Advanced Practice Nurses: A Case Study

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,

The roles of advanced practice nurses have been an ongoing debate in many states. In a globalized world, advance nurse leaders are regarded as forefront leaders that provide first-rate healthcare to the public. However, the role of new advanced practice nurses is known to be complex. Advance practice nurses use countless different strategies and nursing theories to improve the wellbeing of their patient. To improve the well being of all patients, there is a growing demand for advance practice nurses worldwide. The advanced practice roles of CNM, CNP, CNS, and CRNA require a toolbox of skills, understanding, and integrative abilities that synthesize advanced practice nursing knowledge" (Buppert, 2011). With the rapid development of the advance practice nurse leader, the national organization of Nurse Practitioners are eager to help ensure the competencies of the diverse roles of APN.

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).

Some practical obstacles that hinder the delivery of proficient and economical services include differences in language, cultural and knowledge of health issues. However, the prudent advanced practice nurse (APN) considers these obstacles to communication when providing patient-centered care. Nevertheless, when language barriers are not addressed, the provision of quality care to patient and families are undermined, which then transcends to both economic and ethical dilemmas. According to the centers for disease control and prevention (CDC, 2016), the gateway to healthcare is often hindered to a great extent by the lack of the ability to communicate medical necessities due to language barrier. In any clinical setting, efficient patient communication is essential in the delivery and accessibility of quality care and safety.

The four that I will address are the Nurse Anesthetist, the Clinical Nurse Specialist, the Nurse Practitioner and the Nurse Mid-wife.

Among older adults aged 65 years and older are found to have difficulty in reading and to comprehend discharge instructions. This has been found to be a concern regarding continuing care and re-admission concerns throughout urban and rural hospitals. Does the integration of Advanced Practice Nurse (APN) guiding discharge education, along with a follow-up contact with the patient after discharge effect compliance and readmission rates, more than not having an APN guiding discharge teaching to help decrease readmission rates?

The advanced practice nurse is on the front lines of care being received or falling short within their community. By having direct asses to the success and failures of health care in the community, the advanced practice nurse (APN) can be the voice of patient to the officials having an impact on health care accessibility. The purpose of this paper is to address a current problem by evaluating multiple influencing factors and investigate a policy capable of changing and providing a more positive outcome.

As the young and rapidly-aging population continues to increase, the demands of primary, acute and chronic disease management will also increase. As a result, more health care professionals who provide primary care will be needed to meet these demands. Thus, the emergence of Advanced Practice Registered Nurse (APRN) evolve. APRN is a nurse who has completed a graduate degree and has acquired advanced knowledge and skills. APRNs are grounded with theory, concepts and principles that enable them to assess, diagnose, treat and manage their patients. APRNs can work in conjunction with other health care professionals or independently. APRNs improve access to health care by providing care in the rural and underserved areas. APRNs also reduce the cost to health care (Joel, 2013).

As our healthcare continue to evolve, Advanced Nurse Practitioners' role is a crucial key component in the way health care is delivered in multiple settings, particularly in the primary care to improve patient's health outcomes. Nevertheless, the existing barriers limit nurse practitioners to practice to full capacity or extent of their training and education. One of the main obstacles faced by the advanced practitioners are the laws that govern the profession. Presently, NP practice rules and regulations vary from state to state(Hain and Fleck, 2014).

Tennessee board of nursing offers advanced nursing registration to nurses with qualifications at graduate levels who have achieved certifications in various areas of specializations. The state board applies the title Advanced Practice Nurse (APN).The state board also recognizes the advanced practice obligations as provided in the National Council Of State Boards Of Nursing (NCSBN). The four advanced practice roles are Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist and Nurse Midwife. APNs in the state of Tennessee must also be licensed as registered nurses. In the event that the nurse resides in another state, RN licensing is done in the state of residence. The

The National Council of State Board of Nursing (NCSBN) is a governmental body mandated to regulate nursing practice in various states in the United States of America. Each state has its own regulatory rules that must be adhered to by every practicing nurse in the concerned region. Depending on the location of the Advanced Practice Registered Nurse (APRN), the NCSBN subdivides nursing practice regulations into three different classes: full practice, partial practice, and restricted practice. Therefore, it is of the essence to examine the nature of practice in different states before an APRN begins training. This paper will take a detailed look at the state of nursing practice in Texas and Arizona. Apart

Advanced practice nurses in Australia, much like other places around the world, were initially trained in a specific clinical setting, such as nurse anaesthetist, nurse midwife or clinical nurse specialist, due to an identified need, which determined their roles (Jansen & Zwygart-Stauffacher, 2010). However, as the need for these roles have become more varied, for example wound care nurse, breast care nurse or diabetic educator, the specific core roles have increased, while becoming more defined within each individual clinical setting (Hamric, Hanson, Tracy & O’Grady, 2014). There is a common theme regarding the core functions of an advance practice nurse, these include professional leadership and development, expert practice, consultancy,

Of the analyzed schools, the University of Saint Joseph requires the lowest number of practicum hour requirements to fulfill the course objectives, that being 60 practicum hours. The MSN handbook describes the course as guided by an examination of each of the eight NLN core competencies. Within the 2016 MSN handbook, it is stated that the course provides students with “the opportunity to examine role and function of the advanced practice nurse in the educator role is examined through the “delivery of educational pedagogy in academic and health care settings.” The course is a blend of classroom and online classes, including the teaching practicum, which is graded as pass/fail. The blended classroom experience utilizes a face-to-face, “Go-to-meeting” format and self-paced online activities involving group activities using Blackboard; chats, blogs, emails, journaling, and web posting are also incorporated. Throughout the semester, weekly practicum experiences are recorded in a log which is reviewed at mid semester and at course completion. Each journal entry is expected to be a short summary of the week’s experience and include one-two references related to the educational concept of that particular week; the journal entries account for 35% of the class grade. In addition, when classes do not physically meet, online discussions of learning experiences, based on course objectives and evidencing literature reviews related to the learning experiences, are shared; this

There should be a support system for new nurse practitioners that is established in graduate school and carried into the first two years of practice. Each graduate school of nursing should have a list of previous graduates who would like to share their experiences as nurse practitioners and help novice practitioners find their way through the transition. Conner (2014) concluded that a support system can be an effective coping mechanism for stress and anxiety. It provides an opportunity for the sharing of information, positive encouragement, and nurturing. Support systems can benefit new family nurse practitioners in their transition.

A nurse provides consistent bedside assistance toward patients and follows order from physicians. Lesley fudge relates nurses are deemed as “Cinderella of healthcare” the “Second-class healthcare workers” (2006). Therefore, nurses feel intimidated when communicating with a physician. In addition, to feelings of intimidation, nurses are consumed with stress from nurse shortages, increase load of responsibilities (Fudge, 2006), and colleagues conflict (Riley & Manias, 2006). A journal article published in 2015 entitled “Managing and mitigating conflict in healthcare teams: an integrative review” stated that “In the USA, 53% of nurses reported conflict as common and contributing to practice errors” (Almost, Wolff, Stewart-Pyne, McCormick, Strachan & D’Souza, 2015). Therefore, how do physicians and nurses presume a collaborative partnership?