Air Force Functional Brief: The Pediatric Nurse Practitioner

in Air Force and Joint Operations

I. Introduction

 Nurses in Military Health System (MHS) have:

o competence, passion, dedication and professional values that are
o aligned with philosophy MHS , mission, vision, and goals
o as well as individual military hospitals aside from their specific area of
clinical practice (Bibb, Malebranche, Crowell, Altman, Lyon, Carlson
& Rybarczyk, 2003).
 MHS nurses are also expected to appreciate:
o MHS principles, organizational structure and function
o As well as their individual areas of assignment
 Some wonder about the MHS roles of the Pediatric Nurse Practitioner (PNP).
 In MHS of the United States Air Force, the PNP:
o Is a privileged health care provider, and
o Manages health care of infants, children, and adolescents (Air Force
Personnel Center, 2016).
 This presentation is about my function brief.

II. Pediatric Nurse Practitioner Functions (AFSC 46Y3B)

 A PNP is a registered nurse or nurse practitioner.

 PNPs are advanced-practice registered nurses.
 Specializes in the care of children from birth to young adult.
 The PNP focuses on:
o Primary care, preventive health, and growth and development;
o Management of acute and chronic illnesses.
 The PNPs, first and foremost nurses, mean that:
o Patient education, holistic care, significant part of practice.
o In some states, physicians may or may not be required (Registered
Nursing Org, 2017).

Note: PNPs are advanced practice nurses (APNs) who have completed a master's program in
nursing (MSN) or doctoral degree program (DNP). PNPs are crucial to the healthcare team
because they improve patient outcomes through assessments, analyses, planning,
implementations, and evaluations of different elements of care (Registered Nursing Org, 2017).
In all cases, PNPs deliver essential patient education, compassion, reassurance and quality care
to parents and children in particular aspects of care.

III. Pediatric Nurse Practitioner Functions (AFSC 46Y3B) (con’t.).

 May diagnose/treat patients and perform procedures.

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 The specific PNP functions are:

o Diagnosing illnesses
o Perform routine checkups
o Prescribe medication and other treatments
o Order laboratory tests
o Counsel children and their family.
 PNPs are different from physicians in many ways.
 Their patient care approach is more holistic.
 Gather patient information such as:
o Physical symptoms
o psychosocial and environmental information.

Note: PNPs are competent in education and because of this, one of their most crucial functions is
providing education to children and their parents or caregivers (Registered Nursing Org, 2017).
PNPs educate these individuals on disease processes, interventions as well as healthcare
prevention. The American Association of Nurse Practitioners states that PNPs help lower
healthcare costs because as primary care providers, they facilitate reductions in emergency room
visits, as well as shorter hospital stays. They also help in filling the primary care physician
shortage in the United States.

IV. Pediatric Nurse Practitioner Functions (AFSC 46Y3B) (con’t.).

 Educational and training requirements of PNPS:
o Completed accredited nursing program
o Higher education such as MSN and DPN.
o Starting points: associate's degree in nursing (ADN) or bachelor's
degree in nursing (BSN).
o For licensure, successful completion of NCLEX-RN.
o Well-trained in assessment/ pharmacological management in acute care
settings.
 Personal and professional attributes of PNPs include:
o Enjoy working with children and families.
o Family-centered care, involving parents, grandparents, and siblings.
o Unbiased and accepting: parenting styles/family values may differ
from theirs.
o Patience: children patients are less cooperative with aspects of care.
 As APNs, PNPs demonstrate skilled autonomy
o In diagnosis/ treatment of individuals, families, and communities
o To manage acute and chronic illness and promote wellness (Teicher,
Crawford, Williams, Nelson & Andrews, 2001).
 PNPs bring cohesiveness:
o Between nurses, physicians, and other healthcare team members.
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 General areas of advanced roles include:
o Case management
o Clinical pathway development
o Educator/consultant
o Research, and
o Collaboration.

V. The PNP and AF Doctrines

 The most relevant AF Doctrine is “Synergistic Effects” (Air Force, 2015).

 Synergistic Effects Doctrine holds that:
o An effective force results from multi-domain coordination
o Which produces “effects that exceed the contributions of forces
employed individually” (Air Force, 2015).
 AF Objective: coordinate air and surface powers to:
o Defeat enemy forces, or
o Make them at least comply with U.S. national will (Air Force, 2015).
 Speed and agility are of utmost importance.
 Airpower uniquely dictates tempo/ direction of warfighting effort.

Note: The main objective of modern warfare is not to destroy the greatest number of targets
through attrition. Rather, the objective here is “the precise, coordinated application of
the various elements of airpower and surface power” (Air Force, 2015). This coordination
translate into immense pressure on enemy leaders so that they will (a) bend to the will of the
United States, or (b) be functionally defeated. In addition to these, superior airpower enables
joint force commanders to effectively respond to enemy movements with “unprecedented speed
and agility” (Air Force, 2015). Notably, airpower allows the AF (2015) to drive “the tempo and
direction of an entire warfighting effort regardless of the scale of the operation.”

VI. The PNP and AF Doctrine of Synergistic Effects

 PNP function is closely aligned with Synergistic Effects.
 PNPs are essential parts of multi-domain coordination (healthcare and AF).
 Skills in case management, clinical pathway development,
educator/consultant.
 PNP attributes, competencies, roles
o Help keep youngest Air Force family members healthy
o Thus, Airmen have peace of mind
o They can focus on their respective missions.
o This way, PNPs help achieve AF objectives.
 PNP skills and competencies enable Synergistic Effects by:
o Contributing to a coordinated force across multiple domains
o PNPs enable airmen to concentrate on their tasks because
o PNPs help ensure that airmen’s children are in good health
o Or, if otherwise, are competently taken care of.
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VII. The PNP and AF Doctrines

 PNPs are very versatile providers of care (Lewis, Yackel & Prior, 2016).
 Have requisite skill to meet demands of combat.
o They can substitute for other medical assets such as physicians
o That are critically short due to sustained conflict
o Because PNPs are educated and trained to be primary care providers
during deployment.
o This way, PNPs enable speed and agility objectives in AF.
 PNPs provide holistic care:
o May care for entire family
o Have competencies to deal with illnesses and airmen’s injuries.
 PNP training, skills, competence:
o Helps ensure that airmen are at peak health
o Airmen can deliver: precise, coordinated application of
the various elements of airpower” (Air Force, 2015).
o Airmen’s health and peace of mind enhance performance,
o Regardless of scale of operation (Air Force, 2015).

VIII. Joint Chiefs of Staff Doctrine on Joint Health Services

 The Doctrine on Joint Health Services establishes:

o AF health-related activities, training and performance
o In consideration of interaction with multi-stakeholders
o Including government agencies, NGOs, multinational forces, inter-
organizational partners.
 The Doctrine is necessary because of:
o Interrelated health system sharing
o Medical services
o Capabilities
o Specialists among the Service components (Joint Chiefs of Staff,
2017).
 The Doctrine serves as military guidance for exercise authority
o By combatant commanders and other joint force commanders (JFCs),
 The Doctrine has Principles pertaining to:
o Conformity
o Proximity
o Flexibility
o Mobility
o Continuity of care
o Control.
 Most relevant Principles for PNP: flexibility, continuity.
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IX. The Principle of Flexibility

 Flexibility: preparedness, empowerment to

o shift medical resources to meet changing requirements.
 PNPs facilitate flexibility because of multifaceted skills.
o Diagnoses, prescribes, treats and evaluates patient outcomes.
o Enabled by high level education, training
o Holistic care approach (Lewis et al., 2001; Teicher et al., 2001;
Registered Nursing Org, 2017).
 PNPs flexible: may work autonomously, or collaboratively.
 PNP’s skills, competence, education, training:
o Means they are prepared for rapid transitions
o In the event that violence escalates to a higher level.
 PNP’s advanced skills cover:
o Case management, clinical pathway development, educator/consultant
o These are useful in effective management of scarce resources (Joint
Chiefs of Staff, 2017).

Note: Flexibility means that the MHS should be prepared as well as empowered to shift
medical resources where and when needed (Joint Chiefs of Staff, 2017). There could be sudden
changes to the operation plan such that there should be flexibility in medical planning and
execution in order to support the combatant commander’s strategy of maneuver. The PNP can
diagnose illnesses, perform routine checkups, prescribe medication and interventions, order
laboratory tests and counsel children and their family. Therefore, they can provide significant
inputs especially when medical resources are scarce.

X. The Principle of Continuity of Care and Treatment

 Continuity of care and treatment is achieved by:

o Moving patient to higher role of care
o Either through roles of care, or
o Bypassing to a more appropriate role of care
o To definitive care (Joint Chiefs of Staff, 2017).
 PNPs facilitate continuity of care.
 PNPs: have APN competence
o May care for entire family
o Can provide healthcare education for patients and family members.
 PNPs can respond effectively to increased demand for primary care
 Thus, PNPs can help ensure positive patient outcomes even at specialized care
levels.

Note: Continuity of care and treatment is attained during times when a patient is moved to a
higher level of care, encompassing from the point of injury to definitive care. The Air Force may
experience high casualty rates, long distances, as well as a range of patient conditions, which
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mean to say that a patient would have the need to obtain treatment at each level of care or bypass
levels of care, depending on his or her condition (Joint Chiefs of Staff, 2017). The PNP can help
achieve continuity of care because even though they specialize in caring for children, they have
the education, training, competence, skills, necessary from primary to advanced care.

XI. Conclusion

 PNPs are considered APNs.

 PNPs possess competence, dedication, compassion, nursing values.
 PNPs facilitate achievement of AF Synergistic Effects
 PNPs facilitate Joint Health Services Principles on:
o Flexibility
o Continuity of Care
 PNP roles strongly aligned with AF and Joint Doctrines.

References

Air Force. (2015). Volume 1, Basic Doctrine. Retrieved from http://www.doctrine.af.mil/Core-

Doctrine/Vol-1-Basic-Doctrine/

Air Force Personnel Center. (2016). Air Force officer classification directory (AFOCD).
Retrieved from http://static.e-publishing.af.mil/production/1/af_a1/publication/afi36-
2101/afi36-2101.pdf

Bibb, S. C., Malebranche, M., Crowell, D., Altman, C., Lyon, S., Carlson, A., & ... Rybarczyk, J.
(2003). Professional Development Needs of Registered Nurses Practicing at a Military
Community Hospital. Journal Of Continuing Education In Nursing, 34(1), 39-45.

Joint Chiefs of Staff. (2017). Joint Health Services. Retrieved from

http://www.jcs.mil/Portals/36/Documents/Doctrine/pubs/jp4_02.pdf

Lewis, P. C., Yackel, E., & Prior, R. M. (2016). The Role of Army Nurse Practitioners Supporting
Wars in Iraq and Afghanistan. U.S. Army Medical Department Journal, 58-61.

Registered Nurse Org. (2017). Pediatric Nurse Practitioner. Retrieved from

https://www.registerednursing.org/nurse-practitioner/pediatric/

Teicher, S., Crawford, K., Williams, B., Nelson, B., & Andrews, C. (2001). Emerging role of the
pediatric nurse practitioner in acute care. Pediatric Nursing, 27(4), 387-390.