Q: How did your backgrounds contribute to the development of your article “Competencies for dermatology nurse practitioners?”
Nolen: My background has been in dermatology for decades, way before the formal programs and influx of dermatology nurse practitioners (NPs) we see today. Over the years, I worked with many physicians who appreciated the role that I was creating in this specialty. In 2003, I was contacted with the idea to begin a fellowship for NPs to learn dermatology. Certified NPs were already out practicing and had a desire to learn the specialty, so I created one of the first post-grad fellowships in dermatology at Lahey Hospital & Medical Center. Initially, many NPs had been hired by private practice physicians to join them in their practices, but they had no formal background in dermatology—it was all on-the-job training. We sought to address this gap by creating a residency-style program where post-master’s NPs would attend lectures and spend a year in a clinic learning dermatology. It has been extremely successful in expanding the knowledge base for NPs in our specialty; but, as more NPs enter the dermatology specialty, there has become an even greater need for education and certification. When Margaret and I met and began collaborating, it became clear that there wasn’t a set foundation of competencies or curriculum.
Dr. Bobonich: At University Hospitals Cleveland Medical Center, I created the Post-Master’s Dermatology Nurse Practitioner Training Program, which was modeled after Mary’s fellowship program. When the two of us got together, it became evident that we, NPs in the dermatology space, needed to define the specialized knowledge, skills and abilities unique to our group. The foundation of our work was based on published data from the Core Curriculum for Dermatology NPs: Using Delphi Technique (2012). Study data was collected from both dermatology NPs and dermatologists across the United States, and that data identified essential knowledge and skills for education. However, we still needed to clearly define entry-level competencies for dermatology NP practice. If we couldn’t identify core competencies for the specialty, how could we teach others? We looked to the emergency NPs, who had also conducted a Delphi study, and used their model for defining and standardizing competencies. After a call for volunteers through the AANP Dermatology Specialty Practice Group (SPG), we established the National Dermatology NP Task Force, a diverse group of expert dermatology NPs from across U.S., including those from the Department of Veterans Affairs (VA), HMOs, private practice and academic centers.
Nolen: We then developed a Validation Panel, comprised of professionals from the dermatology task force, certification boards and other professional nursing organizations to objectively review our drafted document and make recommendations. The group focused on the relevancy, specificity, comprehensiveness and entry-level versus advanced-level dermatology competencies.
Q: As co-chairpersons for the National Dermatology NP Task Force, why was the development of dermatology NP competencies so important?
Dr. Bobonich: To be recognized as a nursing specialty, it was essential for us to delineate the unique knowledge, skills and abilities of a dermatology NP that are in addition to our core competencies in one of the population-foci areas. We were really defining who we are and what we do as a specialty. This article should provide a model of professional practice and guide curriculum development, self-assessment and lifelong learning. I was recently asked by a hospital’s credentialing group about the core competencies for dermatology NP practice. The now published and easily accessible “Competencies for dermatology nurse practitioners” provided the basis for specialized guidelines for practice and performance standards.
Nolen: The breadth of our specialty is huge—it includes conditions like acne and psoriasis, but it’s also so much broader, and many providers don’t learn that until they’re practicing dermatology. We needed a very clear document, not unlike what our physician colleagues use to define their competencies.
Dr. Bobonich: I think this comes just in time. The demand for dermatology care is rising due to the aging population. Health care professionals are retiring, and a lot of new graduates are going into subspecialties; where we had physicians go into general dermatology, they now specialize in Mohs surgery, cosmetics or other focus areas. The supply and access to care has been challenging. Now, more than half of dermatology practices have at least one NP or physician assistant (PA). The realization is that patients can choose high-quality dermatologic care by NPs who have acquired these specialized competencies. It’s our professional responsibility to define and standardize the care we provide.
Nolen: These competencies show new NPs what they need to be doing, and they empower NPs to ask for more opportunities and more education. For years, my fellowship was the only one, I think, in part, because there was a lack of understanding in terms of criteria. There are more programs in development today, and the first thing they do is ask for the competencies. I think we’ve come a long way, and I hope the trend continues.
Q: What led to you applying for the Open Access Award?
Nolen: Open access so important; estimates from the 2018 AANP National Sample Survey indicate there are approximately 3,000 NPs practicing dermatology, and we had no clear way to reach every single one of those people. It was necessary to disseminate this information far and wide. AANP recognized early on the importance of dermatology for its constituents and launched dermatology as one of the first SPGs. We’re really grateful. It’s very exciting to be able to share with employers, credentialing bodies, insurers and others that this is our core body of competencies. It also provides a template to help new NP graduates study for the certification exam, and this is what we’ll drive toward in standardizing education for dermatology NPs and developing appropriate training programs across the country.
Dr. Bobonich: This is truly an authoritative document, and there should be no barriers to accessing these guidelines for practice. If you call yourself a dermatology NP, you must attain these entry-level competencies. We have strong, valued relationships with our physician colleagues, PAs, NPs in other specialties and health care organizations, and this document can serve to increase interprofessional education and practice. It also demonstrates how an NP’s primary care knowledge and skills can contribute additional value in a dermatological practice. NPs are skilled at preventive care and managing chronic disease. Conditions like psoriasis and atopic dermatitis are lifelong diseases, and we excel in aspects of patient education and comprehensive care, including comorbidities.
Q: Do you have any advice or words of wisdom for others who may want to apply for this award?
Nolen: Our goal was to define and establish standards for dermatology NP practice. However, our colleagues needed access to this document. Open access for publications is a great way to disseminate information, but it can be expensive. Receiving this award enabled us to reach almost 100,000 NPs with this information. I would encourage anyone or any group who needs to disseminate important documents to consider applying for this award. One of the other ways AANP was also very helpful was in letting us contact other NPs through the Dermatology SPG. There are so many NPs who belong to this association, and through the SPG, we were able to get in touch with lots more people in the dermatology specialty. Now, they’re writing in, asking questions and discussing the competencies on the site.
Dr. Bobonich: We also looked at the AANP National Sample Survey for data on the number of practicing dermatology NPs. If I didn’t read the e-blasts I received from AANP regularly, I would never have seen this opportunity. Mary and I were struggling with how to disseminate this information, and the award application and process were very reasonable. AANP understands that there are many NPs out here who provide education and conduct research. AANP is in great part who we have to thank for enabling us to do this. Since publication of the “Competencies for dermatology nurse practitioners,” many other NP specialty groups have reached out to talk about their similar struggles and hopes to develop their specialty competencies to standardize their practice. I hope others who need to find a way to reach their colleagues know that this is great opportunity to reach their goal.
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