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The role of the advanced practice provider in pediatric urology
Maryellen S. Kelly, DNP.
Duke University, Durham, NC, USA.

BACKGROUND: The burden of urologic disease has been increasing, the current and projected supply of urologists will unlikely be able to meet the needs of patient access in the future. Advanced practice providers (APPs), a common term to include Physician Assistants (PA) and Nurse Practitioners (NP), have become increasingly more common in surgical practices, such as urology to help fill this growing gap. Nonsurgical conditions make up a large proportion of pediatric urology conditions and therefore APPs could aid the expansion of pediatric urology services in the country. The aim of our research was to increase the knowledge of what roles APPs have, and can provide, to a pediatric urology practice now, and in the future.
METHODS: A survey querying the training, practice patterns, and demographic information of pediatric urology APPs was created. Permission was gained to distribute the survey electronically to all members of the Pediatric Urology Nurses and Specialists (PUNS) professional association. PUNS is affiliated with the American Urological Association, Society of Pediatric Urology, American Academy of Pediatrics, International Children's Continence Society, National Association of Pediatric Nurse Associates and Practitioners and the Society of Urologic Nurses and Associates. Descriptive statistics were carried out using R studio.
RESULTS: Response rate was 20% (n=45) of registered APPs. All responders were female, 43% were 31-40 years old. Their pediatric urology practices have an average of 3 (range 1-16) APPs in the practice and 4 (range 0-14) physicians. Eighty percent work within an academic/university setting. Six individuals had doctoral degrees (5 with Doctor of Nursing Pracitice (DNP) and 1 non-nursing PhD). Three individuals also had their registered nurse first assistant certificate (RNFA). Most (82%) have independent clinics where they do not share patients with physicians but do have a collaborative agreement with a physician per state guidelines. 95% report seeing patients with voiding dysfunction; 84% will see any general pediatric urology concern; 77% see post-operative patients; 66% see patients with spina bifida and 36% see prenatal consultations for urologic conditions. APPs are involved in many procedures: urodynamics, percutaneous tibia nerve stimulation, transcutaneous electrical nerve stimulation, release of labial adhesions, release of penile skin bridges, newborn circumcision and cystoscopy. Some are completing circumcisions and circumcision revisions in the operating room independently. 39% report assisting in the teaching of urology residents within their clinics, and over 80% assist in teaching nursing and/or APP students who rotate through urology. 9% report having their own research funding and only 16% act as a primary investigator in research. Eleven individuals have had any publications in a peer-reviewed journal in the past 2 years. CONCLUSIONS:
APPs are utilized in different ways but many practice in spina bifida clinics and general pediatric urology clinics. APPs are carrying out procedures in clinic settings and in the operating room. APPs are also assisting in education of medical residents and APPs. Few APPs are active in research.


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