My Specialty

Associate Professor and Pediatric Nurse Practitioner, Nancy Pike, UCLA School of Nursing

Training APRNs to fill the primary care gap

Please tell us about your nursing career journey.

I’ve been a nurse for 34 years. I graduated with my BSN from Penn State University in 1985. My first nursing job was in an adult med/surg ICU at Hershey Medical Center, taking care of mostly postoperative cardiac surgery patients. Not long after I started, my manager asked if I wanted to learn how to take care of pediatric cardiac surgery patients. That was my first experience taking care of children and I loved it.  I wanted to earn my MSN, but there were only a few cardiopulmonary MSN programs in the U.S. and UCLA had one of them. So, I moved to California, graduating in 1993.

My next clinical position was at Stanford at the Lucile Packard Children’s Hospital. It became apparent that I needed to medically manage patients, so I did a post-master’s nurse practitioner certification at UCSF.

In 2003, I returned to Southern California to pursue a Ph.D. at UCLA. I continued to work part-time as an NP in pediatric cardiac surgery at Children’s Hospital Los Angeles. I completed my Ph.D. in 2007. Around 2009, I transitioned to academia and took a faculty position at UCLA School of Nursing.

Are you practicing clinically at this time?

I still practice per diem as a pediatric nurse practitioner (PNP) at Children’s Hospital Los Angeles. I enjoy that I can still engage in clinical work while being an educator. It enhances my teaching and keeps me in touch with the concerns of patients living with congenital heart disease.

Tell us about your position at UCLA.

Primarily, I teach in the PNP program and have an NIH-funded research program focusing on adolescents with congenital heart disease, in particular single ventricle heart disease. I’m looking at structural changes in the brain, cerebral blood flow and neurocognitive outcomes in teenagers who have had multiple open-heart surgeries at a young age. My goal is to develop and test interventions that can improve cognitive deficits and the patient’s future self-care ability.

What changes are you seeing in the education of advanced practice nurses?

Over the past decade, I’ve seen the growing need for PNPs in the inpatient and acute settings. In 2003, the Accreditation Council for Graduate Medical Education (ACGME) imposed medical resident hour restrictions, which were updated again in 2010. Coupled with a shortage of primary care physicians in many communities, this has led to a need for highly skilled nurse practitioners — not just PNPs — in both acute and primary care.

At UCLA, we have a well-established pediatric primary care program, but did not offer acute care training. With so few acute care PNP programs in California, I wanted to develop a program to train more pediatric acute and primary care providers to provide care across the continuum of health/illness and increase employment flexibility for PNPs.

The concept of a dual-educational master’s degree program for acute/primary care PNPs is not new. Through the Association of Faculties of Pediatric Nurse Practitioners (AFPNP), which is an important national organization for our specialty, I developed standards and guidelines for this type of program back in 2008.

We conducted a UCLA pre-program survey of 144 practicing PNPs and students found that 86 percent wanted, or would have wanted, dual (acute/primary care) education. I then put the wheels in motion to integrate this curriculum into our current program.

I created a two-year master’s degree program for pediatric nurses to be dually trained in both acute and primary care. In the first year of the program, students learn primary care. In the second year, they then build upon that knowledge with acute care skills.

Graduates of this program will have the job flexibility to work in an acute care position and then transition to an ambulatory setting if their lifestyle changes or if they simply wish to eventually work in a less-intensive setting.

Our program will prepare graduates to sit for both the acute and primary care PNP certification exams.  This is not the only program of its kind —there are about 16 in the U.S. — but it is currently the only one in California.

How do the roles of acute care PNP and clinical nurse specialist compare and contrast?

Both the CNS and the acute care PNP are part of an interprofessional team, providing expertise and support for the nursing team as well as for patients and families. The CNS helps to drive practice changes throughout the organization, ensuring that best practices and evidence-based care are maintained and developing patient care guidelines.

Key aspects of this important role include education, consultation and research into new technologies or treatment options. In contrast, the acute care PNP focuses on making evidence-based independent or collaborative care decisions, with full accountability for the assessment, diagnosis and management of acute, complex or chronic pediatric illnesses.

Is the role of the acute care PNP growing?

Yes, I think we’re gaining more visibility, acceptance and demand for the role in the hospital setting. In California, we still need physician oversight and so are not utilized to our full scope of practice, but I’m optimistic that this will change in the future.

Nursing Education

Currently, acute care PNPs are the “cornerstones” of most ICUs, subspecialty services and surgical service lines. Another newer or emerging role for the PNP is that of the inpatient hospitalist. In such positions, which are becoming more widespread across the country, PNPs work as part of a team managing general pediatric admissions. We have growing evidence that adult or pediatric nurse practitioners serving in this role can provide high-quality, cost-effective inpatient care.

When is your dual acute/primary care PNP program launching?

Our first cohort of students will start in fall 2019. We’re also completing the accreditation process with the Commission on Collegiate Nursing Education (CCNE) as well as the Pediatric Nursing Certification Board (PNCB), which is currently the only board that offers an acute care PNP certification exam.

What is your opinion of NP education moving towards mandatory doctorates?

Overall, it’s hard to say if or when a DNP will be mandated and if so by whom. I don’t think state-mandated doctorate education will come to pass, but most nursing programs are transitioning to doctoral preparation of their own accord.

With our new post-master’s DNP program at UCLA, we hope to have our master’s curriculum changed over to a DNP in a few years. In California, certification is not mandatory, but some institutions are choosing to make it mandatory for their own clinicians, just as some institutions now only hire BSNs rather than ADNs.

Many nurses I’ve spoken with consider this change to be a good thing. Institute of Medicine (IOM) reports link more nursing education to better patient outcomes. Many members of our interprofessional team are already doctorate-prepared, but APRN team members often are not. We want to level that playing field while also increasing our credibility as highly skilled providers.

Don’t get me wrong, I’m an APRN without a DNP, so it’s not about the DNP being better than the MSN. Rather, it’s about APRN providers having consistent professional standards that are known to both healthcare consumers and other providers.

What brings you the most joy in life, personally or professionally?

The thing that lights me up is when I see students using critical thinking to figure out a clinical problem or make a diagnosis. This happens when we use simulations that allow the students to apply what they learned in class in a simulated clinical scenario. That’s when they actually get it.

It gives me great satisfaction to know that what I’ve done has made a difference to our students and to the lives of the patients who’ll be under their care in the future.

On a personal level, I love being at home with my husband and dog, going for walks, riding bikes and spending time together. My home life makes me very happy and I try to keep a good balance whenever possible.

What are the next anticipated steps in your career?

I will continue teaching, mentoring students, conducting research and passing on knowledge to the next generation of clinicians, teachers and researchers. I enjoy that aspect of my work and will hopefully leave my stamp on the nursing profession through my research, in turn positively impacting the lives of patients living with congenital heart disease.


Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.


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