Free «Advanced Nursing Practice» Essay

Advanced Nursing Practice

The evolution of the new and advanced technology, especially in the field of nursing, has called for the need to advance nursing practices in an attempt to improve the quality and standards of health care. This evolution has come with different specialized areas of study and experience in the nursing field, all of which are focused on addressing the pressing complex health care issues. In many countries and health care institutions, advanced nursing practice has been used as an informative and educative tool that enables nurses in conducting medical research and disease prevention procedures. In the process, it has resulted into four distinct components and roles being played by advanced practice registered nurses. This write up, thus, defines and describes the four roles of the Advanced Registered Nurse (APRN). These include; nurse practitioner (NP), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and certified nurse midwife (CNM). It also compares and contrasts the four roles of Advanced Practice Registered Nurse as well as highlighting my preferred advanced practice role and its reflection on the personal philosophy of nursing.

According to Buckley & Philipchuk (2008), an advanced nursing practice defines an advanced level of clinical nursing practice that is designed to maximize on the use of advanced educational preparation, nursing knowledge, and expertise. They note that advanced nursing practice is normally incorporated in order to meet the required health needs by different population groups, individuals, communities, and families. It entails analyzing and synthesizing nursing knowledge in order to understand, interpret, and apply the nursing theory and research, thereby advancing and developing nursing knowledge and professionalism required for meeting health standards.

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Buckley & Philipchuk (2008) note that the existence of evolving society, which demands for advanced health care services, has been the main contributor for the need of advanced nursing practice. This has resulted in many challenges that the society faces in acquiring improved and advanced health care services. These challenges include the rising health care cost, the existence of aging population, lack of adequate nursing professionals, and the emergence of the new technology, which has made it difficult in accessing important health care information and services. It is such challenges that strengthened the need to demand for collaborative and innovative nursing practitioners who could act as prominent pace makers in healthcare services provision and delivery (Buckley & Philipchuk, 2008).

As pointed out by Buckley & Philipchuk (2008), this prompted various countries and health institutions to advance their nursing practice in coming up with national frameworks that would improve their healthcare services. This would ensure that advanced nursing practice is not only defined, but its characteristics and competencies are identified through necessary educational preparation and practice in highlighting its potential roles and regulations in improving health care.

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This write up, thus, defines and describes the four roles of the Advanced Registered Nurse (APRN) which include nurse practitioner (NP), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), and Certified Nurse Midwife (CNM). It also compares and contrasts the four roles of Advanced Practice Registered Nurse as well as highlighting on my preferred advanced practice role and its reflection on personal philosophy of nursing.

Definition and Description of a Nurse Practitioner

As defined by McGee (2009), a nurse practitioner is a registered nurse (RN) with advanced and complete medical training. Such trainings as obtained by aspiring nurses must have its scientific basis of nursing meeting the required educational and clinical competence. He notes that the role of a nurse practitioner is to provide patient care that would promote, maintain, and restore the health and well-being of the patients. According to him, a nurse practitioner can achieve this by performing health assessment, determining diagnosis, and developing treatment plans. These treatment plans would not only prescribe medication but would also incorporate research activities which are engaged in providing training and education on how to administer or counter various medical conditions.

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McGee (2009) notes that since patient care is normally provided under a variety of clinical settings, a nurse practitioner may be involved in general medicine or specific area. This means that it is therefore necessary for these practitioners to be competent in their work. He points out that a competent nurse practitioner is identified and describe by his or her technical knowledge, critical thinking ability, communication strategy, advising, and mentoring services. He explains that the technical knowledge of a nurse practitioner describes his or her professional care practices and procedures that enable him or her to connect medical terminologies, disease processes, and the patient’s body system. This would result in current and advanced clinical diagnostic procedures and treatment, thereby improving health care standards.

On the other hand, McGee (2009) points out that the critical thinking required of a nurse practitioner would portray his or her ability to assess and interpret patient symptoms. It would thus ensure that a nurse practitioner is not only able to access clinical information but also able to modify the treatment plans that review patient’s symptoms and medical records in offering improved health care. Significantly, McGee explains that communication and mentoring is essential in nursing, as a nurse practitioner would be able to develop effective information convey channel with patients. Moreover, a nurse practitioner would be able to counsel both their friends and close friends who are affected, hence, communicating the basic elements of healthcare promotion and how to prevent diseases (McGee, 2009).

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Definition and Description of a Clinical Nurse Specialist (CNS)

As admitted by Donald, Lukosius & Misener (2010), lack of clarity on the role and definition of clinical nurse specialist (CNS) and Nurse practitioner (NP) can hinder the integration of advanced practice nursing in improving heath care standards. Their exclusion can lead to ambiguous health care expectation, thus, adversely affecting the health care provision and delivery.

According to Donald, Lukosius & Misener (2010), CNS defines a registered nurse (RN) with a high qualification graduate degree in nursing and a standout expertise in clinical nursing specialty. They note that the key responsibilities of the CNS normally depend on the need for special settings in areas of clinical practice, education, research, consultations, and leadership. They point out that a clinic nurse specialists is normally entitled to mentor nurses through his or her developed nursing knowledge, and evidenced-practices. This would ensure that the associated complex healthcare issues in the field of nursing are evident among patients, or policy makers are effectively addressed.

As pointed out by Donald, Lukosius & Misener (2010), a clinical nurse specialist is normally entitled to develop nursing leadership standards that can be emulated and practiced by other nurses. He or she is mandated to provide inter-professional policies and practice guidelines that would instill good professional standards among nurses.

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Definition and Description of a Certified Registered Nurse Anesthetist (CRNA)

As defined by O’Grady (2006), a certified registered nurse anesthetist (CRNA) is a qualified registered nurse with advanced specialty in accredited nurse anesthesia program. They are majorly involved in the management of patient care in as far as the administration of anesthesia under specific surgical situations. According to her, a CRNA is usually educationally prepared and competent in engaging in nurse anesthesia practice. In this process, CNRA is normally entitled to administer and provide any type of anesthesia for any surgical operation in order to manage pain experienced by the patient.

Additionally, O’Grady (2006) notes that a CNRA is normally capable of conducting his or her illustrative independent professional judgment based on outlined scope of competency and licensure. This would ensure that CNRA collaborates with surgeons, dentists, anesthesiologists, and other qualified health care professionals in managing pain after surgical operations.

Definition and Description of a Certified Nurse Midwife (CNM)

As pointed out by O’Grady (2006), a certified nurse midwife (CNM) refers to a licensed health care practitioner with educational qualification in nursing and midwifery. She notes that a CNM normally provides health care services to women regarded to be in childbearing age, which include prenatal care, labor management, and delivery care. She adds that a certified nurse midwife is normally entitled to provide after-birth care, conduct gynecological exams, and assist parties in family planning decisions. Moreover, CNM offers preconception and menopausal management care with further illustrative health care maintenance counseling that would ensure disease prevention and health care improvement, especially in child delivery and bearing.

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Comparison and Contrasts of the Four Roles of Advanced Practice Registered Nurse

While Donald, Lukosius & Misener (2010) admit the discrepancy surrounding the role of CNS and NP, it is clear that all the practitioners in health care professionalism focus on improving health care services. However, the originality, educational requirements, and practice responsibilities tend to be alike, while some are also different, calling for the need for advanced nursing practices in all the specialized areas.

As pointed out by Buckley & Philipchuk (2008), the evolution of the nurse practitioners was based on the inability by the nurses to, for decades, reach out to rural and remotes patients and the public in these areas. In Canada, the work of nurse practitioners was formally recognized in 1970s when policy-makers recommended the establishment of nursing practitioners who would provide health care services to isolated population based in rural and remote areas (Buckley & Philipchuk, 2008). However, they note that lack of enabling legislation to enhance education programs associated with nursing led to the decline of the concept of nursing practitioners.

In U.S., O’Grady (2006) notes that nurse practitioners originated from evidence-based research on the effectiveness of NP in enhancing acute health care settings. Based on hospitalized geriatric patients and health status due to NP care and Physician care, the researchers were able to prove that Nurse practitioners were better in the delivery of health care services compared to physicians. This was especially so in cases where diagnosis was historically dependent.

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According to Buckley & Philipchuk (2008), the existence of nurse practitioners rekindled in 1990s through the need for integrated health care services and standards. They point out that this led to the formation of the Canadian Nurse Practitioner Initiative that was to ensure full integration of nurse practitioners into the country’s health care sector. Additionally, the rising demand for change in technology being used and the knowledge being applied in health care delivery have enabled nurse practitioners to advance their experience and education, thereby improving their nursing practices. Buckley & Philipchuk (2008) observe that most countries have currently set the required minimum educational preparation for NP as a graduate nursing degree with theoretical nursing foundation. This would ensure that a NP promotes nursing research, thereby, develop new knowledge on health care delivery and servicing for effective clinical practices.

Contrary to the evolution of NP, clinical nurse specialist developed due to the growing complex issues in client care that hindered the administration of effective health care services. For instance, in Canada, clinical nurse specialists emerged in 1970s in order to provide clinical guidance and leadership to the nursing staff in enabling them to address pertinent pressing issues they encountered (Buckley & Philipchuk, 2008). According to Donald, Lukosius & Misener (2010), the practice responsibilities of NP and CNS tend to differ sparingly. They note that while NP’s practice and responsibilities tend to provide direct patient care, CNS’s roles tend to divert from this concept. According to them, CNS is more concerned with professional development, leadership, research, and educational strategizing that would enable nurses to expand on their clinical functions. Therefore, CNSs are normally authorized to performed duties similar to those of registered nurses.

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On the other hand, Goudreau, Baldwin & Clark (2007) note that the clinical expertise in specialty associated with CNS practice requires advanced educational preparations. Therefore, any CN has to have a graduate preparation usually from masters, post masters or doctorate degree from national accredited nursing programs. More significantly, master’s degree is the minimum credential entry for one to be a CNS.

On its side, the origin of certified registered nurse anesthetist (CRNA) was based on the need to counter the anesthesia-caused mortality and severe mobility in administering aesthesia to counter pain from survival operations. O’Grady (2006) notes that the research conducted by the Centers for Disease Control and Prevention in 1988 indicated that death only occurred for every 200 000 to 300, 000 patients who had been administered with aesthesia. It is through such study that the question of patient’s surgical safety became a big issue. This led to the insurgence of certified registered nurse anesthetists. O’Grady points out that the administration of anesthesia is based on creating health care systems that revolves around patient’s safety in managing pain and preventing disease infections.











However, O’Grady (2006) notes that the educational preparation of a certified registered nurse anesthetists differ from those of NP and CNS. While basic baccalaureate degree in nursing is essential for both professionals, he points out that CRNA requires at least one year experience in acute care nursing with a further two years involvement in anesthesia master’s program. This is based on the specialty required for CNRA, since they directly administer anesthesia to affected patients.

Contrary to NP, CNS, and CRNA, certified nurse midwife (CNM) was established based on studies that identified the need of CNM to provide safe and alternatives to maternal care as compared to health care given by physicians. O’Grady (2006) notes that CNM was projected to control both the social and health risk factors associated with women at their child bearing age, prenatal, and delivery stage. This did not only reduce the infant death during these stages, but it also increased the mean birth weight of infants as compared to women under the care of physicians. While the practice responsibilities of CNM have been discussed earlier, its educational preparation is essential for a person to qualify and serve as one.

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As pointed out by O’Grady (2006), a person can only be allowed to be a CMS if he or she has completed an accredited obstetrical care program and clinical experience. This helps CMS in participating actively though provision of gynecological services, counseling women on health, and personal care, especially during their pregnancy.

Preferred Advanced Nursing Practice and Personal Philosophy in Nursing

Among the four roles of the Advanced Registered Nurse (APRN), certified nursing specialists (CNS) come out as an effective nursing practice that could help in coping with the current health care challenges. This is in coherent with my personal philosophy in nursing. I believe that in nursing, every health care practitioner should be envisaged with specified energy for caring. This should be embodied in their knowledge and skills to enable it to be emulated and practiced by other health care professionals. CNS is imperative to this concern as CNSs normally define the type of care and medical attention need by each and every population setting, disease, and medical subspecialty. Therefore, CNS understands the uniqueness associated with each and every patient of whom a CNS health professional would develop an evident-based inter-policies, and organizational structure. This will enable each health care professional practitioner in meeting the demand of every patient.

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In conclusion, the demand for improved health care accessibility and efficiency has been highlighted as the main contributors for the need to have advanced nursing practice. While the four roles of the advance practice registered nurses (APRN) stand out, the educational requirements, practice responsibilities and role evolution of NP, CNS, CRNA, and CNM denote them as agitating for patient’s safety and clinical competence. It is, therefore, essential for health care professionals to adapt the key roles played by CNS in providing health care leadership and improved health care services. Moreover, the government and health institutions should fund and provide for the formation of inter-professional health care teams in order to develop advanced knowledge and skills on how to address the complex issues in the filed of nursing.

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