists of a visit to a physician’s office for antibiotics.

When a pediatric nurse practitioner (PNP) treats this common ailment, however, not only does the child receive the antibiotic, but his or her family also benefits from a thorough discussion on how to prevent such infections, says Pat Clinton, associate clinical professor of nursing.

“PNPs look at a much bigger picture,” she says.

Clinton is the director of the Pediatric Nurse Practitioner Program, which celebrated its 30th anniversary this past summer at the College of Nursing. The master’s program prepares registered nurses to provide basic primary care to children as well as prescribe medication. The University program is the only one in the state and is one of the oldest of its kind in the nation. A model for other nurse practitioner programs, it recently was reaccredited for another four years.

Clinton and Toni Clow, associate professor of nursing and director of the PNP program from 1976 to 1990, discuss the recent milestone like proud parents. They have sent more than 200 PNPs into the workforce.

“Iowa has been a leader in this field,” Clinton says. “People recognize our graduates as having received a quality education.”

The idea of delivering advanced pediatric training to nurses surfaced in the 1960s, when there was a national shortage of pediatricians. Realizing that nurses with such training could help fill the void, health care providers at the University of Colorado teamed up in 1965 to develop the first PNP program. Seven years later, a federal grant allowed Iowa to launch its PNP curriculum. Since then, Iowa has helped shape standards written by the Iowa State Board of Nursing.

Students who enter the program—only 10 are admitted each year—must have a B.S.N. as well as a year of professional experience. After graduation, Clinton explains, they may practice independently or work in a variety of settings, including hospitals, specialty clinics, schools, HMOs, physicians’ offices, and public health agencies. They conduct physical exams, take medical histories, interpret lab tests and X rays, and diagnose and manage acute health problems.

Clinton is careful to note that PNPs are not trained to replace physicians, but rather to alleviate their workload of routine well-child care in a field that has become more demanding. Although the two professions often work in tandem, she adds, what sets PNPs apart is their perspective.

“Nurse practitioners bring a holistic approach to the table,” she says. “Rather than simply making diagnoses and treating symptoms, they really look at a patient, as well as that patient’s lifestyle and family unit, and engage in health promotion.”

There are about 12,000 PNPs nationwide and 90 academic programs, including Iowa’s.

In addition to pediatrics, nurse practitioner sub-specialties at Iowa include adult/gerontology and family care. All students complete a core curriculum of classes on theory and research, health promotion, informatics, and health economics and policy, as well as an advanced group of courses that includes hard science, such as pharmaceuticals and physiology. Within each subspecialty, additional course work and practicum experience are required. In addition to Clinton, who teaches about half of the program’s courses, a number of health care professionals from the University and surrounding communities contribute as guest lecturers and practicum supervisors.

After about two years, graduates receive a master’s degree and are eligible for national certification—an exam on which Iowa graduates have achieved a 100 percent pass rate for more than 20 years, according to Melanie Dreher, dean of the College of
Nursing.

“I think that’s in part due to the quality of leadership and the high standards to which we hold our students but also to the wonderful preceptors in the field who have taken an interest, with no compensation to them, and given freely of themselves to make sure that Iowa’s children get the best health care they can.”

Clinton and Clow note that many current students were inspired to enter the program because of positive interactions they had with PNPs as they were growing up.

“PNPs contribute to the quality of life in young people that will serve them throughout their lives,” Clow says. “We need to make sure that children and their parents have the best health care they can have. We take pride in what we’ve accomplished here, and we want that to continue. The need is still there.”

Article by Sara Epstein