Academic Journal
Reframing the Role of Advanced Practice Providers in Emergency Medicine: A Response to ACEP and AAEM Position Statements.
| Τίτλος: | Reframing the Role of Advanced Practice Providers in Emergency Medicine: A Response to ACEP and AAEM Position Statements. |
|---|---|
| Συγγραφείς: | Bragg KJ; Author Affiliation: Department of Emergency Medicine, Mayo Clinic Florida, Jacksonville, Florida (Bragg, Mohseni, Bonner, and Graham)., Mohseni MM, Bonner M, Graham C |
| Πηγή: | Advanced emergency nursing journal [Adv Emerg Nurs J] 2026 Apr-Jun 01; Vol. 48 (2), pp. 112-118. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 101285075 Publication Model: Print Cited Medium: Internet ISSN: 1931-4493 (Electronic) Linking ISSN: 19314485 NLM ISO Abbreviation: Adv Emerg Nurs J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Philadelphia, Pa. : Lippincott Williams & Wilkins, c2006- |
| Ιατρικοί όροι (MeSH): | Advanced Practice Nursing*/education , Advanced Practice Nursing*/methods , Advanced Practice Nursing*/standards , Emergency Medicine*/education , Emergency Medicine*/standards , Consensus Statements as Topic*, Nurse Practitioners/education ; Nurse Practitioners/standards ; Nurse Practitioners/supply & distribution ; Physician Assistants/education ; Physician Assistants/standards ; Physician Assistants/supply & distribution ; Clinical Competence/standards ; Health Workforce/standards ; Humans ; Professional Autonomy ; Scope of Practice ; United States ; Professional Role |
| Περίληψη: | Abstract: Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), play a vital role in emergency medicine (EM), addressing workforce shortages and enhancing patient care. Despite their growing presence, position statements from the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) challenge APP autonomy and scope of practice. This article critically examines the educational pathways, clinical competencies, and certification standards of APPs, highlighting disparities in recognition and misrepresentation of training. It explores the historical context of EM specialization, the evolution of APP roles, and the impact of restrictive policies-particularly in underserved areas. The authors propose actionable solutions, including standardized credentialing, formal recognition of postgraduate training, and policy reform to support full practice authority. Emphasizing collaboration over division, the article advocates for a team-based approach to emergency care that values the contributions of all provider types and promotes equitable integration. (Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.) |
| Competing Interests: | Disclosure: The authors report no conflicts of interest. |
| References: | American Academy of Emergency Medicine (2025). Updated Position Statement on Non-physician Practitioners. https://www.aaem.org/statements/updated-position-statement-on-non-physician-practitioners/. American Academy of Emergency Nurse Practitioners (n.d.). American Academy of Emergency Nurse Practitioners. Retrieved from https://www.aaenp-natl.org/. American College of Emergency Physicians. Guidelines Regarding the Role of Physician Assistants and Nurse Practitioners in the Emergency Department. Retrieved October 17 from https://www.acep.org/patient-care/policy-statements/guidelines-regarding-the-role-of-physician-assistants-and-nurse-practitioners-in-the-emergency-department/. American College of Emergency Physicians (2020). Joint Statement Regarding Post-graduate Training of Nurse Practitioners and Physician Assistants. Retrieved October 17 from https://www.acep.org/administration/personnel--team-management/post-graduate-training-of-nps-and-pas. American Medical Association. (2023). AMA successfully fights scope of practice expansions that threaten patient safety. American Medical Association. Retrieved October from https://www.ama-assn.org/practice-management/scope-practice/ama-successfully-fights-scope-practice-expansions-threaten#:∼:text=AMA%20successfully%20fights%20scope%20of%20practice%20expansions%20that%20threaten%20patient%20safety,-Updated%20May%2015&text=Patients%20deserve%20care%20led%20by,expand%20their%20scope%20of%20practice. American Medical Association (2020). 3 big reasons why letting NPs practice independently is a bad idea. American Medical Association. Retrieved October from https://www.ama-assn.org/practice-management/scope-practice/3-big-reasons-why-letting-nps-practice-independently-bad-idea#:∼:text=They%20are%20not%20required%20to,Pennsylvania%20Wharton%20School%20of%20Business. American Medical Association. Why we fight: Fighting scope creep. American Medical Association. Retrieved October 17, 2025 from https://www.ama-assn.org/amaone/why-we-fight-fighting-scope-creep?gad_campaignid=10493330102&gad_source=1&gbraid=0AAAAADDj8TJYKa3uzS_7aaYHWmW1GdqwM. American Nurses Association (n.d.). Find an accredited organization. NursingWorld. https://www.nursingworld.org/organizational-programs/accreditation/find-an-accredited-organization/. Asfour A. F. A., Winter J. P. (2018). Whom should we really call a “doctor”?. CMAJ, 190(21), E660. doi: 10.1503/cmaj.69212. (PMID: 10.1503/cmaj.69212) Barry J. (2009). To use or not to use: The clinical use of the title: “Doctor”: by DNP Graduates. The Journal of Nursing Administration, 39(3), 99-102. doi: 10.1097/NNA.0b013e3181989542. (PMID: 10.1097/NNA.0b013e3181989542) California Business and Professions Code § 2054 (2025). Retreived from https://california.public.law/codes/business_and_professions_code_section_2054. Campo T. M., Comer A., Dowling Evans D., Kincaid K., Norton L., Ramirez E. G., Roberts E., Smith A., Stackhouse K., Wilbeck J. (2018). Practice standards for the emergency nurse practitioner specialty. Advanced Emergency Nursing Journal, 40(4), 240-245. doi: 10.1097/TME.0000000000000209. (PMID: 10.1097/TME.0000000000000209) Chekijian S. A., Elia T. R., Horton J. L., Baccari B. M., Temin E. S. (2021). A review of interprofessional variation in education: challenges and considerations in the growth of advanced practice providers in emergency medicine. AEM Education and Training, 5(2), e10469. doi: 10.1002/aet2.10469. (PMID: 10.1002/aet2.10469) Chism L. A. (2021). The Doctor Nurse: Overcoming Title Issues. The Doctor of Nursing Practice: A Guidebook for Role Development and Professional Issues (Vol. 267) Jones and Bartlett Learning, Burlington, MA. Cirillo L. A. (2024). ACEP LAC 2024 recap. ACEP Now, 43(6). Cook T., Adler J. (2021). After the match: NPs pushing expansion of independent practice. Emergency Medicine News, 43(3), 1-36. Cusimano L. D., Maestas N. (2024). High-Risk opioid prescribing and nurse practitioner independence. JAMA Health Forum, 5(12), e244544. doi: 10.1001/jamahealthforum.2024.4544. (PMID: 10.1001/jamahealthforum.2024.4544) Davis W. D., Hallman M. G., Wilbeck J. (2023). Aligning emergency nurse practitioner programs using a national validation process. The Journal for Nurse Practitioners, 19(7), 104653. doi: 10.1016/j.nurpra.2023.104653. (PMID: 10.1016/j.nurpra.2023.104653) Dowling Evans D., Davis W. D. (2024). The American Academy of Emergency nurse practitioners: the first years. Advanced Emergency Nursing Journal, 46(4), 302-323. doi: 10.1097/tme.0000000000000537. (PMID: 10.1097/tme.0000000000000537) Dowling Evans D., Hoyt K. S., Davis W. D., Wilbeck J. (2021). Revisioning the ENP among emergency workforce changes: specialty or population? Advanced Emergency Nursing Journal, 43(3), 171-177. doi: 10.1097/tme.0000000000000366. (PMID: 10.1097/tme.0000000000000366) Dunbar-Jacob J., Schlenk E. A., Tuite P. (2023). The doctor of nursing practice: a narrative review of the history and current status. Medical Research Archives, 11(7.1). doi: 10.18103/mra.v11i7.1.4037. (PMID: 10.18103/mra.v11i7.1.4037) Evans D. D., Campo T. M., Ramirez E. G. (2018). Fostering leadership through the changing practice of the emergency nurse practitioner specialty. Journal of the American Association of Nurse Practitioners, 30(9), 475-477. doi: 10.1097/JXX.0000000000000132. (PMID: 10.1097/JXX.0000000000000132) Gigli K. H., Calhoun J., Dierkes A. M., Martsolf G. R. (2024). The perspectives of advanced practice provider directors on acute care nurse practitioner alignment and hiring. Policy, Politics, & Nursing Practice, 25(1), 20-28. doi: 10.1177/15271544231204879. (PMID: 10.1177/15271544231204879) Innes G., Murphy M., Nijssen–Jordan C., Ducharme J., Drummond A. (1999). Procedural sedation and analgesia in the emergency department. Canadian consensus guidelines. The Journal of Emergency Medicine, 17(1), 145-156. doi: 10.1016/s0736-4679(98)00135-8. (PMID: 10.1016/s0736-4679(98)00135-8) Katz J., Powers M., Amusina O. (2021). A review of procedural skills performed by advanced practice providers in emergency department and critical care settings. Disease-a-Month, 67(1), 101013. doi: 10.1016/j.disamonth.2020.101013. (PMID: 10.1016/j.disamonth.2020.101013) Kayingo G., Gordes K. L., Kulo V., Cawley J. F. (2022). Accreditation in the health professions: implications for physician assistant education. The Journal of Physician Assistant Education, 33(4), 318-324. doi: 10.1097/JPA.0000000000000462. (PMID: 10.1097/JPA.0000000000000462) Kesten K. S., El-Banna M. M. (2021). Facilitators, barriers, benefits, and funding to implement postgraduate nurse practitioner residency/fellowship programs. Journal of the American Association of Nurse Practitioners, 33(8), 611-617. doi: 10.1097/JXX.0000000000000412. (PMID: 10.1097/JXX.0000000000000412) Kidd V. D., Kidd V. D. (2023). Exploring motivations and barriers to accreditation adoption among physician assistant and nurse practitioner emergency medicine and orthopedic surgery residency and fellowship programs. Cureus, 15(3). Martin A. E. R., Kayingo G. (2025). Doctoral education for physician assistants/associates: trends and characteristics in the U.S. BMC Medical Education, 25(1), 2. doi: 10.1186/s12909-024-06606-5. (PMID: 10.1186/s12909-024-06606-5) Mayer A. (2019). AAEM opposes NP and PA independent practice. Emergency Medicine News, 41(4), 2-3. doi: 10.1097/01.eem.0000554857.87023.81. (PMID: 10.1097/01.eem.0000554857.87023.81) Mundinger M. O., Kane R. L., Lenz E. R., Totten A. M., Tsai W.-Y., Cleary P. D., Friedewald W. T., Siu A. L., Shelanski M. L. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA, 283(1), 59-68. doi: 10.1001/jama.283.1.59. (PMID: 10.1001/jama.283.1.59) Neff D. F., Yoon S. H., Steiner R. L., Bejleri I., Bumbach M. D., Everhart D., Harman J. S. (2018). The impact of nurse practitioner regulations on population access to care. Nursing Outlook, 66(4), 379-385. doi: 10.1016/j.outlook.2018.03.001. (PMID: 10.1016/j.outlook.2018.03.001) Phillips A. W., Klauer K. M., Kessler C. S. (2018). Emergency physician evaluation of PA and NP practice patterns. JAAPA, 31(5), 38-43. doi: 10.1097/01.JAA.0000532118.98379.f1. (PMID: 10.1097/01.JAA.0000532118.98379.f1) Phillips A. W. (2017). News: Are NPs and PAs Taking EP Jobs?. Emergency Medicine News 39(8), 1-38. doi: 10.1097/01.EEM.0000522209.68828.c1. Pines J. M., Zocchi M. S., Ritsema T. S., Bedolla J., Venkat A., & US Acute Care Solutions Research Group (2021). Emergency physician and advanced practice provider diagnostic testing and admission decisions in chest pain and abdominal pain. Academic emergency medicine, 28(1), 36-45. doi: 10.1111/acem.14161. (PMID: 10.1111/acem.14161) Pitts S. R., Morgan S. R., Schrager J. D., Berger T. J. (2014). Emergency department resource use by supervised residents vs attending physicians alone. JAMA, 312(22), 2394-2400. doi: 10.1001/jama.2014.16172. (PMID: 10.1001/jama.2014.16172) Rice B., Pickering A., Laurence C., Kizito P. M., Leff R., Kisingiri S. J., Ndyamwijuka C., Nakato S., Adriko L. F., Bisanzo M. (2021). Mortality outcomes in task-sharing for emergency care: impact of emergency physician supervision on non-physician emergency care in Rural Uganda. medRxiv. 2021.2009. 2015.21263465. Shaw G. (2022). Special report: the rural emergency workforce: should PAs and NPs fill the gap? Emergency Medicine News, 44(5), 1-16. Steele R. (2023). Board certification for All ED providers. Emergency Medicine News, 45(7), 2. doi: 10.1097/01.Eem.0000945452.18162.65. (PMID: 10.1097/01.Eem.0000945452.18162.65) Thomas E. T., Heneghan C. (2022). Catalogue of bias: selective outcome reporting bias. BMJ Evidence-Based Medicine, 27(6), 370-372. doi: 10.1136/bmjebm-2021-111845. (PMID: 10.1136/bmjebm-2021-111845) Tyler D. O., Hoyt K. S., Evans D. D., Schumann L., Ramirez E., Wilbeck J., Agan D. (2018). Emergency nurse practitioner practice analysis: Report and implications of the findings. Journal of the American Association of Nurse Practitioners, 30(10), 560-569. doi: 10.1097/JXX.0000000000000118. (PMID: 10.1097/JXX.0000000000000118) Veenema T. G., Lavin R. P., Thornton C. P., Schneider-Firestone S., Seal S. (2021). Alignment of nurse practitioner educational preparation and scope of practice in United States emergency departments: A systematic review of the literature. Journal of Emergency Nursing, 47(4), 563-581. doi: 10.1016/j.jen.2021.04.005. (PMID: 10.1016/j.jen.2021.04.005) Wilbeck J., Schumann L., Comer A., Davis W. (2022). Consideration of the emergency nurse practitioner as a population within the APRN consensus model: A SWOT analysis. Journal of the American Association of Nurse Practitioners, 34(10), 1126. doi: 10.1097/JXX.0000000000000781. (PMID: 10.1097/JXX.0000000000000781) |
| Contributed Indexing: | Keywords: AAEM position statement; ACEP position statement; CAQ in emergency medicine; ENP certification; advance practice providers; emergency medicine; independent practice; nurse practitioners; physician assistants; scope of practice |
| Entry Date(s): | Date Created: 20260501 Date Completed: 20260513 Latest Revision: 20260629 |
| Update Code: | 20260629 |
| DOI: | 10.1097/TME.0000000000000626 |
| PMID: | 42066224 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1931-4493 |
|---|---|
| DOI: | 10.1097/TME.0000000000000626 |