New solutions to dermatology nurse practitioners' biggest challenges

“As a growing presence within the dermatology sector, we are often being compared to our physician colleagues. With that, there are challenges from our physician colleagues who sometimes don’t understand what it means to be a dermatology nurse practitioner,” says Lakshi Aldredge, MSN, ANP-BC, DCNP.

Dermatology nurse practitioners (NPs) faced pressing challenges in 2018, including a misperception of their role and scope of practice and a lack of established competencies needed in the specialty. Many of these issues, according to one expert NP, will be remedied in 2019.

There are three major professional hurdles for NPs and specifically dermatology NPs, according to Lakshi Aldredge, MSN, ANP-BC, DCNP, a nurse practitioner at the VA Portland Healthcare System, where she works in a medical dermatology clinic. Aldredge also serves as an editorial board member for the Journal of the Dermatology Nurses’ Association.

“As a growing presence within the dermatology sector, we are often being compared to our physician colleagues. With that, there are challenges from our physician colleagues who sometimes don’t understand what it means to be a dermatology nurse practitioner,” Aldredge says. “I think that clarifying our role, competencies and scope of practice is one of the challenges that both dermatology NPs and physician assistants (PAs) face.”

Adding to the confusion is another issue that affects NPs in general. It’s the state-by-state variation in NP scope of practice, according to Aldredge.

“There are many states where nurse practitioners are licensed independent practitioners and there are other states that require a collaborative relationship with a physician colleague. There are some states where prescriptive privileges also vary,” she says. “This state-to-state variability can be challenging not only for nurse practitioners to understand but also the public and our other colleagues in healthcare.”

A third challenge, more specific to dermatology, is that until late last year there was no single document that delineated dermatology NP competencies. Publishing the dermatology nurse practitioners competencies in November 2018 in the Journal of the American Association of Nurse Practitioners has been a big step forward, according to Aldredge. The competencies were developed by a group of expert dermatology NPs representing all areas of dermatology practice, she says.

“It’s very important to understand that these are the entry level competencies. For new dermatology nurse practitioners coming into the field, these are your expected levels of practice. These are the conditions you should be able to treat. These are the procedures you are expected to have knowledge and competency about. They are baseline standards,” Aldredge says. “We’re also going to be publishing our scope and standards in a few months. I think those two big things were challenges that are being remedied. I think that will help not only our other healthcare colleagues, but also the public at large, and enable them to understand very specifically what it is a dermatology nurse practitioner can and should do.”

The work to publish dermatology nurse practitioner competencies, as well as scope and standard of practice, is a result of the Dermatology Nurse Practitioner Coalition, which includes members from the Dermatology Nurses’ Association, Dermatology Specialty Practice Group of the American Association of Nurse Practitioners and Dermatology Nursing Certification Board, according to Aldredge.

“We came together and put forth initiatives to publish the competencies and to create and publish the scope and standards of practice,” Aldredge says. “We have another initiative to ensure that all nurse practitioners practicing in the field of dermatology obtain the dermatology nurse practitioner certification. The [Dermatology Certified Nurse Practitioner] DCNP exam is currently in the process of being revised and will be accredited this year as well.”

The Dermatology Certified Nurse Practitioner (DCNP) credential is an objective measure of competency and puts dermatology nurse practitioners in line with other nursing and medical specialties that require board certification, according to Aldredge.

“The certification exam is currently not required but we are encouraging all dermatology NPs to obtain that certification,” she says.

The Dermatology Nursing Certification Board is the certifying body that provides that examination.

These are the things that are shaping the future for dermatology NPs. With these tools, NPs are poised to be able to function at the highest level of their education, training, licensure and scope of practice, Aldredge says.