When you visit any healthcare provider, including your urologist, you may notice many non-physicians serving different roles to provide you with quality medical advice and treatment. This group is often referred to as allied health professionals. The trend of integrating these professionals into urologic practices has arisen out of the increasing number of urological patients and the simultaneous limited availability of urologists. These non-physician provider members of the urological healthcare team allow surgeons to focus on more difficult problems and procedures while giving the patient increased personalized attention during their evaluation, diagnostic assessment and management. This article describes the education and training of urological nurses, nurse practitioners and physician assistants.
Urology nursing staff may consist of Licensed Practical Nurses (LPNs), Registered Nurses (RNs) and Advanced Practice Registered Nurses (APNs). LPNs are typically educated in a program that may last from approximately 9 to 24 months. LPNs work closely with RNs, APNs, PAs and urologists, assisting them in delivering care to patients. RNs, who have associate or bachelor degrees, provide professional nursing care to patients and work together with the providers (APNs, PAs and urologists) to help urology patients achieve optimal health.
There are different types of Advanced Practice Registered Nurses -- Clinical Nurse Specialist (CNS), Nurse Practitioner (NP), Certified Registered Nurse Anesthetist (CRNA) and Certified Nurse Midwife (CNM). Presently, all APNs have a master's degree in nursing, and the trend is for many to obtain either a PhD or DNP (Doctorate in Nursing Practice). The two types of APNs working in the field of urology are CNS and NP, both of whom must pass examinations to be board credentialed to practice by a national nursing organization.
The scope of practice for nurses is determined by state law with practice and regulatory differences between NPs and CNSs1. Nurse Practitioners can write prescriptions in all states but the level of autonomy varies from state to state. Clinical Nurse Specialists' ability to write prescriptions depends on state laws. Nursing organizations across the United States are working to standardize the scope of practice for APNs. Following a recent study, the Institute of Medicine recommended allowing all APNs in the United States to function to their full potential to meet the growing needs of patients2.
Another group of healthcare providers are Physician Assistants, who achieve a bachelor's degree but many attain a master's degree. PAs are trained under the "medical model," with the majority trained by physician MDs. PAs must successfully pass their boards to practice and be re-tested every 6 years to maintain certification. PAs practice in the office and operating room settings, and have prescriptive privileges. The scope of practice for PAs is determined by state law.
Urology APNs and PAs work closely with their urology colleagues, focusing their attention on early intervention for urological problems, disease prevention and educating and counseling patients about their urological conditions. They also focus on promoting wellness informed decision making for patients and their families. Many urological procedures, such as transrectal ultrasound and biopsy of the prostate, penile Doppler ultrasound performance and interpretation, urodynamic study performance and interpretation, and cystoscopy, may be performed by the APN/PA under the direction of the urologist.
The American Urological Associations and the Urology Care Foundation's Policy on Use of Allied Health Professionals in Urological Practice:
The American Urological Association (AUA) and the Urology Care Foundation recognize that in some areas, allied health personnel contribute to the care of the patient with genitourinary disease and, therefore, encourage the proper utilization of allied health personnel. Allied health personnel should be considered as para-professionals and should work in a closely and formally defined alliance with a physician. Where the major duties of allied health personnel are those of diagnosis, treatment, or management of [patients with] urological disease or problems, the designated supervising physician should be a urologist certified by the American Board of Urology (ABU). The AUA recognizes that the role and privileges of allied health personnel vary according to individual state regulations and that the restrictions and/or controls established in any state should be honored.
1. Phillips SJ: 22nd Annual Legislative Update: regulatory and legislative successes for APNs. Nurse Pract 2010; 35: 24.
2. Institute of Medicine: The future of nursing: leading change, advancing health.