Nyamweya is a Kenyan scholar who has done many years of research on a diversity of topics
The Role of Advanced Practice Nurse
Advanced Practice Nurse (APN) is a term used for professionals in nursing with additional post-graduate training, masters or doctorate, to carry out advanced functions in health care (ICN, 2008)
These healthcare providers work in a setting that requires a quality standard of patient care as a responsibility. They can be authorized to perform specific roles independently, like seeing the patients without doctor permission, such as ordering diagnostic tests and even making critical medical decisions. There are differences, though, to what a physician and an Advanced Practice Nurse are licensed to do regulated by each regulation body.
Advanced Practice Nurses work in various clinical settings, including the Veterans Affairs and Indian Health Care facilities, clinics, private physicians, nursing homes, schools, and hospitals.
Advanced Practice Nursing roles can be classified into (N.P.)Nurse Practitioners, (N.S.)Nurse Specialist, (N.A.) Nurse Anesthetists, and (N.M.) Nurse-Midwives. Advanced Practice Nurses that assist and provide prenatal care for expecting mothers throughout pregnancy are called Certified Nurse-Midwives(Hudspeth & Klein 2019). They also assist in delivering babies and can work in a team consisting exclusively of nurse-midwives or a team composed of physicians and nurse-midwives.
Nurse anesthetists are primarily found in the surgical operating room caring for patients during surgery. Their roles include administering a powerful medication that prevents the patient from experiencing pain during surgery or putting a patient to sleep and monitoring the vital signs during a surgical operation. After the surgery, they often are in charge of providing immediate post-surgery care to the patient.
Clinical nurse specialists are Advanced Practice Nurse working within a medical care team. Their roles can be to make rounds of the patients in the medical institution. They can also make decisions regarding the patients' medical care, work as general care nurse practitioners assisting in providing varied medical care, or perform their advanced roles and provide specialized care to the patients.
Their role includes obtaining the histories of the patient's health so that they can perform physical examinations and assessments, participate in research activities, order and interpret results from the medical labs and other tests, like diagnostic, carried out, and carry out different diagnostic tests(International Council of Nurses 2012).They can also recommend therapeutic plan care for their patients, be in charge of maintaining patient records, evaluate them, provide family counseling, and arrange for patients to get consultations.
The transition from a general nurse to an advanced practice nurse
The transition of a nurse from a General Nurse to an Advanced Practicing Nurse, specifically a Nurse Practitioner in the U.S. takes time. The first step includes earning a Bachelor of Science in Nursing degree even though associates may fulfill registered nurse requirements on rare occasions. The degree takes four years to complete. It has internships and practicums. There are also nursing classes and fieldwork that are essential for specialization.
The next step is obtaining a registered nurse license. To be granted this license, one needs to acquire a degree, nursing and pass the (NCLEX) National Council for Licensure Examination scores. Some states may request criminal records before one is admitted in the program and before a license is issued.
While working as a registered nurse, one can focus on areas like mental health and family care. These areas require different skills, and if a candidate is interested in more than one specialization, he can do so by taking exams and fieldwork related to the same. The national certifications are essential to earn Nurse Practitioner credentials.
Step four would be to be admitted into a recognized Master of Science in Nursing or Doctor of Nursing Practice program. Nurse Practitioners are Advanced Practice Nurses, which means they either hold a master's or doctorate. One will increase his/her chances of qualifying for leadership positions in nursing in management and policy-building, however, if their degree is of a doctorate. America Association of Colleges of Nursing (2004) pushed to make the doctorate a requirement for advanced practice nurses. If this advancement occurs, graduates with doctorate degrees will already have the required educational qualification. Another advantage of holding a doctorate is an increase in salary expectations for Nurse Practitioners.
To acquire an advanced degree, one would have to be involved in clinical works incorporating what they specialized in to prepare for their future careers. A student, for instance, who wants to be a pediatrician, will choose a program with concerns related to the same when performing practical exercises or during internships in a pediatric-focused setting. They can also participate in school events organized by schools and training opportunities organized by the locals related to their focus areas.
Certifications may come from institutions like the American Nurses Credentialing Center (ANCC) that require one to produce evidence of ever work in a clinic if the candidate has already met the academic qualifications, an application fee, and a standardized examination (International Council of Nurses 2012).
The next step would be to acquire a state nurse practitioner licensure. Its requirements include evidence that the candidate has a degree in advanced nursing and national nursing certification related to what the candidate specialized in while in school.
Candidates must consider their career goals before taking an academic program and certifications to ensure their credentials illustrate their specialization. There may be additional requirements for a Nurse Practitioner, such as an application, proof of a collaborative agreement with a physician depending on the state the license was issued, acknowledgment of board standards, and a fee. The credentials for a Nurse Practitioner may also require periodic renewal. The final step is to apply for a job as a Nurse Practitioner.
The potential and possibilities for a Nurse Practitioner
According to a survey carried on International developments in advanced nursing practices, there is proof of the formation of recognized Advanced Practice Nursing roles in other countries like New Zealand. However, there was concern from these countries when implementing the Nurse Practitioners` positions for the first time that with task-shifting from doctors to nurses, the insufficient numbers of nurses that already exist will be further eroded(Pulcini et al, 2010).
However, the experiences in the U.S. seem to suggest the opposite. More jobs are being created for Nurse Practitioners, providing them with opportunities to take charge of programs in groups while making higher nursing education accessible, which stimulates an interest in nursing, a catalyst responsible for the increases in nurses' number.
Another potential that comes from being a Nurse practitioner is that with advanced nursing education, a nurse practitioner can advance career-wise in the healthcare and education sector. For example, a Nurse Practitioner can become a director of nursing services or a chief nursing officer. The Nurse Practitioners` roles have evolved over the years, leading to higher salaries and clinical decisions. This action seems to have attracted a lot of people to consider a nursing career. In the U.S., compared to other countries like Israel, nursing is one of the most preferred choices as a career.
Health services are on-demand with an increase in chronic disease and aging. There are academic arguments that primary health care needs a comprehensive approach that combines biomedical techniques with social determinants and social justice. The Nurse Practitioner role in the United States as an opportunity gives them a path to take up more charge critically to extend primary health care(Mannix & Jones 2020). Nurse practitioners can be used by the government, for example, to shore up the nature and style of existing primary careservice configurations. Nurse Practitioners can help lead a revolution against outdated approaches towards effective and genuine primary health care delivery systems.
There are challenges like insufficient nursing staff (both students and health workers in health facilities), the issue of an aging nursing workforce, and the delay in nursing payments that have seen an increase in demand for nurses. The Balanced Budget Act of 1997 opened new avenues for advanced practice nurses, including enhanced autonomy, to provide services and bills independently of the physicians(Schneider 1997).
These avenues have brought opportunities to an advanced practice nurse, who are entrepreneurs in nature, to practice their art independently and positively impact the health of communities with regards to the Federal government's vision of a "Healthy People 2010." Physicians will have no choice but to accept that advanced practice nurses' roles will continue to grow just like their opportunities. There is, therefore, a need for a collaborative practice arrangement to exist between them though Nurse Practitioners stand to gain most from these changes. For example, a Community Wellness Center offers an opportunity for independent practice.
How a Nurse Practitioner can incorporate each of the five advanced nurse roles
Nurse Practitioners have become the preferred health official for a large number of people. They act as clinicians that blend clinical expertise when performing diagnosis and treating health conditions with added focus on disease prevention and health management. They bring a perspective that is not only comprehensive but also personal to health care. Other nurse practitioners work for the National Institutes of Health (NIH). During clinical trial studies carried out by the National Institutes of Health, these advanced practice nurses are needed for protocols.
Nurse practitioners with plenty of experience can serve as administrators for hospitals or clinics. More nurse practitioners every day opening up their practices in collaboration with physicians. These Nurse Practitioners are pioneering forging the way forward (Brown and Draye,2003). Nurse Practitioners who display this act of demonstrating something new that has never been done before as a pioneer are only possible if the candidate in question has assumed the leadership role.
There are nurse practitioners who have the gift of teaching. The advantage of being a nurse practitioner is that you can teach and do clinical practice simultaneously. It is an opportunity for nurse practitioners to teach when caring for their patients and talk about disease management and self-care.
These actions create value-based reimbursement opportunities for nurse practitioners to play a significant role in influencing the developing standards for population-based health care. There was a review of non-physician medical educators, which examined that nurses contribute to learning through teaching directly and when evaluating medical learners.
Nurse Practitioners in Canada need to engage in evidence-based practice (EBP) while maintaining clinical competency as it is regulated, as per a province or territory (Wong &Farrally 2013). Therefore, advanced practice nurses, Nurse Practitioners are in a position to be leaders while participating in research meaningful to their settings.
They also maintain competency by reading and incorporating evidence-based publications into practice, attending conferences, and participating in informal organizations(Lambert & Housden 2017). Nurse Practitioners have a unique perspective on the healthcare system and patient care, which they can make in research.
'Consultant nurse' is a term that has been used as a title to refer to an 'advanced nurse practitioner. Although consultant nurses and nurse practitioners share similar roles and functions, each performance within these roles is different. A Nurse Practitioner forms a relationship with his/her patients, just like they share a direct care role. They can also provide independent clinical practice and make very complex decisions (Therefore, it enables the nurses to play a leadership role at a clinical level and a consultancy role by advancing others' practice at a strategic level as a consultant to implement change and innovation in medicine.
Address the regulations and scope of practice issues for a Nurse Practitioner
Scope of Practice
Nurse Practitioners' practice is almost in all health care settings, for example, the Veterans Affairs, the Indian Health Care facilities, clinics, private physicians, nursing homes, schools, and hospitals. The practice includes performing diagnostic tests and laboratory tests, prescribing medicines to patients, caring and counseling as well as teaching patients(Spurlock et al.,2019).
Licensed Nurse Practitioners practice autonomously in collaboration with health care professionals. They provide services that range from managing acute and chronic health problems and promoting good health habits through counseling and education. The scope of practice is not specific to the setting regarding a Nurse Practitioner but instead changes depending on the patient's need (APRN Consensus Model, 2008).
Nurse Practitioners are advanced practice registered nurses who have obtained graduate education, master's degree, or doctoral degree and obtain national board certification. Their education programs follow established standards to make sure one attains the APRN core, role core, and core competencies regarding population. These preparations provide Nurse Practitioners with knowledge and clinical competency that can enable them to practice their specialties in various settings.
Each Nurse Practitioner is responsible for his/her patient. Nurse Practitioners are expected to have a high level of ethics, certification, evidence-based principles, and practice standards.
The nurse practitioner role's patient-centered nature demands total commitment to meet the ever-changing needs of society and innovations in health care science. They are responsible to the public and adaptable to the dynamic changes in health care. They take responsibility for continuous professional development while being involved in professional organizations and participating in health and activities at all levels of government.
Practice Environment Details
Every Nurse Practitioner is permitted by State practice and licensure laws to perform a diagnosis, order, and interpret the test and manage the treatments, including prescribing medicines to patients and controlled substances, under the exclusive licensure authority of the state board of nursing (Mezibov 2000).
State practice and licensure laws restrict the ability of NPS to engage in at least one element of Nurse Practitioners practice. State law requires career-long supervision, delegation, or team management by another health provider for the N.P. to provide patient care.
The hospital bylaws in some states in the United States have impeded the regulations to practice within scope-of-practice. Safriet (2011) found that Nurse Practitioners with the same educational qualifications and certifications face many restrictions when moving from one state to another and, as a result limiting their scope of practice.
The physician's degree of supervision may affect practice opportunities and policies that dictate the pay for Nurse Practitioners. The nurses are being impacted by the variations in the scope of practice regulations (Hudspeth & Klein 2019).
Analyzing various documents by the National Council of State Boards of Nursing was conducted due to the current literature focusing on Nurse Practitioner SOP has led to reviewing the state-based statutes and rules(Bosse et al., 2017).There must be clarification and understanding of SOP as it is essential for safe practice. As inconsistent SOP regulation continues to exist between states, the Nurse Practitioners can find themselves in situations that place them in a position to breach their SOP regardless of the practice's not being setting specific.
Safriet (2002) found that Nurse Practitioners and other APNs, unlike R.N.s and M.D.s, do not have access to the same multi-state standard SOP and, as a result, face significant challenges in applying their full practice authority. One reason is the perception of Nurse Practitioners SOP infringing on long-standing medical SOP, which has served as the main reason why the physicians are supervising Nurse Practitioners. As healthcare demand has grown, several other disciplines have evolved their practice to include what medicine had previously asserted as their exclusive domain.
The training scope should be determined by the expertise of the license holder, the academic credentials, competency, and job position, not by the physician or the physician's role. The same Education consistency used to determine the quality of Nurse Practitioner' education, just like from one state to another, needs to be used on graduates of programs that undergo the same credential tests—one of the licensure criteria (Mezibov 2000).
While Nurse Practitioner licensure is not location-specific after introducing the Affordable Care Act, patients with complex conditions are being discharged from hospitals and seeking treatment in lower acuity medical settings. There is a need for regulations to be formed to check on Nurse Practitioners that are not qualified in acute care and have predominantly primary care experience.
Synthesize how regulations and scope of practice issues can impact role evolution for the chosen Advanced Practice Nursing role, Nursing Practitioner
The study includes guidelines for putting the main messages into action, and it acknowledges that "overly restrictive scope-of-practice regulation of N.P.s in some states is one of the most serious obstacles to affordable treatment" (IOM, 2010). Soon after the publication of this study, the Robert Wood Johnson Foundation (RWJF), in collaboration with the American Association of Retired Persons (AARP), initiated the Nursing Movement for Action Campaign, which has since worked to shepherd the report's recommendations at the national and state levels(Maier & Aiken 2016).
The IOM suggests that the nursing community, other health professions associations, and policymakers create a common ground to eliminate the scope of practice constraints and increase interprofessional cooperation to promote the formation of these models that increase access to quality health care.
Using the Nurse Practitioners more effectively in health care delivery is a proposal that tries to expand the primary care capacity, which is moderated by state scope-of-practice regulations. Such regulations limit the Nurse Practitioners from providing care to the fullest extent of their education. However, there is evidence that some states have reduced restrictions on SOP regulations to give an independent Nurse Practitioner environment that is strategic and effective to increase the primary care capacity and health care utilization (Gadbois et al.,2015). States that have shortages of PCPs and increased care demand would benefit greatly from this move.
With the scope of practice restrictions being restricted, the (NPS) Nurse Practitioners could meet the demand for primary care services in urban and rural areas even with regulations varying from state to state regarding ARNPs' scope of practice and level of professional autonomy.
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