Application of Course Knowledge: Review the history of the advanced nursing practice role
and answer all questions/criteria with explanations and detail.
• Describe factors that supported the development of the advanced nursing
practice role.
• Analyze barriers to advanced nursing practice.
• Examine either the American Association of Colleges of Nursing Essentials or role-
specific competencies related to your advanced practice role. Identify the selected
competencies. Discuss one domain or competency area in which you excel and one
in which you have growth opportunities.
The role of advanced practice has undergone significant changes over time. APRNs now play a
crucial role in meeting the healthcare needs of various populations and sub-specialties across the United
States. During the Civil War, nurses were trained by American surgeons to assist with anesthesia care for
the numerous wounded soldiers. As there was a shortage of anesthetists, physicians were hesitant to
provide anesthesia in remote rural areas; nurses began to take on this responsibility. The American
Association of Nurse Anesthetists (AANA) was established in 1931, originally known as The National
Association for Nurse Anesthetists. Similarly, the American Association of Nurse-Midwives (AANM)
was founded in 1928, initially named the Kentucky State Association of Midwives. Certification and
credentialing processes were introduced in 1971 after the establishment of formal educational programs
and accreditation in the United States. In 1943, Frances Reiter coined the term "nurse-clinician" to
recognize the role of nurses in comforting, teaching, protecting, encouraging, and nurturing patients back
to health. Subsequently, the National League for Nursing Education advocated for advanced nursing
training in universities to prepare nurse clinicians to empower and serve patients. In 1965, the American
Association of Nurses (ANA) proposed a position statement allowing nurses with a master's degree or
higher to assume the role of Clinical Nurse Specialist (CNS), emphasizing their clinical expertise in
specific populations (Boehning, 2023).
The Nurse Practitioner (NP) role was initiated in the 1960s by Dr. Loretta Ford, a nurse, and Dr.
Henry Silver, a doctor, with the aim of addressing the healthcare needs of underserved pediatric
populations in rural Colorado. This role served as a disruptive innovation, bridging the gap between
nursing and medicine. It was based on the belief that nurses can deliver high-quality primary care to
those in need (Boehning, 2023).
APRNs play a crucial role in delivering healthcare services, including preventive care, to the public.
However, there are various barriers that hinder their practice and impact the provision of essential
healthcare services that they are authorized to provide based on their education, training, licensure, and
certification (Kleinpell, 2023). Apart from state regulations that limit practice authority in certain states,
there are other barriers that restrict APRN practice. These include institutional and organizational barriers
such as bylaws that restrict APRN roles and authority, lack of hospital privileges, issues with provider
credentialing, limited clinical privileges, and reimbursement problems (Kleinpell , 2023). Additionally,
there are restrictions that require physician cosignatures for prescribing medications and admitting
patients to hospitals, limitations on being listed as the primary care provider, and electronic health
records that do not accurately capture APRN care. These barriers significantly reduce the productivity
capacity of APRNs, limiting the types and amounts of healthcare services that can be provided to those in
need (American Association of Nurse Practitioners, n.d.).
I have a strong proficiency in Domain 2: Person-centered care. The implementation of person-
centered care is essential for nurses in the ICU due to the complex physical and psychological
requirements of patients. I am confident that I can further develop my skills in Domain 1: Knowledge of
Nursing Practice, especially since I am currently pursuing my MSN degree. Each day, I am enhancing
my
and answer all questions/criteria with explanations and detail.
• Describe factors that supported the development of the advanced nursing
practice role.
• Analyze barriers to advanced nursing practice.
• Examine either the American Association of Colleges of Nursing Essentials or role-
specific competencies related to your advanced practice role. Identify the selected
competencies. Discuss one domain or competency area in which you excel and one
in which you have growth opportunities.
The role of advanced practice has undergone significant changes over time. APRNs now play a
crucial role in meeting the healthcare needs of various populations and sub-specialties across the United
States. During the Civil War, nurses were trained by American surgeons to assist with anesthesia care for
the numerous wounded soldiers. As there was a shortage of anesthetists, physicians were hesitant to
provide anesthesia in remote rural areas; nurses began to take on this responsibility. The American
Association of Nurse Anesthetists (AANA) was established in 1931, originally known as The National
Association for Nurse Anesthetists. Similarly, the American Association of Nurse-Midwives (AANM)
was founded in 1928, initially named the Kentucky State Association of Midwives. Certification and
credentialing processes were introduced in 1971 after the establishment of formal educational programs
and accreditation in the United States. In 1943, Frances Reiter coined the term "nurse-clinician" to
recognize the role of nurses in comforting, teaching, protecting, encouraging, and nurturing patients back
to health. Subsequently, the National League for Nursing Education advocated for advanced nursing
training in universities to prepare nurse clinicians to empower and serve patients. In 1965, the American
Association of Nurses (ANA) proposed a position statement allowing nurses with a master's degree or
higher to assume the role of Clinical Nurse Specialist (CNS), emphasizing their clinical expertise in
specific populations (Boehning, 2023).
The Nurse Practitioner (NP) role was initiated in the 1960s by Dr. Loretta Ford, a nurse, and Dr.
Henry Silver, a doctor, with the aim of addressing the healthcare needs of underserved pediatric
populations in rural Colorado. This role served as a disruptive innovation, bridging the gap between
nursing and medicine. It was based on the belief that nurses can deliver high-quality primary care to
those in need (Boehning, 2023).
APRNs play a crucial role in delivering healthcare services, including preventive care, to the public.
However, there are various barriers that hinder their practice and impact the provision of essential
healthcare services that they are authorized to provide based on their education, training, licensure, and
certification (Kleinpell, 2023). Apart from state regulations that limit practice authority in certain states,
there are other barriers that restrict APRN practice. These include institutional and organizational barriers
such as bylaws that restrict APRN roles and authority, lack of hospital privileges, issues with provider
credentialing, limited clinical privileges, and reimbursement problems (Kleinpell , 2023). Additionally,
there are restrictions that require physician cosignatures for prescribing medications and admitting
patients to hospitals, limitations on being listed as the primary care provider, and electronic health
records that do not accurately capture APRN care. These barriers significantly reduce the productivity
capacity of APRNs, limiting the types and amounts of healthcare services that can be provided to those in
need (American Association of Nurse Practitioners, n.d.).
I have a strong proficiency in Domain 2: Person-centered care. The implementation of person-
centered care is essential for nurses in the ICU due to the complex physical and psychological
requirements of patients. I am confident that I can further develop my skills in Domain 1: Knowledge of
Nursing Practice, especially since I am currently pursuing my MSN degree. Each day, I am enhancing
my
