In the interest of providing cost-effective and high-quality care, a growing number of health care organizations are enhancing their pediatric critical care nursing staff, by hiring nurses with an even higher professional scope of practice. Two such examples include; the pediatric clinical nurse specialists (CNS) who tends to work within the hospital setting and the pediatric nurse practitioner (NP), who often works in outpatient clinics.

The need for more specialized pediatric critical care nursing stems from changes in health care delivery systems and the fact that patients are having more dynamic and complex health care needs. In an effort to create a more seamless, synchronized and effective method of care delivery, some health care professionals are advocating that these two roles, the CNS and NP, be merged into one advanced nursing role.

Pediatric critical care nursing is specialized, in that it focuses on the pediatric patient. However an advanced practice nurse, such as the NP, has further training and the knowledge required for taking histories, performing physical exams, making a diagnoses, and prescribing medications. The CNS focuses more on patient and staff education; they are valued for their unique contributions to case management, care coordination, and patient teaching.

he exact scope of the CNS and NP roles can be governed by the policies and procedures of their employer, as well as their state licensing board. Advocates for merging these roles, suggest that an advanced pediatric critical care nurse should be able to perform both of these roles, of CNS and NP.

Health care organizations are concerned about containing costs, ensuring patient and family satisfaction and improving quality of care. Pediatric critical care nursing benefits by having access to these higher level specializations. Some specialty physicians, such as pediatric cardiologists, recognize that employing a pediatric NP may support the expansion of his/her current practice. However, not all professions will necessarily be supportive of a merger between the CNS and the NP roles; some Physician Assistance may perceive the new Advanced Practitioner role as a threat to their current positions.

Moving forward with this proposed merger will require restructuring at the academic and institutional levels. Educational administrators will be required to find innovative ways of facilitating the enrollment process for nurses who wish to progress from pediatric critical care nursing, toward advance practice nursing. Offering these courses via distance education or through evening courses, may facilitate the nurse's ability to pursue professional development and career advancement, while at the same time balancing work, family and school.

Beyond physiology, pathophysiology, pharmacology and diagnostics, the APN is expected to be knowledgeable in the areas of health promotion, counseling, and management of common pediatric conditions from birth through adolescences. The APN is also expected to support the administration team.

Therefore, the course curriculum is expected to cover management principles such as budgeting, creating and developing corporate policies and procedures and managing human resources; each of these issues affects the APN's role.

Pediatric critical care nursing has become increasingly complex. The merging of the CNS and NP roles into one advance practice nursing role is expected to produce a more efficient and effective form of care delivery. However, the benefits of such a merger continue to be hotly debated amongst academic circles. Time will tell whether the CNS and NP roles merge or remain distinct and separate positions; in either case, these advanced level roles play a critical role in providing cost-effective and efficient quality of care.