Roles for advanced practice nurses

Discussion essay One:

As with many progressive changes in health care, the evolution of advanced practice nursing (APN) arose from a need to provide improved access to health care in underserved populations (Stewart, 2021). Stewart notes that the first APN education program was based on the nursing model of care but that it progressed to teaching students how to provide primary care and make medical diagnoses.

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Today, APN has evolved to include specialties of advanced practice registered nurses (APRNs), including nurse anesthetists, nurse midwives, and nurse practitioners with varying areas of specialty. The unique roles of the APRN include not only providing advanced-level direct patient care, but also expands to other indirect-care roles such as nurse educators, community and public health nursing, and various other leadership roles within health care. Stewart also highlights the importance of the APN role to inform and assist in designing and implementing healthcare delivery systems to improve quality of care.

Admittedly, I previously found the delineation between doctor of nursing practice (DNP) and masters-prepared APRNs to be unclear and ambiguous. The American Association of Colleges of Nursing (AACN, 2021) suggests similar level 2 sub-competencies for both masters-prepared APRNs and DNP roles, aside from the DNP requirement of a scholarly project with a systems focus. I found that Stewart’s (2021) description of the roles of masters-prepared APRN and DNP provided more clarity to the respective roles. Stewart discusses how the DNP-prepared APRN provides direct patient care within a certain context that allows the DNP graduate to “use their understanding of the practice context to document practice trends, identify potential systemic changes, and make improvements in the care of their particular patient populations in the systems within which they practice” (Stewart, 2021, p. 31). In other words, the DNP role considers factors beyond individual patient care to include ways to improve health care delivery at the systems level. Further, the DNP-prepared APRN brings a unique body of knowledge in leadership, policy, informatics, evidence-based practice, quality improvement, and can become educators of future APRNs (DeNisco & Barker, 2021).

While the courses in my degree plan surely combine to provide a holistic and rounded educational experience that will meet all level 2 sub-competencies under each domain listed by AACN (2021), it seems that the core courses focusing on advanced health care assessment, primary care of chronic disease, acute disease, and pediatric patients will provide curriculum material that most closely aligns with the AACN competencies. Further, it seems that the synthesis practicum courses and clinical rotations toward the end of our curriculum is where we as APN students will receive the most enriching experiences that allow us to truly develop and hone the level 2 sub-competencies listed by the AACN. The AACN’s domain 6 discusses developing inter-professional partnerships through interdisciplinary collaboration, while domain 9 discusses fostering our professional identity in practice. Throughout the family nurse practitioner program curriculum, I have already seen evidence of the AACN’s level 2 sub-competencies at work. An example of working toward domain 6 competencies is through our work in small groups/teams doing collaborative assignments and group discussions. We are able to reflect our roles, values, and dynamics and how we influence team performance (AACN, 2021).

APRNs go beyond identifying theoretical concepts in nursing to translating and applying scientific evidence to practice, which is a component of AACNs domain 1: knowledge of nursing practice (2021). Domain 1.2 further posits that the APRN use theory and research-based knowledge from nursing and other disciplines to inform education, practice, and research. Importantly, nursing practice decisions must be justified and made in a systematic manner, which is where the application of theory and research is required (AACN, 2021). Scientific knowledge should guide care decisions, so the APRN must remain informed through lifelong research. Stewart (2021) further suggests that APRN should be familiar with nursing theories and use them to guide practice. The discipline of nursing has fostered a health care framework that emphasizes interpersonal relationships and humanistic care, which has lent to the development of its own unique theories that should continue to inform nursing practice.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf (Links to an external site.).

DeNisco, S. M., & Barker, A. M. (2021). Introduction to the role of advanced practice nursing. In S. M. DeNisco (Ed.), Advanced practice Nursing: Essential knowledge for the profession (4th ed., pp. 5-21). Jones & Bartlett Learning.

Stewart, J. G. (2021). Historical perspectives: The art and science of nurse practitionering. In S. M. DeNisco (Ed.), Advanced practice Nursing: Essential knowledge for the profession (4th ed., pp. 23-46). Jones & Bartlett Learning.

Edited by Meagan Gamlen on Jun 16 at 11:50am

Discussion two

As with many progressive changes in health care, the evolution of advanced practice nursing (APN) arose from a need to provide improved access to health care in underserved populations (Stewart, 2021). Stewart notes that the first APN education program was based on the nursing model of care but that it progressed to teaching students how to provide primary care and make medical diagnoses. Today, APN has evolved to include specialties of advanced practice registered nurses (APRNs), including nurse anesthetists, nurse midwives, and nurse practitioners with varying areas of specialty.

The unique roles of the APRN include not only providing advanced-level direct patient care, but also expands to other indirect-care roles such as nurse educators, community and public health nursing, and various other leadership roles within health care. Stewart also highlights the importance of the APN role to inform and assist in designing and implementing healthcare delivery systems to improve quality of care.

Admittedly, I previously found the delineation between doctor of nursing practice (DNP) and masters-prepared APRNs to be unclear and ambiguous. The American Association of Colleges of Nursing (AACN, 2021) suggests similar level 2 sub-competencies for both masters-prepared APRNs and DNP roles, aside from the DNP requirement of a scholarly project with a systems focus. I found that Stewart’s (2021) description of the roles of masters-prepared APRN and DNP provided more clarity to the respective roles. Stewart discusses how the DNP-prepared APRN provides direct patient care within a certain context that allows the DNP graduate to “use their understanding of the practice context to document practice trends, identify potential systemic changes, and make improvements in the care of their particular patient populations in the systems within which they practice” (Stewart, 2021, p. 31).

In other words, the DNP role considers factors beyond individual patient care to include ways to improve health care delivery at the systems level. Further, the DNP-prepared APRN brings a unique body of knowledge in leadership, policy, informatics, evidence-based practice, quality improvement, and can become educators of future APRNs (DeNisco & Barker, 2021).

While the courses in my degree plan surely combine to provide a holistic and rounded educational experience that will meet all level 2 sub-competencies under each domain listed by AACN (2021), it seems that the core courses focusing on advanced health care assessment, primary care of chronic disease, acute disease, and pediatric patients will provide curriculum material that most closely aligns with the AACN competencies. Further, it seems that the synthesis practicum courses and clinical rotations toward the end of our curriculum is where we as APN students will receive the most enriching experiences that allow us to truly develop and hone the level 2 sub-competencies listed by the AACN. The AACN’s domain 6 discusses developing inter-professional partnerships through interdisciplinary collaboration, while domain 9 discusses fostering our professional identity in practice. Throughout the family nurse practitioner program curriculum, I have already seen evidence of the AACN’s level 2 sub-competencies at work. An example of working toward domain 6 competencies is through our work in small groups/teams doing collaborative assignments and group discussions. We are able to reflect our roles, values, and dynamics and how we influence team performance (AACN, 2021).

APRNs go beyond identifying theoretical concepts in nursing to translating and applying scientific evidence to practice, which is a component of AACNs domain 1: knowledge of nursing practice (2021). Domain 1.2 further posits that the APRN use theory and research-based knowledge from nursing and other disciplines to inform education, practice, and research. Importantly, nursing practice decisions must be justified and made in a systematic manner, which is where the application of theory and research is required (AACN, 2021). Scientific knowledge should guide care decisions, so the APRN must remain informed through lifelong research. Stewart (2021) further suggests that APRN should be familiar with nursing theories and use them to guide practice. The discipline of nursing has fostered a health care framework that emphasizes interpersonal relationships and humanistic care, which has lent to the development of its own unique theories that should continue to inform nursing practice.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf (Links to an external site.).

DeNisco, S. M., & Barker, A. M. (2021). Introduction to the role of advanced practice nursing. In S. M. DeNisco (Ed.), Advanced practice Nursing: Essential knowledge for the profession (4th ed., pp. 5-21). Jones & Bartlett Learning.

Stewart, J. G. (2021). Historical perspectives: The art and science of nurse practitionering. In S. M. DeNisco (Ed.), Advanced practice Nursing: Essential knowledge for the profession (4th ed., pp. 23-46). Jones & Bartlett Learning.

Edited by Meagan Gamlen on Jun 16 at 11:50am

Disscussion three

The advanced practice registered Nurse (APRN) role was first established to provide healthcare to underserved populations (Stewart, 2021).  The APRN role has primarily been created by nurses seeing ways to fix problems in healthcare. Many of these problems were in areas where there were not enough physicians to cover specific tasks. The first nurse practitioner program was established at the University of Colorado by Loretta Ford and Henry Silver, the program was established as a means for pediatric nurses to practice under physicians and provide outpatient services. In the beginning, nurse practitioners who practiced under providers had to take time out of a visit to describe their purpose. Now many patients primarily see a nurse practitioner (Berg, 2020).

When the coronavirus pandemic occurred, nurse practitioners gained the power to do even more; although this emergency order for nurse practitioners to practice at the full scope of their authority is temporary, it will be interesting to see if it becomes permanent. Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), nurse practitioners are now permanently able to sign home health orders (Stucky et al., 2020). This has made a significant impact in the home health field, as nurse practitioners are often easier to reach, allowing more patients to receive home health.

The coursework in my degree plan compares closely with competencies listed in the Essentials document by the American Association of Colleges of Nursing (AACN). (American Association of Colleges of Nursing, 2021). The competencies are split up among ten domains. All the core classes required for the degree are reflected in the domains. The philosophy class closely fits with domain one, which covers nursing theory. The advanced nursing practice class is reflected in domain nine, which covers professionalism and ethics. The advanced assessment class taken can be seen in domain two, which covers patient-centered care and covers the integration of assessment skills (American Association of Colleges of Nursing, 2021).

I believe that all the core classes for my degree plan will assist in developing my skills as an APRN. Advanced practice nurses can run diagnostic tests, prescribe medications, treat chronic and acute conditions, and manage a patient’s overall care. A doctorate in nursing practice (DNP) is now considered as a “terminal practice degree”(Chism, 2021, p. 50). DNP students must also complete a scholarly project that will “focus on a change that affects healthcare outcomes either through direct or indirect care” (Stewart, 2021, p. 29).

Research and theory are critical to the APRN role. Theory allows nurses to look at their own beliefs and incorporate them with early theories to find their best practice. It can help nurses to reflect on not just a diagnosis but the patient as a whole. Research allows nursing to improve continually; just because a procedure or treatment regimen has worked in the past doesn’t mean it will always be the best way. Research can help to improve the quality of healthcare that is provided.

References

American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education [PDF]. www.aacnnursing.org. https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf (Links to an external site.)

Berg, J. A. (2020). The perils of not knowing the history of the nurse practitioner role. Journal of the American Association of Nurse Practitioners, 32(9), 602–609. https://doi.org/10.1097/jxx.0000000000000441 (Links to an external site.)

Chism, L. A. (2021). Overview of the doctor of nursing practice degree. In S. M. Denisco (Ed.), Advanced practice nursing: Essential knowledge for the profession (4th ed., pp. 50–73). Jones & Bartlett Learning.

Stewart, J. G. (2021). Historical perspectives: The art and science of nurse practitionering. In S. M. DeNisco (Ed.), Advanced practice nursing: Essential knowledge for the profession (4th ed., pp. 5–20). Jones & Bartlett Learning.

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2020). Covid 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nursing Forum, 56(1), 222–227. https://doi.org/10.1111/nuf.12515 (Links to an external site.)

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