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Procedures Performed by Nurse Practitioners

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The 10 most common procedures reported by all nurse practitioners are listed in Table 1. Those procedures that were performed by at least 75% of the NP participants were included. Family NPs performed the most procedures.

NPs reported that they learned all of the 10 most common procedures in a variety of educational formats. Four of the procedures (gram stain, suturing, x-ray interpretation and ECG interpretation) were predominantly learned during formal NP educational programs  and six during on-the-job training. All 10 procedures, whether initially learned in formal NP education programs or on-the-job training, were augmented by more than one educational setting and special continuing education classes.

Table 2 shows the breakdown of procedures by specialty. Those procedures with a mean of .70 or better are shown. Fifty percent of family NPs performed 58 procedures (pediatric NPs, 26 procedures; adult and gerontologic nurse practitioners, 30 procedures each; women's health NPs, 23 procedures).

Table 3 shows the array of procedures performed in varied ambulatory care practice sites. NPs in urgent care/emergency department sites performed a larger percentage (66%) of procedures. NPs in physician office practice sites performed 31.7% procedures, and NPs in clinic sites performed 27.5% procedures.

Discussion
As expected, the results revealed that many procedures are being performed by NPs in ambulatory care settings. Family NPs reported performing more procedures in all settings than did pediatric NPs, adult NPs, gerontologic NPs and women's health NPs. Family NPs have a broader education and care for clients across the lifespan. The other specialties are limited in their client populations by age groups or gender.

Several of the procedures listed as among the10 most common may be considered as basic nursing skills (Steri-Strip application, peak flow metering, aerosol administration, ear irrigation). Whether these skills are taught uniformly in all basic nursing programs is not known. However, these procedures are consistently being performed by nurse practitioners in ambulatory care settings.

In addition, NPs of various specialty preparations are performing a different set of procedures in their practices. A special set of procedures results from the differing populations and their health care needs. To meet the market trends for NPs, preparation of family, adult, gerontologic, pediatric and women's health NP specialties may require more comprehensive curricula.

The trend is for NPs to learn a procedure in one educational setting and then supplement that education in another educational setting. One explanation for this trend is that when NPs move from one practice site to another, they might need to renew information on procedures they haven't practiced since their formal NP education program. Also, NPs are aware of the many changes occurring in health care today. Updates on procedural skills may be seen as beneficial to patient care.

NPs in diverse practice sites perform many of the same procedures. Five of the procedures (Seri-Strip application, venipuncture, suturing, peak flow metering and chest x-ray interpretation) were on each specialty list. Each type of practice setting will have a unique focus and specific population; however, the procedures required in the different practice settings seem to be related to the patient health care problems rather than type of population. As the need to perform more procedures has increased, NPs need to be prepared when they accept a position.2

Recommendation
Recommendations for further research include exploring procedures preferred by other NP specialties (for example, acute care, neonatal, occupational, oncology, psychiatric/mental health and school NPs) and practice sites (for example, in-patient, prison and armed forces settings).

A correlation between what NPs are currently performing and what NP employers perceive they need for practice would be beneficial to NPs in preparing for the current market needs. A study focused on nurse practitioners' competency performing procedures would be helpful in determining the need for more procedural information in NP education programs.

Research on the level of comfort and amount of confidence NPs possess in their abilities to perform procedures required in their practices would also be informative. And comparing procedures performed by physicians to the corresponding NP specialty might promote reimbursement for NP services.

Margaret Colyar is a family nurse practitioner and pediatric nurse practitioner who is codirector of the NP program at the University of Utah in Salt Lake City. She is an assistant professor and has a doctorate in nursing science. Reach her at Margaret.Colyar@nurs.utah.edu.

Cynthia Ehrhardt is a family nurse practitioner. She is  an instructor at Central Florida Community College in Ocala, Fla., and continues to maintain a part-time practice with a local group of family practice physicians in Ocala.


Procedures Performed by Nurse Practitioners

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