With a shortage of primary care physicians in the United States, the demand for advanced practice registered nurses (APRNs), including pediatric primary care nurse practitioners and family nurse practitioners, is growing, especially in rural and underserved areas like El Paso.
Studies have shown that APRNs are trusted by the public, have good patient outcomes, and are cost effective, said Mercedes Martinez, director and adviser of The University of Texas at El Paso’s pediatric nurse practitioner programs.
As more young patients and their families rely on pediatric primary care nurse practitioners for health care, the number of graduates from UTEP’s online Master of Science in Nursing program for Pediatric Nurse Practitioners-Primary Care has grown.
In August 2016, the UTEP School of Nursing graduated the largest class of pediatric nurse practitioners in the program’s history. Tanya Marin was among the 35 graduates, earning aPediatric Nurse Practitioner Acute Care Post-Master’s Certificate.
When Marin, DNP, started her career as a pediatric primary care nurse practitioner in 2002, she offered her services for free to clinics and physicians’ offices in El Paso.
At the time, Marin was one of only a handful of pediatric primary care nurse practitioners, or PNPs, providing comprehensive child health care services in El Paso County.
But before Marin could hang out her shingle, she had to prove to parents, doctors and the community that as an APRN in pediatric primary care, Marin had the knowledge, training and experience to carry out many of the services performed by primary care physicians.
“I had to knock on doors and say, ‘Let me work for you for free,’ so they could see what I can do,” recalled Marin, who earned a B.S. in nursing and a Doctor of Nursing Practice degree from The University of Texas at El Paso. She received an M.S. in nursing in pediatric nurse practitioner primary care from The University of Texas Health Science Center at San Antonio in 2002.
“Back then, doctors didn’t know what a pediatric nurse could do,” she said. “There were maybe another two (PNPs) in the community, but nobody knew what we did.”
Similar to a pediatrician, pediatric primary care nurse practitioners like Marin provide services to patients from birth through 21 years, diagnosing illnesses, interpreting lab work and prescribing medications. In Texas, pediatric primary care nurse practitioners must have a collaborative physician.
Since 2012, UTEP’s two PNP programs have prepared APRNs to provide either primary care or acute care services to infants, children, adolescents and young adults. To date, 86 PNPs have graduated from the UTEP School of Nursing. The program is the only one available in El Paso and provides flexibility as courses are taken online.
A primary care PNP provides care to patients in a clinic setting. The main focus is health promotion and disease prevention, but also treatment of acute stable illnesses, such as colds, flu, ear infections and more.
An acute care PNP provides care to patients with acute, critical and chronic health conditions in a hospital setting, such as a pediatric emergency room or pediatric intensive care unit, and in subspecialty areas, like a pediatric cardiac intensive care unit.
“There are unique and specific health care needs that are exhibited by children that need to be provided by those advanced practice nurses who have that particular specialty focus,” said Leslie Robbins, Ph.D., School of Nursing assistant dean of graduate programs.
Fourteen years after Marin paved the way for pediatric nurse practitioners in El Paso County, the number of PNPs has increased to 41, according to the Texas Board of Nursing.
After Marin earned her Doctor of Nursing Practice degree in 2015, she opened Santa Teresa Children’s Night Clinic in neighboring Santa Teresa, New Mexico, where she is able to operate the clinic independently, without physician oversight. Marin treats more than 700 patients from medically underserved areas, including Santa Teresa, La Union, and Sunland Park.
Marin returned to UTEP for a post-master’s certificate in pediatric acute care in order to expand her scope of practice and bridge the gap in the continuum of care for her acutely or critically ill patients. Marin will now be able to see patients not only in her clinic, but also in acute care settings, making it possible for her to oversee her patients’ health care in and out of the hospital.
“In primary care I take care of kids that are healthy,” Marin said. “But I need to be able to identify the kids that are going to be sick (in the hospital), then I need to be able to treat them. That’s where I found my gap. My gap was not in identifying them, but in making sure that they got the treatment that was evidence-based once they were in the hospital. Now that I have my certificate, I’m able to take care of patients completely on my own.”
When she’s not caring for her patients or her own family, Marin also serves as a clinical instructor in the UTEP School of Nursing, where she has become a role model for future pediatric nurse practitioners.
Sandra Nungaray, who graduated from the pediatric nurse practitioner primary care program, said she came to admire Marin after watching her interact with patients and their families.
“(Marin) was the social worker, counselor, educator, confidant, cheerleader and of course, trusted provider,” Nungaray said during her remarks at the UTEP School of Nursing’s Graduate Recognition Ceremony. “The rapport she had built with her patients and their families was amazing and what I hope to achieve as a novice practitioner.”
Preparing the next generation of pediatric nurse practitioners is another way that Marin is helping to take care of pediatric patients in the community.
“If I can show my students the love that I have for what I’m doing and get them excited about what they’re going to do (as PNPs), I’ve done my job,” Marin said.
Author: Laura L. Acosta – UTEP Communications