Advanced Practice Roles in Nursing

Advanced Nursing Practice
Name of the Student
Professor’s Name
Advanced Nursing Practice
Background on Advanced Nursing Practice
Advanced Nursing Practice is a specialized area, which has the potential to create radical impacts, in the field of healthcare. The healthcare needs are changing all across the globe and nurses should be competent to provide quality care. The specialty voices for more power and delegation to nurses in the process of pharmacological and non-pharmacological interventions. Although the domain of Advanced Nursing Practice is safe, cost-effective and ensures quality of care, there are various practice barriers. This is because various medical organizations and evidenced based clinical forums, limit Advanced Nursing Practice, based on safety considerations for patients. It is a rule, rather than exception, that consulting physicians have to depend on these professionals for rendering pharmacological and non-pharmacological interventions (Ulrich, 2010).
However, when it comes to policy changes, this domain of practice is undermined. Various nursing bodies are in the pursuit of voicing for policy changes; however, appropriate recognition is still far away from reality. The future holds the potential for advanced nursing practice. Hence, the graduate nurses should be prepared to meet such challenges in the near future. There are various roles of nurses in the domain of advanced nursing practice. These include clinical nurse specialist, nursing midwives, nurse anesthetist, nurse educators, nurse informatics and Nurse administrators.

Each role has its specific job functions and contributes to the cause of advanced clinical practice (American Academy of Nurse Practitioners, 2010).
Review of Roles in Advanced Nursing Practice
Nurse Practitioners
A Nurse Practitioner is a registered nurse who has qualified her graduation in nursing. The NP focuses on the provision of primary care to their patients. The sub-specialties of nurse factors are varied and include family health, geriatric health, adult health, pediatric health, Psychiatric-mental health, acute care and women’s health domain. A nurse practitioner under any settings must act in collaboration with consulting physicians and allied healthcare professionals in providing holistic care to their patients. These specialists work in office settings, clinical settings, ambulatory care settings, long term rehab clinics and in hospitals. To be eligible for a Nurse Practitioner, a Master of Arts or Master of Science in Nursing is desirable (American Academy of Nurse Practitioners, 2010).
The nurse practitioners implement advance practice skills to document medical histories of their patients, investigate them with physical examinations, and assess the need of specific treatment requirements. Further, these professionals treat and investigate acute and chronic debilities in a patient. They have the ability to prescribe and titrates dosage of medications, as per the need of the patients. They provide the necessary education and warrants counseling in their patients, to inculcate healthy behavior and healthy lifestyle. They perform health screening in their patients and provide disease prevention services (American Academy of Nurse Practitioners, 2010).
Further they are equipped with advance skills to identify the specific and advanced health care needs of their patients and thus, provide a timely and appropriate referral to the concerned physician specialty. These professionals may apply through the American Nurses Credentialing Center and American Academy of Nurse Practitioners for their certification and registration. However, before applying for certification the minimum certification requirements and educational qualifications must be met (American Academy of Nurse Practitioners, 2010).
These practitioners have the legal authority to prescribe medications. Finally, the Nurse Practitioners must have a collaborative practice agreement with licensed physicians. Such agreements and collaboration define the scope of practice boundaries and autonomy of executing care in clinical settings. The areas that are deemed important include the autonomy in prescribing medications, the monitoring procedures to be employed independently by the Nurse Practitioner and changing the medications o the dose of medications, in conditions of need (American Academy of Nurse Practitioners, 2010).
Nurse Educators
In the need of engaging professional activities which lead to innovation within the specialty and nursing care in practice settings the role of education and clinical education is highly relevant. The nurse educators are the primary actors who orient nursing education to practice. These educators provide knowledge on academics, clinical issues and personal and professional development areas. They orient teaching based on practical care and scientific rationale of care, which builds evidenced based competency in the advanced care nurses (www.ncbsn.org).
Nurse educators help to integrate competencies, education, research, leadership and education that ensures professional development of nursing personnel. In 2005, the domain of practice of nurse educators was specified by the National League for Nursing Certification Governance Committee. It recognized the nursing area as a specialty area in the domain of advanced nursing practice. Nurse Educator certification examination and a minimum of master’s degree points are needed for the nurse educator to be accepted in the Advanced Nursing Practice system (www.ncbsn.org).
Nurse Administrators
They are registered nurses who are endowed with the responsibility of managing the delivery of nursing services, as per the need of hospitals and healthcare facility systems. As they co-ordinate and integrate nursing care to patients, they must have the appropriate knowledge of professional nursing practice and nursing service administration. Direct and coordinate the work of all nursing staff under their authority. They draft, implement and evaluate various policies that govern the nursing services appropriate to the institution. They ensure effective quality and standards of care. They are also engaged in hiring, recruiting and training nursing personnel in an institution. A minimum bachelor’s degree is required for the post (www.ncbsn.org).
Clinical Nurse Specialists
Any individual who is licensed in professional nursing and have a certificate in clinical nurse specialist practice may function as a “Clinical Nurse Specialist’. These individuals may deliver and manage advanced nursing care to individuals or a group of individuals. They assess healthcare needs of a patient and uses appropriate methods relevant to the population and area of practice. They diagnose human responses for actual and potential health problems and plan for promotion, disease prevention, and therapeutic interventions in agreement with the client. They intervene and implement therapeutic interventions based on their specific area of expertise that is documented (Watson & Hillman, 2010).
Midwives in Advanced Nursing Care
Certified midwives implement advanced nursing care that is appropriate and as per established protocol. These protocols have been approved my medical staff of healthcare services where midwifery services are rendered. They are entitled to perform superficial minor surgical operations; they are entitled to manage a patient during labor and delivery. These professionals are also entitled to intervene in amniotomy, episiotomy, and repair. Certified midwives provide anesthesias and orders relevant medications. Performs post partum examinations and provides family planning services. Finally, they are also entitled to manage the medical care of obstetrical patients and initiate and manage care giving in the new born (Watson & Hillman, 2010).
Review of Job Functions: Family Nurse Practitioner (FNP)
Family Nurse Practitioners (FNP) are nurse specialists who specialize in aspects of family nursing. They practice in the context of the community and have a broad knowledge and experience, regarding people across all age groups. These nurses are committed to providing a family-centric care in ambulatory care settings (American Academy of Nurse Practitioners, 2010). The competencies required by the FNPs are:
Responsible for the promotion of health, protection of health, prevention of diseases and provides treatment: The FNPs are associated with direct healthcare services and, therefore, they utilize theoretical, scientific and contemporary clinical knowledge for managing health conditions.
Assessment Roles
The FNPs exhibit evidence-based clinical practice to perform screening activity identifies health promotion needs and demonstrates guiding and counseling for addressing environmental, developmental and lifestyle issues in an individual. They gather relevant medical history for all patients across age groups, assesses the impact of family factors on an individual’s health and conditions which lead to a delay in achieving milestones. They are also responsible in the assessment of the reproductive health of men and women. These would include pregnancy, sexual health, post partum care and beyond. They must also intervene in issues of substance abuse and domestic violence. FNPs must ensure screening of mental health status and should identify the psychological risk for patients across all age groups. Functional assessment should be implemented for challenged individuals (elderly and disabled). They must assess the impact of acute or chronic illness or common injuries on the entire family.
Diagnosis
To ensure the diagnostic capabilities, the FNPs must employ critical thinking and differential diagnosis based on the signs and symptoms of the individuals concerned. They must be able to analyze and correlate clinical data in an integrated fashion. Gender specific and condition specific diagnostic tests must be recommended. These practitioners must consider the epidemiology, environmental and community issues while arriving at a specific diagnosis.
Plan of Care
The objectives of the plan of care should be to ensure the return of a patient back to the stable state. FNPs should take utmost care to stabilize the patient by minimizing physical and psychological complications. Further, they should be able to prescribe medications with their knowledge of pharmacodynamics and pharmacokinetics. FNPs must meet the complex needs of special populations (elderly and children). They must be capable of managing acute exacerbations of chronic illnesses. One of the important aspects in the planning of care is to evaluate patient’s/or other care giving support systems and collaboration with such resources. They must inculcate coping mechanisms in a patient. Appropriate referrals should be made to other healthcare professionals and community services. Primary care procedures like suturing, removal of minor lesions, application of splints, microscopic tests, and Pap smear evaluations must be done by them. They must ensure appropriate prenatal and postnatal care to women. FNPs must identify the transitions in the family like parenthood and retirement on the health of individuals in the family. They should implement family theories, for providing individualistic care. Moreover, they must apply family-centric research that helps to bring positive changes in the health of the family and provides avenues for better care giving.
Relationship building role
FNPs must collaborate with patients in a person-centric approach to identify the needs and goals of well-being in their patients and the family members associated with the patients. They should ensure sustained partnership for effective care delivery process. FNPs should facilitate family members in the decision-making process. They should also help out members with ethical issues related to care and help them understand the differential needs and age-related transitions in behavioral approaches or illness amongst the family members.
Teaching and Educational Role
FNPs should have the ability to extend knowledge and relevant psychomotor skills on their dysfunction or illness. They must be capable of addressing sensitive issues like sexual issues, mental problems, substance abuse and terminal illness, with the patient and their family members. Information must be elicited regarding the goals, perceptions, and needs of the patients and their family. The FNPs must provide anticipatory guidance, counseling, and teaching on self-care procedures to the patient and the family.
Professional Role
As a professional, the FNPs must always demonstrate a commitment to care for the whole family. They must participate in community and professional organizations which influence the health of the family and supports their thriving. FNPs must act as a resource in designing community-based health services, which will benefit the family.
Managing and interacting with Health care Delivery Systems
FNPs must ensure that appropriate clinical services are sought and implemented to the patient. Hence, it is important that they should be aware of the state and federal regulations and programs directed towards family care.
Maintenance and ensuring quality of healthcare
They must maintain and ensure the quality of healthcare through effective consultation, collaboration, continuing education, appropriate certification, and self-evaluation.
Development of Cultural Competence
Finally, the FNPS must provide culturally competent services. This means they should respect the cultural and spiritual needs of the patient and their family members, and must not erode their belief systems.
Advanced Nursing Practice Regulations: Florida
A valid Registered Nurse License in the State of Florida.
Should have a master’s degree or post-masters degree certification. Certified registered nurse anesthetist should complete the requirements for a master’s degree program.
Must have the proof of malpractice insurance or exemption
The nursing law in Florida states that FNPs may perform acts of medical diagnosis, treatment, prescription of medications and operations that are approved by the joint National Committee. This committee comprises of three members who are appointed by the Board of Nursing, and out of them two members should be advanced registered nurse practitioners, three members to be appointed by the Board of Medicine and two of these members should have prior work experience with advanced registered nurse practitioners; and the State Surgeon General.
FNPs are authorized to change or alter medications, initiate appropriate tests and render physical and occupational therapy.
Appraisal of Leadership Role in FNP
In advanced nursing practice, individuals must exhibit leadership capabilities to implement strategic decision making and situational flexibility, to render effective healthcare. From my individual assessment, I exhibit a participative and delegation form of leadership style. However, in the context of my specialty of practice as a Nurse family Practitioner, I would exhibit the participatory type of leadership. My present leadership attributes are creating an open atmosphere to encourage discussion and debate, have excellent active listening skills, belief in teamwork, and respect for people and have the ability to take calculative risks.
I do have the requisite communication skills that are effectively perceived by others. Further, I have the ability to demarcate boundaries of clinical practice and can take self-decision regarding care needs of a patient. As a family nurse practitioner, I should create an atmosphere where family members or the patient can share their concerns without the fear of retaliation. I should involve every family member in the decision-making process and must be flexible enough to orient care protocol. I exhibit appropriate verbal and non-verbal communications in assessing and implementing healthcare needs in a patient.
I also maintain uniform care options according to evidence-based guidelines, across different cultural diversities. I integrate such actions due to my capabilities of creating an inclusive environment and transparent education to the family members regarding the healthcare needs of the patient.
However, there are certain attributes that I need to improve upon in the leadership role of a Family Nurse Practitioner. These include:
I need to influence policy makers and motivating colleagues about clinical challenges in my domain of practice.
Maintaining close contact with professional organizations. This is very important to stay informed regarding the national and state policy agendas (Pulcini & Hart, 2010). Further, it would help to seek support network and accessing the changes in information and evidenced based knowledge. As a Family Nurse Practitioner, I would access American Nurses Association (ANA) for my professional development and growth (Pulcini & Hart, 2010).
Maintaining Balance between Personal and Professional life: This would be important because it is important to render care to patients in a stress-free behavior. Since, my involvement is fairly high in my practice settings; often it leads to burn outs and fatigue.
I would further increase my global awareness on nursing practice and cultural diversities. This would help me to shape my approach of care in the context of cultural diversities. Further, I would become aware of various care guidelines followed and implemented all across the globe that is relevant to my practice settings.
Therefore to address the above leadership roles, I must voice for policy changes with the support of my professional organizations (ANA). I should also visit the library services and access the relevant journals on family nurse practicing and should also visit the websites of various nursing bodies all across the world, to make myself aware of the global changes in treatment and care guidelines.
Policy Change in Perspective: Childhood obesity
Although the advanced nursing practice is recognized as an important care facility, the scope of practice still suffers from various obstacles. The discussion regarding the practice profiles and job responsibilities, clearly demonstrate that advanced practice registered nurses (APRNs) has the immense potential to create a difference in the field of healthcare. However, they are restricted through various State regulations and compensation issues. The field of practice is very specific, cost-effective, and safe. The boundary limitations of implementing clinical interventions are predefined. However, various medical councils and organizations continue to impose practice barriers and oppose this field of practice due to safety concerns, in the context of patients. The nursing organizations has created state and national level awareness and appropriate movements for making a change in policy guidelines. However, the quality of care and safety concerns must be established with policy makers to change their apprehensions. Various funding agencies and public support must be rendered to address the gap in compensation issues. The views and policy changes can only occur with a strong exhibition of leadership by each and every APRNs in their respective professional set ups (Villegas & Allen, 2012).
References
American Academy of Nurse Practitioners. (2010). Scope of practice for nurse practitioners.
Retrieved from www.aanp.org/images/ documents/publications/ScopeOfPractice.pdf
Pulcini, J., & Hart, M. A. (2007). Politics of advanced practice nursing. In D. J. Mason, J. K.
Leavitt, & M. W. Chaffee (Eds.), Policy & politics in nursing and health care (5th
ed., pp. 568-573). St. Louis, MO: Saunders Elsevier
Ulrich, C. M. (2010). Who defines advanced nursing practice in an era of health care reform?
Clinical Scholars Review, 3(1), 5-7. doi:10.1891/1939-2095.3.1.5
Villegas, W., & Allen, P. (2012). Barriers to Advanced Practice Registered Nurse Scope of
Practice: Issue Analysis. The Journal of Continuing Education in Nursing, 43(9), 403-
409
Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure,
education, scope of practice, and liability issues. Journal of Legal Nurse Counseling,
21(3), 25-29.
www.ncsbn.org/boards.htm