THE ROLE OF ADVANCED PRACTICE NURSE STUDY GUIDE

In this Week one review module, all of the course content in NSG 5000 will be outlined. The remediation plan will cover 5 themes relative to Advance Practice Roles: History & Evolution (HE) Competencies(C) AP Roles (AP) Professional Issues (PI) and Health Policy (HP). 1. History and Developmental Aspects of Advanced Practice Nursing a. Definition of advanced practice nurse (APN) 1. The definition proposed in Hamric’s first chapter builds on and extends the understanding of advanced practice nursing. Important assertions of this discussion are as follows: a. “Advanced practice nursing is the patient-focused application of an expanded range of competencies to improve health outcomes for patients and populations within a specialized clinical area of the larger discipline of nursing” (Hamric 134) b. Advanced practice nursing is a CONCEPT; a function of educational and practice preparation and a constellation of primary criteria and core competencies. c. Direct clinical practice is the central competency of any APN role and informs all the other competencies. d. All APNs share the same core criteria and competencies, although the actual clinical skill set varies, depending on the needs of the APN's specialty patient population. (Hamric 70) e. The development of a common language and conceptual framework for communication, guidance, and evaluation is common to sound progress in any practice discipline f. Conceptual models offering a systemic approach to nursing research, education, administration, and practice g. Globally, some notable similarities exist among definitions, particularly in acknowledging competencies, expanded practice, and recommending graduate education. The ICN definition is general and recognizes that the terms nurse practitioner and advanced practice nurse are used interchangeably in some parts of the world. (Hamric 134) Hamric, Ann, Charlene Hanson, Mary Tracy, Eileen O'Grady. Advanced Practice Nursing: An Integrative Approach, 5th Edition. Saunders, 07/2013. VitalBook file. b. Distinguishing Between Advanced Nursing Practice and Advanced Practice Nursing 1. The terms advanced practice nursing and advanced nursing practice have distinct definitions and cannot be seen as interchangeable. In particular, recent definitions of advanced nursing practice do not clarify the clinically focused nature of advanced practice nursing. Page 2 of 2 NSG 6006 Pre-Specialty Evaluation ©2017 South University 3 The Role of the Advanced Practice Nurse NSG 6006 Week 2 (Hamric 69) 2. The term advanced nursing practice as “characterized by the integration and application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education.” This broad definition has evolved from the American Association of Colleges of Nursing's “Position Statement on the Practice Doctorate in Nursing” (AACN, 2004), which recommended doctoral-level educational preparation for individuals at the most advanced level of nursing practice. The Doctor of Nursing Practice (DNP) position statement (AACN, 2004) advanced a broad definition of advanced nursing practice as the following: … any form of nursing intervention that influences health care outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy. In conclusion, the practice doctorate (DNP) is a degree, not a role, which prepares those who are APNs or those who are in ANP positions to meet the demands of the health care system. A definition this broad goes beyond advanced practice nursing to include other advanced specialties not involved in providing direct clinical care to patients, such as administration, policy, informatics, and public health. (Hamric 69) Understanding how direct clinical and non-clinical advance nursing roles differ and share competencies that impact patient outcomes, it vital for all nurses in advance practice to articulate. These new innovative roles include– educator, administrator, informaticist Hamric, Ann, Charlene Hanson, Mary Tracy, Eileen O'Grady. Advanced Practice Nursing: An Integrative Approach, 5th Edition. Saunders, 07/2013. VitalBook file. 2. History of APN movement (see Box 1-1) (Hamric 2) for a complete timeline of nursing history. a. Henry Silver, MD and Loretta Ford, RN started the first nurse practitioner program at the University of Colorado in 1965 b. Throughout the century, APNs have been permitted by organized medicine and state legislative bodies to provide care to the underserved poor, particularly in rural areas of the nation. However, when that care competes with physicians' reimbursement for their services, there has been significant resistance from organized medicine, which resulted in interprofessional conflict. Page 3 of 2 NSG 6006 Pre-Specialty Evaluation ©2017 South University 4 The Role of the Advanced Practice Nurse NSG 6006 Week 2 c. Documentation of the outcomes of practice helped establish the earliest nursing specialties and continues to be of critical importance to the survival of APN practice. d. The efforts of national professional organizations, national certification, and the move toward graduate education as a requirement for advanced practice have been critical to enhancing the credibility of advanced practice nursing. e. Intra-professional and interprofessional resistance to expanding the boundaries of the nursing discipline continues to recur. f. Societal forces, including wars, the economic climate, and health care policy, have influenced APN history. (Hamric 21-22) Hamric, Ann, Charlene Hanson, Mary Tracy, Eileen O'Grady. Advanced Practice Nursing: An Integrative Approach, 5th Edition. Saunders, 07/2013. VitalBook file. 3. Evolution of the APN role (Specialty and subspecialties) Patterns in the Evolution of Specialty to Advanced Practice Nursing a. Before discussing the evolution of specialty nursing practice into advanced practice nursing, it is important to make a distinction between the two, as well as to clarify the use of the term subspecialty in this chapter. Specialization involves focusing on practice in a specific area derived from the field of professional nursing. Specialties can be further characterized as nursing practice that intersects with another body of knowledge, has a direct impact on nursing practice, and is supportive of the direct care provided to patients by other registered nurses (American Nurses Association [ANA], 2010a). Example: Oncology Nursing Society [ONS], traces its origin to the first National Cancer Nursing Research Conference, supported by the ANA and American Cancer Society, in 1973. (Hamric 112-113) Sub-specialization further delineates the focus of practice. In subspecialty practice, knowledge and skill in a delimited clinical area is expanded further. With this expanded knowledge and skill, there is potentially further advancement of theoretical, evidence-based, and practical knowledge in caring for a specific patient population base. Examples of subspecialty practices within the specialty of adult health nursing include diabetes, transplant, and palliative care nursing (Hamric 113) 1. The initial stage of the evolution from specialty practice to advanced practice is characterized by the development of a specialty focus.. Examples from our history include the specialty of enterostomal therapy (ET) nursing, now known as wound, ostomy, and continence (WOC) nursing, and forensic nursing, which has historically encompassed care provision in correctional facilities, psychiatric settings, and emergency