Advanced Practice Nursing Role Development Essay
Advanced Practice Nursing Role Development Essay
Interview Assignment (20 points)
• The purpose of this assignment is to explore the role of the advanced professional nurse in depth as she /he functions in the context of the institution in which he/she is employed. Compare and contrast the observed /evaluated role to that cited in professional guidelines, theory, and research.
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a. Develop an Interview Guide with 10 questions, which reflect the topics reviewed in the course such as: professional expectations, health policy, reimbursement, professional role history, theoretical foundations of research and EBP, ethics in healthcare, leadership, interprofessional collaboration, and/or any other relevant issues that affect the professional role Advanced Practice Nursing Role Development Essay.
b. Using the developed interview guide, schedule an interview with an advanced professional nurse to learn about their role within the health care system. Please include the interview questions in your paper (see APA 6th ed. for guidelines to writing an interview). Prior to the interview, review the mission, vision, and goals of this agency. Does this professional nurse carry out the mission, vision, and goal of the agency and how?
This paper should be 5 pages and NO MORE than 5 pages (excluding title page, abstract, and reference page) and include. Advanced Practice Nursing Role Development Essay.
• Title page
• Interview (include questions)
• Reference page (minimum of 4 references, excluding your text)
APA 6th ed. is the required format, double-spaced, 12 point font.
The advanced practice registered nurse has become an important cornerstone in the provision of primary health care in the country. They bridge a very important gap between the physician and the disadvantaged in the society. In a country where health care is one of the most expensive commodities, the APRN has an important role to play in ensuring affordable universal health coverage for all Advanced Practice Nursing Role Development Essay. To achieve this, the advanced practice nurse has very well defined professional roles that fit in well with this objective of primary health care for all. Unfortunately, in the quest to exercise their designated roles the APRNs find themselves facing resistance and limitations both from the system and the healthcare fraternity itself. These frustrations and hindrances are the factors that are threatening to derail the noble objective of having advanced practice nurses, as had been envisioned by the pioneers of the discipline in 1965.
Key words: advanced practice nurse, APRN roles, interview.
The Roles of the Advanced Practice Registered Nurse (APRN) According to Professional Guidelines As Opposed to the Reality on the Ground: An Interview with Lauren O’Connor, PhD, ARNP, ANP-BC
The title of APRN refers to a nurse who has undergone extensive advanced training and education at the postgraduate level with at least a masters degree in their specialty. This nurse is registered, certified, and licensed to practice by the state in which they are practicing. The high level of training and education equips the APRN with all the necessary skills to offer the highest level of clinical care to the patient. However, this is an inclusive term that encompasses the different role specialties of the APRN, viz. the certified nurse midwife (CNM), the clinical nurse specialist (CNS), the certified nurse practitioner (CNP), and the certified registered nurse anaesthetist or CRNA (DeNisco & Barker, 2014). Because of their training, the APRN possesses the competence to independently evaluate, diagnose, order and interpret laboratory and non-laboratory tests, treat, and follow up patients. This is what the APRN is trained and qualified to do. However, the situation on the ground is more often than not dissimilar to the picture painted above. Some serious limitations still exist and which hinder and impede the APRN from practicing to the full extent of their abilities and education. These issues are largely to do with recognition and acceptance by the state healthcare system and physician cadres, reimbursement or payment for services rendered, and prescriptive independence (Gordon et al., 2012; DeNisco & Barker, 2014). The first training program for nurse practitioners aiming at equipping them with primary health care skills was in 1965. It was a certificate course. By 1970, tremendous progress had been made such that the course was now being offered as a bachelors and masters degree (Hain & Fleck, 2014) Advanced Practice Nursing Role Development Essay.
The National Council of State Boards of Nursing (NCSBN) APRN Advisory Committee and the APRN Consensus Work Group have outlined the roles of the advanced practice nurse in the Consensus Model for APRN regulation, which is a policy guideline (DeNisco & Barker, 2014). These roles are four and they flow from the four designations of the APRN as stated previously. Thus the APRN serves the clinical nurse specialist role, the nurse anaesthetist role, the nurse-midwife role, and the nurse practitioner role. Other roles of the advanced practice nurse have also emerged with the passage of time and include the clinical nurse leader role and the nurse educator role (DeNisco & Barker, 2014). According to the American Nurses Association (ANA, n.d.), though, these four broad APRN roles can be spread out into finer specific roles as follows:
Evaluation, diagnosis, treatment, and follow up of patients at the primary health care level;
Provision of reproductive health care, especially to vulnerable women in ethnic minorities and immigrant populations;
Provision of expert nursing advice and guidance to bedside nurses on the best evidence-based practices (EBPs);
Implementation of pain management and delivery of sufficient and appropriate anaesthesia (nurse anaesthetists) for patients undergoing surgery;
Engaging in continuous knowledge acquisition and development for the betterment of the nursing profession;
Provision of preventive care and promotion of health. Advanced Practice Nursing Role Development Essay.
The APRN also acts as a valuable team member in the health care chain, working in close collaboration with physicians and other clinicians while referring difficult cases as appropriate. This paper looks at the practical discrepancies that are currently present in terms of what the guidelines indicate are the roles of the APRN and what happens in reality. The views of an experienced and practicing APRN will be sought through interview questions concerning this pertinent matter of professional roles.
It is not easy to get the real picture of the challenges and limitations that APRNs experience on their role in practice by merely reading literature. For this reason, an interview was found to be one of the most effective ways to get primary unadulterated information on the subject. This was to get a feel of the actual role of the APRN in practice and the factors that impact this role. The telephone interview was scheduled with a practicing APRN. Lauren O’Connor [PhD, ARNP, ANP-BC] is a nurse practitioner who has been practicing the profession for 15 years. She teaches at the university and is an associate professor who has published several hard-hitting peer-reviewed journal articles and opinion pieces. Her pet subjects are full practice authority (FPA) for APRNs, equitable reimbursement for APRNs by payers, and admission rights for nurse practitioners in hospitals. Because of her wide expertise and experience, she is the most suitable person to respond to the questions that touch on the advanced practice nursing role. The vision of her agency is “To be the state leader in the provision of holistic primary health care to marginalised communities and minority groups.” Its vision is “To significantly reduce the prevalence of non-communicable diseases and conditions together with mental health issues like depression in the target population.” And its goal is “To achieve sustainable and affordable primary health care for ethnic minorities and marginalised communities in the catchment area by the year 2025.”
I started by asking Lauren, “What are some of the professional expectations that you would advise the new APRN to look forward to?” She answered that the new entrants should expect a fulfilling and rewarding career that will give them an opportunity to exercise their talents and put to practice their education. However, she cautioned that the advanced practice nurse should expect to find some hurdles here and there; and that it is important for them to anticipate these hurdles so as not to be disillusioned. She went ahead to single out what she termed as the “most challenging” obstacle to the APRN’s role – the lack of recognition of the nurse practitioner in some quarters. Next I asked Dr. Lauren, “Considering the history of the APRN’s professional role, do you think a lot has changed up to the present for the better?” she responded that: Advanced Practice Nursing Role Development Essay.
Since 1965 when the first certificate course for nurse practitioners was started by Loretta Ford and Henry Silver, a lot of water has passed under the bridge. The contemporary APRN is a highly educated health professional capable of managing even the most challenging of ailments. Certainly, the APRN’s role has expanded since then. (L. O’Connor, personal communication, September 12, 2019).
I next asked Dr. Lauren, “What is your view on the professional relationship between APRNs and physicians as at present?” Her answer was that most physicians are working “seamlessly” with advanced practice nurses. However, she noted that there is still a sizeable number of practicing physicians that do not properly understand the role of the APRN. These physicians are the ones frustrating the professional efforts of the nurse practitioners, according to Dr. Lauren. In fact, she says that some of them have gone as far as using their professional bodies to lobby against granting of full practice authority to APRNs in some the states that are still restrictive. Next I asked her, “How bad is the question of selective reimbursement by payers towards APRNs – especially the Centres for Medicare and Medicaid Services or CMS?” Her answer was:
It is quite bad, although slow progress is being made. Many advanced nurse practitioners still have to bill ‘incident-to’ physicians’ services. This means their contribution to the healthcare system remains hidden. Furthermore, their income is reduced as they have to pay the physician whose name they use to bill. (L. O’Connor, personal communication, September 12, 2019).
On health policy I asked her, “Is the federal health policy adequate to empower APRNs, given that the Affordable Health Care Act of 2010 relies on them for the increased primary health care burden?” to this question, her response was straight forward: “No. It is not adequate. What makes it even more ineffective in my opinion are the disparate legislations and regulations of different states that at times do not align with the aspirations of the federal government” (L. O’Connor, personal communication, September 12, 2019). On practice philosophy, I asked Dr. Lauren “Are the current APRNs basing their interventions on the theoretical framework of research and evidence-based practice or EBP?” Her response was simply “Yes. EBP is nowadays the cornerstone of all interventions and therapies.” I then asked her, “Do you feel that you’re sufficiently involved in championing the mission, vision, and goals of the agency that you work for, and how?” Her response was:
Of course. I do this my adopting a Total Quality Management or TQM philosophy. This means I strive to reduce “defects” in my APRN practice to the very minimum. These defects include issues like misdiagnosis, unwarranted prescription of scheduled drugs, and lack of respect for the ethical principle of autonomy. L. O’Connor, personal communication, September 12, 2019) Advanced Practice Nursing Role Development Essay.
The last 3 questions I asked her were, “How are APRNs agents of change in a country of expensive healthcare, with regard to ethics?” “What is the place of APRNs in healthcare leadership?” and “To what extent are APRNs vulnerable to malpractice suits?” Her answers: “APRNs are guided by nonmaleficence; leadership is one of their roles; and they are very vulnerable to suits hence must take individual indemnity cover for the same.”
APRN roles are defined by professional scopes of practice and guidelines. However, there still exists hindering limitations to the full expression of these roles.
American Nurses Association [ANA] (n.d.). Advanced practice registered nurse (APRN): APRNs practice specialty roles. Retrieved 12 September 2019 from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
Bloom, L. (2018). How to write an interview in APA format. Retrieved 12 September 2019 from https://work.chron.com/write-interview-apa-format-6612.html
DeNisco, S. & Barker, A. (2014). Introduction to the role of advanced practice nursing. Retrieved 12 September 2019 from bit.ly/2mbdGwR
Gordon, J.M., Lorilla, J.D. & Lehman, C.A. (2012). The role of the clinical nurse specialist in the future of health care in the United States. Perioperative Nursing Clinics, 7, p. 343-353. Doi: 10.16/j.cpen.2012.06.006
Hain, D. & Fleck L.M. (2014). Barriers to NP practice that impact healthcare redesign. The Online Journal of Issues in Nursing, OJIN, 19(2). Doi: 10.3912/OJIN.Vol19No02Man02 Advanced Practice Nursing Role Development Essay
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