Nurse Anesthetists: Advanced Practice Registered Nurses

Advanced Practice Nurses are Registered Nurses with specialty training at the master 's-degree level, in primary care settings, such as the Nurse Practitioners and Nurse Midwives and acute care of inpatients, such as the Clinical Nurse Specialists and in operating rooms, such as Nurse Anesthetists. This has opened a door in the nursing field. Nurses ' roles are no longer limited. Nurses now have opportunities to advance their career and expand their roles. Advanced Practice Nurses can be more directly involved in patient care

Introduction 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.

Advanced Practice Nurse Professional Development Plan The role of the Advanced Practice Nurse (APN) is expanding internationally throughout the healthcare system. Since the initiation of the Patient Protection and Affordable Care Act in 2010, there has been an increased need for APNs due to the growing demand for primary care services and increased population that have gained healthcare coverage (Lanthrop & Hodnicki, 2014). The purpose of this paper is to explore the role of APN and develop a professional development plan for my future career.

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.

The Development of Advanced Practice Nursing: The Role of Health Care Reform Lauren Minimo Azusa Pacific University The Development of Advanced Practice Nursing: The Role of Health Care Reform 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,

Advanced Practice Registered Nurses 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).

Nurse Practitioner Role The success of NPs depends on practicing evidence-based care with competency in assessment, diagnosing, managing patients, and maintaining a caring practice. The nursing component of the NP role continues to be challenged from within nursing, as well as by large national physician organizations. NPs are extensions of nursing practice who are guided by nursing theory. The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health,

According to the American Association of Colleges of Nursing (2015) the traditional roles of the advanced practice nurses include nurse practitioners, clinical nurse specialists, nurse midwives and nurse anesthetists. Therefore, the impact of the research on the practice of the preparation of DNP nurse educator requires education in evidence-based practice, quality improvement, leadership, policy advocacy, informatics, and systems theory. Furthermore, transitioning to the DNP as a nurse educator does not change the current scope of practice of the Advance Practice Registered Nurses (APRNs) for their current roles. The transition of the DNP better prepares APRNs by utilizing new models of the care delivery system and growing complexity of health

Healthcare reform in the United States (U.S.), continues to be a hot topic in the news. Whether it discusses how the program will be financed, the need to redesign the organization, or how the process of delivering healthcare will be implemented; one thing that is a frontrunner, is the need for registered nurses (RNs) and advanced practice registered nurses (APRNs) to fill the increased demands on the primary care system (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 375). “Several programs and initiatives included in the health reform legislation involve interdisciplinary and cross-setting care coordination and care management services of RNs” (Institute of Medicine, & Robert Wood Johnson Foundation, 2011, p. 377).

Reimbursement for the advanced practice nurse (APN) is improving but how they fit into reimbursement systems is vey important. One question that arises is if the APN should be paid the same fee for service as a physician or should only a percentage of the payment be received. Most third-party reimburses, which include a few large insurance companies are now reimbursing APNs and more states are getting on board with reimbursements by developing reimbursement models for APNs (Hamric, 2009). For example, Aetna US Healthcare, Anthem Blue Cross and Blue Shield of Kentucky, Medicare and Medicate all credential NPs as primary care providers and pay at 85% of the physician rate. Tricare of Kentucky credentials NPs and pays 100%.

NSG5000 Final Project The Nurse Practitioner, Nurse Educator, Nurse Informaticist, and Nurse Administrator have different educational background and training, thus they play a different role in the field of advance practice nursing but they have a common goal, and that is to ensure a safe and effective delivery of care to every patient, regardless of the type of health care setting. The difference is their roles lies in the fact that the Nurse Practitioner practices in the advanced clinical role while the Nurse Educator, Nurse Informaticist, and Nurse Administrator have the non-clinical roles. Having a clinical role means that the having a direct contact with patient. The NP’s main role is to provide direct care to patient, making diagnosis

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).

NPs are not only moving into increased roles within the acute care hospital setting, but also into roles in the community as Primary Care Providers (PCPs). The anticipated shortage of physicians to handle an increased number of aging patients already affects my position as a staff nurse at a hospital. A career in nursing offers countless paths to further your education, whether it is to become a specialist in a field of practice, foray into research or to pursue a position as a nurse practitioner. I was interested to learn more information about how expanding the role of Advanced Care Nurse Practitioners (ACNP) may relieve shortages of physicians and lessen the burden on our current healthcare system. Increasing the roles of ACNP would only be feasible if patients are still receiving quality care while decreasing the cost of healthcare. As a nurse returning to school to further my education, I would like to know if pursuing a career as an ACNP would be a viable option for me to continue to interact with patients in an acute care setting in a more specialized role.

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).

“Advanced nursing practice is the deliberative diagnosis and treatment of a full range of human responses to actual or potential health problems.” (Calkin, 1984). Advanced nurse practitioners attempt to maximize the use of knowledge and skills and improve the delivery of nursing and health care services. The field of advanced nursing practice differs from basic practice as the former requires clinical specialization at the master’s level. At this level, nurses become expert practitioners whose work includes direct and indirect patient care. Direct patient care involves caring for patients and their families; this is the focus of my section on nurse clinicians. Indirect patient care includes work as an educator, researcher, and a