Nursing Nurse Practitioner : An Integrative Approach

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.

These organizations developed the Consensus Model document in 2008 to unify practice, identify APRN clinical roles, identify the acceptable titles to for NPs, and define the requirements for general practice and licensure. Note to mention that laws and regulations statute on the APN scope of practice may vary by states, whereas some adhere to full scope of practice, other to reduced practice, or restricted practice. For instance, the state of Florida defines advanced registered nurse practitioner as a licensed person with ability to practice professional nursing and certified to in advanced or specialized nursing practice (Buppert, 2011). The four advanced clinical specialized roles include certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialist, and nurse practitioners (Buppert, 2011). In terms of licensure, 46 states out of 50 require nurse practitioners to pass a certification exam. The Florida Board of Nursing requires certification by an appropriate specialty board and graduation from a program leading to a master’s degree (Buppert,

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).

An advanced practice registered nurse (APRN) is an umbrella term consisting of but not limited to roles such as Psychiatric Mental Health Nurse Practitioner (PMHNP); Adult Geriatric Primary Care Nurse Practitioner (AGPCNP); Certified Nurse Midwife (CNM); and Certified Registered Nurse Anesthetist (CRNA). Across the Commonwealth of Massachusetts, it is an undeniable fact that APRNs care for multitudes of patients across the entire human lifespan and across many certain from the nursing homes and home care to hospitals, pain clinics, and substance abuse centers.

An Advanced Practice Registered Nurse is a nurse who has obtained at least a Master’s Degree in Nursing. Further specialization within in the APRN category includes Nurse Practitioners, as well as Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists. APRNs have the education, training, and skills to perform many of the primary-care

Advanced Practice Nursing (APN) covers four types: Certified Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists.

Advanced practice registered nurses (APRNs), whether they are nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse anesthetists (CRNA), or nurse midwife (CNM), play a pivotal role in health care (American Nurses Association [ANA], 2015). APNs are quite often providing primary, preventative, chronic, and routine care to patients. According to BMJ Open (Kanda et al., 2015) nurses are on the frontline and continue to be the largest profession in the world. APRNs obtain at least a Master’s degree, have an expert knowledge base, possess superlative clinical skills and demonstrate complex decision making skills often time utilizing the interdisciplinary team approach. As Indicated by the Journal of Pediatric Health Care,

The educational requirement for advanced nursing practice is a master’s level education in a program or track leading to APN licensure, including graduate degree-granting and post-graduate certificate programs with established educational standards and attainment of the APN core, role core and population core competencies (National Council of State Boards, 2012). APN’s acquire increased knowledge in the sciences of anatomy, physiology, microbiology, chemistry, pathophysiology, and pharmacology. The core curriculum for the advanced practice role includes priorities in

Errors pervade in our lives whether it is our home, in our workplace, or in our society. The effects of healthcare errors have impacted all our lives either directly or indirectly. Patient safety and quality care are at the core of healthcare system which strongly depends upon nurses. “To achieve goals in patient safety and quality, thereby improve healthcare, nurses must assume the leadership role. Nurses need to ensure that they and other healthcare providers center healthcare on patients and their families. Even though the quality and safety of healthcare is heavily influenced by the complex nature

Nursing and healthcare continue to change on a daily basis. The one thing that has remained constant during these changes is maintaining the safety of our patients. By maintaining their safety, nurses must ensure that they are keeping up-to-date with the changes in technology now being introduced in healthcare, new and emerging diseases, new equipment, and changes in treatment modalities. One such responsibility is ensuring that nurses do not operate equipment they were not oriented to or trained to use in an effort to prevent injury patients. Nurses and other healthcare professionals are being held accountable for practicing within their scope of practice based on their licensure regulations, and the company policies and procedures. Therefore, nurses are responsible for their professional growth and practice by ensuring that they comply with the necessary standards required by their profession.

An Advanced Practice Nurse (APN) is described as a registered nurse with a graduate level education in nursing from an accredited college or university. Over the years, the APN has become a vital part of the healthcare team providing affordable, advanced care both in and out of the hospital setting. An APN has extended his/her nursing skills by not only past and present experiences but also by research. It is crucial for an APN to be grounded in research and theory and to allow that knowledge to guide his/her clinical practice. The APN gains insight from different ways of learning, ways of becoming scholarly, theories, and models that will directly affect the outcomes of his/her practice.

According to Rounds (2013), the Consensus Model has defined the APRN as a graduate level practice role where the nurse has successfully completed the national certification exam for the certified registered nurse anesthetist (CRNA); the clinical nurse specialist (CNS); the certified nurse practitioner (CNP); the certified nurse-midwife (CNM). The Consensus Model was created to speak on the widespread positive changes within the APRN practice and throughout the United States. Also, nursing frontrunners noted the shortage of standardized APRN practice, which limits the compactness of APRNs between states. This model creates unity within the practices and supports patient safety.

Patient safety must be the nurses’ number one priority in providing optimum patient care. Patient safety always starts with proper patient identification with two different identifiers like name, date of birth and hospital identification number (Perry, Potter, & Ostendorf, 2016, p.47). Proper patient and family education about safety can make patient care much easier.

In nursing, “patient safety and quality of care are two of the main cornerstones of nursing practice” (Hunt, 2012). It is the nurse’s responsibility to make every effort to provide a safe environment and care for patients without making errors. In an effort to keep patients’ safety intact, “The Joint Commission and the Agency for Healthcare Research and Quality developed standards for healthcare organizations to employ in an effort to reduce the number of errors” (Hunt, 2012). Robert Wood Johnson Foundation developed a project in 2005, which would eventually become the Quality and Safety Education for Nurses (QSEN) competencies (Hunt, 2012). The QSEN competencies were developed to ensure quality patient centered care. They are: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (QSEN Institute, 2014). These competencies have been implemented in an attempt to decrease sentinel events. However, sentinel events continue to occur, especially when nurses become careless (Hutchinson et al., 2009, p. 2).

Patient safety and good health outcomes are the main focuses of today’s complex health care system (Hendricks, Cope & Harris 2010, p. 252). However, short hospital stays, complexity of patient care, high nurse patient ratio and high pressure work surroundings have contributed to decreased patient satisfaction and safety. As a result health care professional are required to pay more attention to these issues. Nurses are considered competent, valued and necessary for improvements in patient quality care as they work 24 hours and 7 days a week (Vaismoradi et al. 2014, p. 107). They are also expected to work in collaboration with other health care professional and to become advocates on behalf of their patients. Therefore, registered nurses