Advanced Nursing Role

There are four types of Advanced Practice Nurse roles, the nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, and certified nurse-midwife. The Family Nurse Practitioner is the advanced practice role that will be discussed. According to Hamric, Hanson, Tracy, and O 'Grady (2014) the primary care NP provides care for patients in diverse settings, including community-based settings such as private and public practices, acute, and long-term care settings across the life span (pg. 396). Family Nurse Practitioners have faced many challenges in the medical profession to be recognized as health care providers. Most of these challenges where from fellow nurses. According to Hamric, Hanson, Tracy, and O’Grady (2014) conflict and discord about the Nurse Practitioner role continued to characterize relationships between NPs and other nurses (pg. 18). Despite the resistance to NPs in nursing, physicians increasingly accepted NPs in individual health care practices (Hamric, Hanson, Tracy, and O’Grady, 2014, pg. 18). Physicians readily accepted the role of the Nurse Practitioner, working together to improve patient outcomes and safety.

My first encounter with a Certified Registered Nurse Anesthesia (CRNA) was during my undergraduate nursing OB/GYN rotation. I was impressed with the CRNA when she placed the epidural to the patient in labor. I remembered patient had difficulty staying still due to the contraction, but the CRNA took her time to explain the procedure while comforting the distressed patient. Once the epidural was in placed and the medication started working, I could tell the relief the patient experienced. I realized then that a CRNA goes beyond the delivery of anesthesia, pain management and monitoring of patients. Thus, obtaining this degree will prepare me to ease the patient’s mind through education, pain management, monitoring, experience and compassion.

Healthcare systems and the way safe, quality health care is delivered are continually changing to better serve patients and communities. Professional nursing practice is a large component in the healthcare system today. Back in the 1960s, professional nursing leaders tried to adopt the bachelor degree programs as the only educational track to become a registered nurse (Creasia & Friberg, 2011). Due to nursing shortages and demands this motive did not hold fast. Individuals entering the nursing profession today must first decide which educational pathway to take to become a Registered Nurse (RN).

Credentialing from advanced practice registered nurses (APRNs) perspective is defined as “furnishing the documentation necessary to be authorized by a regulatory body or institution to engage in certain activities and use a certain title” (Hanson, 2014). Credentialing is also define from a local institutional process that consider specific documentations for APRN before they assume the practice role as APRN within their facility. In health care system, credentialing ensures individuals meet required standards of practice and is prepared to perform those duties implied by the credentials. National certification and education are considered as part of credentialing for APRN to acquire basic level of competence to practice. (Hanson, 2014)

Nurse Anesthetists are also known as CRNA, which means Certified Registered Nurse Anesthetists. Being a CRNA, one has big shoes to fill when it comes to their job. CRNA’s work with anesthesiologist surgeons and other physicians and medical professionals to give anesthesia to patients undergoing medical and surgical procedures. CRNA’s care for patients before, during and after a medical or surgery by doing a patient assessment , preparing the patient for anesthesia, they must maintain the anesthesia throughout the whole procedure to secure the proper sedation, and pain management, and as a CRNA they must make sure the patient recovers from the anesthesia properly. CRNA’s usually overshadow anesthesiologists. They perform much of the work

The purpose of this paper is to describe the role of health care reform with regards to the evolution and development of advanced practice nursing (APN) in the United States. Foundational aspects prominent in the development of defined APN roles include the health needs in society, support for innovation in health care, governmental health policy and regulation, health workforce supply and demand, and the development of advanced education, among other factors (Ketefian et al., 2001). APNs are comprised of nurse anesthetists, nurse midwives,

There have been concerns regarding the identification and credentialing of advanced practiced registered nurses (APRNs). A APRN is a registered nurse who has successfully completed an accredited graduate-level education program, in which the individual is well prepared and successfully passed the nationwide certification examination (APRN Consensus Model, 2008). However, there are still debating issues of who would fall under the APRN category. The National Council of State Boards of Nursing (NCSBN) has identified four APRNs who are deem fit to be called ARPNs; however, only two will be named. They would be certified registered nurse anesthetists (CRNAs) and certified nurse practitioners (CNPs). Whereas, the nurse informatics and the nurse administrations are not considered to be APRNs; although, they are still license registered nurses but they do not provide direct patient care and are not required to take the national certification examination (ARPN Consensus Model, 2008).

Merriam-Webster (2015) defines a nurse practitioner (NP) as ?a nurse who is qualified through advanced training to assume some of the duties and responsibilities formerly assumed only by a physician.? The NP is a direct care provider that provides a plethora of services ranging from primary prevention to disease management. For example, the NP has authority to monitor and alter drug therapies and order diagnostic tests.

As a practitioner or a population health coach, both APNs considered other nurses at any level, and physicians within the same discipline, as her peers. Over the course of their professional careers, increased confidence, trust, and knowledge were the commonalities with evolving roles. The confidence and trust originates with oneself, then, includes that of her co-workers and physicians, but mostly from her patients. Maturing from the novice RN to an expert APN, the confidence and knowledge base has developed, building an individual practice and supporting patients and communities towards optimal health. Each considered autonomy the greatest privilege guaranteed them as APN.

The CNS can be defined as an expert in their field (Hamric, Hanson, Tracy, O;Grady, 2013). Hamric, Hanson, Tracy, and O’Brady (2013), also states that the CNS had a positive effect of patient outcomes and nursing care improvement (p. 13). CNSs have very specialized skills that are need in practices, organizations and hospitals. As mentioned by Hamric, Hanson, Tracy, O;Grady (2013), “Specialists in nursing were important to patients and physicians” (p. 14). According to (Stephens, 2009) Clinical Nurse Specialists (CNSs) play a unique role in the delivery of high quality nursing care. These clinicians are experts in evidence-based nursing and practice in a range of specialty areas. These reasons are why I think that CNSs are a valuable nursing

The afore= mentioned issues being addressed through legal channels by the AANP are barriers to effective and efficient practice, the type of barriers that were to be eliminated by the expansion of the Affordable Care Act (ACA) (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Only twenty-two states have allowed full practice authority, which is less than half of the nation. It is imperative that every advance practice nurse has a voice that is heard in their state and the nation, this is the message of the AANP (Hain & Fleck,

Three issues or trends I see that are important with regard to credentialing are reimbursement, malpractice and education. Within each issue are opportunities for the advance practice nurse (APN) to grow in knowledge and participate in change. It is important to understand why each one effects credentialing for the APN.

CRNAs carry a cumbersomely hefty load of responsibility and are compensated accordingly. The reported average annual salary in 2012 was approximately $157,000 with more experienced CRNAs earning up to $214,000 each year. The prospects for finding a good job in this field are excellent for the future. According to the U.S. Department of Health and Human Services, there is a consequential and growing desideratum for CRNAs across the country. More and more community hospitals are opting to employ a team of highly eligible CRNAs than a single, high-cost anesthesiologist. Projected job magnification for CRNAs between 2012-2022: 25% (more expeditious than the 19% magnification projected for RNs and the 11% average for all

"They are also more likely to provide disease-prevention counseling, health education, and health-promotion activities, as well as to know about and use community resources, such as nutrition programs, self-help or group therapy, and parenting and stress-reduction programs" (Mandelblatt 1993). Clinical Nurse Specialists are also proving that high-quality, cost-effective care can be given in place of medical care of inpatients who are stable (Knickman 1992).

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).