The evolution of the Emergency Nurse Practitioner

Photograph by Joe Howell

For years, Jennifer Wilbeck, DNP, PMC’06, MSN’99, FAANP, pieced together nursing knowledge much like working a jigsaw puzzle. Each course’s curriculum interlocked with teachings from another to form a complete picture of what she wanted to learn.

Ultimately, Wilbeck gained instruction from a variety of nursing specialties to learn what she felt she needed to know to work as an emergency nurse practitioner (ENP).

Now nearly two decades later, she holds ACNP-BC, FNP-BC and ENP-C certifications and is responsible for starting Vanderbilt University School of Nursing’s ENP specialty. She also championed the role of the ENP nationwide, establishing curricula and a certification for the specialty on the national level.

“The number of patients going to the emergency department (ED) is rising significantly and there are incredible gaps for providers to staff those emergency departments,” said Wilbeck, associate professor of Nursing and ENP specialty director at VUSN. “Nurse practitioners are filling those gaps, but in order to ensure that you have nurse practitioners providing safe care, they have to be educated in emergency care.”

“As far back as I can remember, I wanted to go into nursing,” she said. “I wanted to be in the emergency department so that I could help sick and hurt people. When I started my education, there was no direct path or program offering all of the specialty preparation I needed.”

Three certifications, six years

Wilbeck began her career as an acute care nurse practitioner (ACNP). Although she could care for the sickest of adult patients, she was not trained to provide care for pediatrics or those needing routine care. Wanting broader preparation, she returned to school so she could see the large number of patients who frequented the ED for primary care. Armed as a family nurse practitioner (FNP) and an ACNP, she returned to the ED.

The frustration that neither program could adequately prepare her to care for all the types of patients seeking help in an emergency department setting put her on a personal mission.

“It took me three different certifications and about six years to get what has now evolved into a program that someone can do in two years,” Wilbeck said. “There was definitely a void in my education. When I joined the faculty at Vanderbilt in 2000, I knew a specialized nursing program for nurse practitioners with a focus on emergency medicine was something I was going to focus on building.”

Six years after she joined the faculty, the ENP program launched. VUSN offered the first dual specialty program in the country offering ENP education; today, it’s one of 10 programs offered in the United States. The innovative specialty combines the FNP and Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) curricula to provide specific instruction preparing advanced practice nurses to provide emergency care across the lifespan for all acuities.

The VUSN program was first initiated with funds from a U.S. Health Resources and Services Administrative (HRSA) grant that allowed the nursing school to develop a blended program of study for nurses who wanted to work in an emergency setting.

“Jennifer saw a need to have people well prepared to work on both sides of the ED,” said Joan King, PhD’84, BSN’72, MSN’75, professor of Nursing at VUSN, who helped write the grant. “Our grant gave folks the opportunity to sit for both certification exams and shortened the program to five semesters.

“The HRSA grant allowed us to meet the growing needs of this group of nurses. Jennifer has taken the lead on this and shepherded it. It has evolved well beyond Vanderbilt.”

Outside the ED

While the majority of emergency care is administered in EDs, the settings where ENPs can provide emergency care are diverse: jails and prisons, urgent care centers and mobile units in conjunction with EMS, for example.

A 2017 study found that emergency departments deliver nearly half of all U.S. medical care. Jennifer Wilbeck, above with TriStar Spring Hill ED co-worker Clark E. Archer, MD, is driven to prepare advanced practice nurses with all they need to help deliver that care. Photo by Joe Howell.

Michael Gooch, DNP, MSN’05, PMC’08, assistant professor, emergency nurse practitioner and flight nurse with VUMC LifeFlight, knows this well.

Gooch has spent all of his professional life providing emergency care. He originally obtained an associate degree in nursing, then a bachelor’s degree. He earned an MSN and a Post-Master’s Certificate (PMC) at Vanderbilt, then continued on for a DNP. He also obtained licensure as a paramedic to allow him to pursue a career as a flight nurse. He holds ACNP-BC, FNP-BC, ENP-BC, ENP-C and EMT-P certifications.

“When I first started as a student, there was no official ENP program,” recalled Gooch, MSN’05, PMC’08. “Some of the course work was there, but there was no structured program. Jennifer saw the need for a focused program, as well as the need for providing potential students with necessary knowledge and experience to be more proficient in emergency medicine.

“Over the past 10 years, the program has grown immensely and has been able to meet the growing demands of what practitioners need.”

Gooch said Wilbeck was also instrumental in creating a national professional organization for ENPs and standardization of the ENP curriculum and certification.

Wilbeck was the founding board chair of the American Academy of Emergency Nurse Practitioners (AAENP), established in 2014. The organization provides education and professional networking and advocates nationally for appropriate licensure and credentialing. One of the biggest accomplishments of the academy was the launch of the ENP certification exam in 2017.

“What started out as a small, small group of individuals has expanded to 1,000 members,” said Wilbeck of the academy. “What this organization has been able to see come to fruition blows me away. When we first started this process, we did not know what we were getting into. We referred to it as ‘ignorance on fire.’

“But it has taken off like wildfire and there is an infrastructure to support nurse practitioners in these roles. Now we can say ‘This is what the data shows’ and ‘Here’s the science behind what we are doing.’ The intricacies of the ENP practice are recognized.”

As awareness and growth of the specialty increase, more nurse practitioners will be academically prepared for emergency care practices, Wilbeck said.

Options at VUSN

VUSN’s ENP specialty program is currently undergoing a curricular change that will enhance its programming and options for ENP students. Now that a national ENP certification exam is available, VUSN will not routinely offer the AGACNP portion of the dual program. The new program will offer a more streamlined FNP/ENP pathway, aligned with national standards.

For students who desire triple certification, the pathway that combines the AGACNP and FNP programs will remain available. “The strength of our blended program is that it provides a firm foundation for more diverse advanced practice in the ED by combining the scope of practice of both an FNP and AGACNP while offering rural and global health compatibility, where the needs are great,” Wilbeck said. “Our students are better prepared for the variety of ages and varying levels of acuity that present in an ED.”

Available to applicants with at least two years of current RN experience, VUSN’s modified distance-learning curriculum is offered on a full-time and part-time basis to allow students to earn a degree without relocating or giving up employment.

Since the creation of Vanderbilt’s ENP program, 100 students have graduated. The largest increase in student volume is among nurses who already have graduate degrees and enroll in the program to earn an additional master’s specialization known as a Post-Master’s Certificate.

Wilbeck, who maintains a clinical practice within several local emergency departments in addition to teaching, directing the ENP specialty and mentoring DNP students, sees new opportunities arising for the specialty and herself.

“I’m definitely not slowing down,” Wilbeck said. “My role will just look different. You have to grow and support the people who will be the next round of leaders and providers, those who will further the ENP role and solidify it, whether that is at Vanderbilt or nationally.

“I still love taking care of ED patients,” she said. “I can go from singing a cartoon show song with a 4-year-old while sewing up his face to talking with a family about their loved one’s last wishes. It’s hard to walk away from that. For someone who has been doing it for a while, it becomes a part of who you are.”

by Jessica Pasley