Defining the Role of the Urogynecology Nurse Practitioner

Defining the Role of the Urogynecology Nurse Practitioner: A Call to Contemporary Distinction through Subspecialty Certification Jennifer L. Cera, DNP, APRN-NP, WHNP-BC; Melanie Schlittenhardt, DNP, APRN, FNP-BC, CUNP; Amy Hull, DNP, WHNP-BC; and Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP, FAUNA, FAANP Research 1.4 contact hours © 2021 Society of Urologic Nurses and Associates Cera, J.L., Schlittenhardt, M., Hull, A., & Quallich, S.A. (2021). Defining the role of the urogynecology nurse practitioner: A call to contemporary distinction through subspecialty certification. Urologic Nursing, 41(3), 141-152. https:// This is the first survey conducted to examine the role of the urogynecology nurse practitioner (NP) and highlights the need for the development of a current, distinct description of the sub-specialty role. Descriptive statis tics were used to report the characteristics of the sam ple group (N = 55). This article reports on the urogyne cology subspecialty NP role, creates a basis that can be used when negotiating a new position or promotion, and provides insight into whether NPs who practice in this subspecialty are interested in a national certification examination to distinguish their expertise. Proposing a new designation that aligns with current female pelvic medicine and reconstructive surgery (FPMRS) physi cians to replace urogynecology NP is discussed as a possible natural progression to define the specific knowledge, clinical competence, and aptitude needed to practice in this field. Key Words Clinical competence, advanced practice provider, workforce, specialty practice, urology, women’s health, urodynamics, ambulatory care, urogynecology. Instructions for NCPD Contact Hours UNJ 2104 Nursing continuing professional development (NCPD) contact hours can be earned for completing the learning activity associated with this article. Instructions are available at Deadline for submission: June 30, 2023 Urogynecology is emerging as a subspecialty role for nurse practitioners (NPs) whose focus is on pre vention and treatment of female urinary and fecal incontinence (also known as dual incontinence) and pelvic floor disorders (PFDs). An increased demand for NPs with knowledge and expertise in this sub specialty is projected to grow considering the preva lence of these conditions, the aging population, and the current shortage of physicians who provide care for this population. According to the U.S. Census Bureau, by 2030, there will be a 35% increased demand in care for women with incontinence and PFD, which is only expected to rise (Kirby et al., 2013). Physician specialists, such as urologists, gynecologists, and female pelvic medicine and reconstructive surgeons (FPMRS), provide most of the care for these conditions. However, there is a Jennifer L. Cera, DNP, APRN-NP, WHNP-BC, is an Assistant Professor and Co-Coordinator, Women’s Health Specialty Program, University of Nebraska Medical Center College of Nursing – Omaha Division, College of Nursing Science; and a Women’s Health Nurse Practitioner, Female Pelvic Medicine & Urogynecology, Olson Center for Women’s Health, Nebraska Medicine, Omaha, NE; and is a mem ber of the Urologic Nursing Editorial Board. Melanie Schlittenhardt, DNP, APRN, FNP-BC, CUNP, is a Family Nurse Practitioner and Co-Owner of an independent continence clin ic, Pelican Health, Bismarck, ND. Amy Hull, DNP, WHNP-BC, is an Assistant Professor of Clinical Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP, FAUNA, FAANP, is an Assistant Professor of Urology and Andrology Nurse Practitioner, Division of Andrology, General and Community Health, Department of Urology, University of Michigan Health System, Ann Arbor, MI; Fellows Taskforce Chair, Fellows of the Academy of Urologic Nurses and Associates (FAUNA); and Editor, Urologic Nursing. Editor’s Note: Findings of the study do not necessarily reflect the opinions of SUNA. The views expressed herein are those of the authors, and no official endorsement by SUNA is intended or should be inferred. This article was vetted through the journal’s standard, blinded peer review process. 141 UROLOGIC NURSING / May-June 2021 / Volume 41 Number 3 Copyright 2021 Society of Urologic Nurses and Associates (SUNA) All rights reserved. No part of this document may be reproduced or transmitted in any form without the written permission of the Society of Urologic Nurses and Associates. Research Research Summary Introduction There is little discussion of nurse practitioner (NP) sub specialty roles in the literature and very minimal specific to urogynecology. This article presents data relative to the urogynecology NP position, including interest in a national certification to define and clarify its unique role. Methods A convenience sample was obtained via five online platforms, along with encouraging respondents to forward the survey link to colleagues (snowball sampling), to attempt to access as wide a sample as possible. Sample Results Only NPs working in urogynecology environments were eligible, regardless of years of experience. A total of 55 NPs completed the survey, representing a range of states and practice experience, as well as experi enced and recent graduate NPs. Sample demographics were similar to national and women’s health NP results, although our sample was slightly younger. The majority of deficit of urologists (American Urological Associa tion [AUA], 2018) and gynecologists (Vetter et al., 2019) in the United States. Even though the projec tion of FPMRS physicians is anticipated to increase, the physician/patient ratio will remain steady at its current level (Brueseke et al., 2016). A hallmark of the NP profession is health pro motion and disease prevention, along with serving as primary care providers in the assessment, diagno sis, and management of health care conditions. Recent research in urogynecology emphasizes the need for prevention. Numerous medical entities, such as the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) initiation of the Prevention of Lower Urinary Tract Symptoms (PLUS) network in 2015 (Harlow et al., 2018), the National Institutes of Health (NIH) in 2011, the 5th International Consultation on Incontinence in 2012 (Dumoulin et al., 2016), and the Agency for Healthcare Research and Quality (AHRQ) (2013) recommend pelvic floor health promotion by addressing modifiable risk factors to prevent the onset of urinary incontinence. Background: History of Urogynecology and Female Pelvic Medicine The creation of urogynecology began in the field of medicine with a few founding surgeons who believed strongly that treatment of female inconti nence and PFDs become a subspecialty of obstetrics and gynecology. A small gathering of founders at first, they formed a non-profit organization that over participants (79.9%) support subspecialized certification, and the importance of a national certification examination was deemed as moderately, very, or extremely important by 70% of respondents. Most respondents work collaboratively with physician colleagues. Results also detail an initial overview of general women’s health and role-specific urog ynecology responsibilities and procedures needed to pro vide competent, comprehensive care. Conclusion This is the first survey to be completed that reports exclusively on the subspecialty role of the urogynecology NP. This provides additional support for the ongoing evolu tion and viability of a national certification examination that can provide an avenue for a contemporary distinction and title. An additional study with a larger, more representative sample is warranted to develop curricula and move toward implementing a national certification examination. Level of Evidence: III-A Source: Johns Hopkins Hospital/Johns Hopkins University, 2016. the years changed names as the subspecialty evolved into what is now known as the American Urogynecologic Society (AUGS). Expertise within this field has grown exponentially over 50-plus years, and several other organizations have originat ed for the common goal to promote education, research, and collaboration within this subspecialty, such as the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU); the International Continence Society (ICS); and the International Urogynecological Association (IUGA), to name a few. The establishment of these organiza tions only validates the significance of this niche of medical exigence and expertise. Finally, a collabora tion between the Board of Obstetrics and Gyne cology and the Board of Urology enabled the devel opment of a physician certification examination; competency in this subspecialty now requires a fel lowship and board certification in FPMRS. Advanced practice registered nurses (APRNs), which include NPs, have long held a pivotal role in providing health care within the urogynecology sub specialty; however, to date, a certification examina tion that ascertains the advanced didactic and clini cal expertise has not been developed. Instead, NP core curriculum requirements and standardization have been used as a springboard for the subspecialty education that the urogynecology NP has had to seek independently and informally. Nurse practitioners begin with a Bachelor of Science in Nursing (BSN) degree that provides a foundation of patient care assessment, pathophysi ology, and pharmacology, and focuses on the art of