Analysis of Nurse Practitioners’ Educational Preparation, Credentialing, and Scope of Practice in U.S. Emergency Departments


In response to physician shortages, economic pressures to contain costs, and evolving hospital policies that appreciate the skills and quality of care that nurse practitioners (NPs) provide, U.S. emergency departments (EDs) employ approximately 16,000 NPs. Recognizing that outcomes of patient care are impacted by providers’ educational preparation and training, licensure and certification, and scope of practice, it is critical that all of these facets are aligned for NPs who are employed in EDs.


The purpose of this article is to explore the current alignment of NP education and training, licensure, and certification with the scope of practice in U.S. EDs.


This multi-phased analysis required data collection from a variety of sources: (a) an environmental scan of existing U.S. academic degree-granting and certificate programs that prepare NPs for working in EDs, (b) a cross-sectional analysis of state NP licensure and certification requirements, and (c) a cross-sectional analysis of state NP scope of practice.


Wide variability exists in the educational preparation of NPs working in the ED setting. Few NPs are certified as ENPs, and states vary widely in their nurse practice acts. No clear, uniform consensus exists regarding what is required for education, training, and certification to work as an NP in an ED. Although standardized curricula and practice competencies have been proposed by the AAENP, they have yet to be adopted.


Extensive variability exists across the academic preparation of NPs working in the ED setting as well as in the licensure and certification requirements governing NP practice in EDs. Until this variability is resolved, we conclude that NPs should not perform independent, unsupervised care in the ED regardless of state law or hospital regulations in order to protect patient safety.

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