Advanced nursing practice has emerged during the last few decades. This is due to the recognition by healthcare organizations and organizations across the globe that maximizing the contributions made by nurses to health through increasing their roles is an efficient approach to enhance health services. Although the development of advanced nursing is common, the understanding of what exactly entails this type of practice differs from one organization to another and from one country/region to another. On the most fundamental level, advanced practice nurses/advanced nurse practitioners are perceived to be specialists in their particular fields. They however take part in activities that surpass the restricted application of technically difficult processes. This paper will examine in depth the roles and contributions of advanced nurse practitioners, their role in improving quality of patients and hospital system, their impact on evidence-based nursing practice and the state of current outcome and descriptive research in relation to their practice.
Roles and Contributions of Advanced Nurse Practitioners to Healthcare
An advanced nurse practitioner has been defined as “a registered nurse who has advanced education certification and clinical training, and serves as a health care provider in a broad range of acute and outpatient settings,” (Florida Coalition of Advanced Practice Nurses, 2008, p. 4). There are different categories of advanced nurse practitioners and include: nurse practitioners (NP), certified nurse midwife (CNM), certified registered nurse anaesthetist (CRNA) and certified nurse specialists (CNS) among others. Advanced nurse practitioners play many crucial roles and make significant contributions to the healthcare organization and system. The most essential role of ANPs is the provision of clinical services to patients. Advanced nurse practitioners spend a considerable amount of time directly with patients. Their advanced education and experience give them authority to independently make diagnosis of illnesses, give pharmaceutical prescription and carry out specific procedures. Second, because ANPs have specialized training in a specific field, they offer expert nursing care to specialized population. For instance, a nurse who has specialized in heart illnesses will spend more time providing nursing care to patients suffering from heart disease. Likewise, a nurse who has advanced training in hospice care will provide expert care to patients on the verge of dying as well as their families (American Nursing Leaders, 2002).
In the direct provision of care to patients, advanced nurse practitioners act as the go-between between the patients, their families and the healthcare team (Royal College of Nursing, 2010). They establish therapeutic relationships with patients and their families that entail mutual participation in the care. They empower patients and their families to uphold a maximum level of care and help their clients to accept the anticipated and the real outcome. They put emphasis on the care of the caregiver by helping them to resolve conflicts that may arise in the course of their duties as well as maintain and improve an environment that upholds the human dignity of the patient. This is especially important in palliative and hospice care. Most importantly, because they have a direct and personal relationship with patients, unlike other healthcare professionals, advanced nurse practitioners communicate the complex needs of the patients and their families to members of the healthcare team. As a result, they help to minimize or eliminate problems that may arise from miscommunication or misunderstanding between the patients/families and healthcare professionals. The role of advanced nurse practitioners however goes beyond the mere treatment of illnesses. ANPs are strong advocates of prevention of illnesses through health promotion programs. As a result, they initiate and supervise health education programs especially in grassroots communities where access to quality healthcare services is limited (Jansen & Zwygart-Stauffaccher, 2010).
The contribution of advanced nurse practitioners to healthcare organizations and systems is broad and far-reaching. ANPs are leaders in their organizations. Their leadership competencies are illustrated in various ways. First and foremost, they initiate the development of clinical guidelines and protocols. They also encourage the use of research evidence in the provision of health care because they know that research-based practice helps improve the quality of care offered. Third, ANPs provide the healthcare organization with specialist support and consultation. They are members of their organizations’ management boards and thus play an important role in the decision-making process. Their leadership role is further demonstrated through the advocacy for patients, families, groups and communities in association with the healthcare services offered to them as well as the decisions and policies made by the organization that influence the quality of services provided (Canadian Nurses Association, 2008).
As leaders, ANPs identify the learning needs of nurses and other professionals working in their organization and develop programs that help to meet such needs. Moreover, ANPs’ leadership role is illustrated through the mentorship and guidance programs they offer to other nurses, professionals and students. They advocate for an organizational culture that is conducive to professional development, advanced learning and mutual practice. They conduct regular evaluations of organizations’ and communities’ programs and come up with innovative solutions to inherent problems. They are also experts in resource allocation and cost-effectiveness and ensure that their organizations make decisions that optimize the available resources. Most importantly, they are key policy makers in matters affecting health not only at the organizational level but also at the national and regional levels. Indeed, advanced nurse practitioners have become an increasingly important asset to healthcare organizations and their roles cannot be exhausted (Canadian Nurses Association, 2008).
Role in Developing and Improving Quality of Patient and Hospital System
Patient safety has become an important concept in healthcare due to the recognition of the numerous preventable medical errors that occur and that lead to severe consequences for the patients. Advanced nurse practitioners play an important role in enhancing the quality of patient care. As primary care providers, their approach to healthcare is somewhat different from other healthcare professionals because they emphasize on a holistic approach. This implies that rather than directly diagnosing and treating a patient, they go a step further by finding out the history of the illness as well as the demographic and socio-economic characteristics of the patient that may influence the illness. The treatment is therefore given with all these factors in mind thus helps to address the root cause of the illness (Florida Coalition of Advanced Practice Nurses, 2008).
Second, advanced nurse practitioners believe in the importance of support systems of patients. As a result, they actively involve the patients, their families and other members of the community in addressing patients’ illnesses. Patients and their loved ones are encouraged to take part in the direct care of the patient. This is achieved through education of the patients, families and communities about the illnesses. This improves the quality of patient care because patients become aware of their health conditions and know what to do to get better. Moreover, they can use the education to prevent similar illnesses from occurring in the future not only to them but also to other members of the community. The same is true of the health promotion and prevention programs the advanced nurse practitioners advocate for (Canadian Nurses Association, 2008).
Advanced nurse practitioners not only improve the quality of patient care but also the entire hospital system. This they do in various ways, for instance, by developing clinical guidelines and protocols for the hospital, educating the entire healthcare professionals’ team on best practices, and carrying out monitoring and evaluation of the programs and the entire organizational system. Such practices help to improve the cost-effectiveness and efficiency of the organization (Florida Coalition of Advanced Practice Nurses, 2008).
Role as Leaders and Change Agents in the Provision and Development of Evidenced-Based Nursing Care
Advanced nurse practitioners have higher degrees such as masters and doctoral degrees in their areas of specialization. As a result, they have a deep understanding of the importance of research in promoting practice. Furthermore, they have extensive experience in clinical research work that comes through higher learning. Thus said, they play an important role in promoting evidence-based nursing practice. They are not only leaders but also change agents in this field of practice. As leaders in evidence-based practice, ANPs produce and construe different sources of data together with members of their teams. This is done through clinical reasoning which is possible only at an expert level. They develop individualized treatment plans for patients based on prior research evidence outcome data. These data are also used by ANPs to make policies, processes and standards of healthcare services. They act as leaders in making recommendations, executing and assessing evidence-based practice. This implies that not only do they initiate evidence-based practice, but they also assess it regularly to ensure that it addresses the needs of the patients and organizations in terms of improved quality of life for patients and cost minimization as well as improved efficiency for the organization (American Association of Colleges of Nursing, 1996).
Evidence-based practice is also executed by ANPs by integrating knowledge, research results and experience to improve nursing practice and to uphold excellence in health care. Advanced nurse practitioners are leaders in the development and conducting of research/outcome studies so as to maximize patient care. They carry out cost-benefit analyses and evaluations of the challenges faced by patients as well as the utilization of medical products and technologies. On the organizational or system level, advanced nurse practitioners carry out monitoring and evaluation of projects by utilizing quality measures. This helps to determine whether the projects executed by the organization/system promote the quality of the services offered. Monitoring and evaluation is also done to determine the cost-effectiveness of the projects (Institute of Medicine, 2003).
As change agents in evidence-based nursing practice, advanced nurse practitioners act as role models, teachers, coaches and mentors by guiding other nurses in the utilization and assessment of research results. Advanced nurse practitioners acknowledge that not all research studies are credible. As a result critique of research studies is important before they can be applied to practice. ANPs guide other staff in the critique of research studies to determine their applicability to practice. This helps in improving the quality of nursing practice. They also act as advocates for evidence-based practice by educating other healthcare professionals on the importance of adopting such practice (Porter-O’Grady, 2003).
Perceptions of Advanced Nurse Practitioner towards their Work
Advanced nurse practitioners have positive attitudes towards their work. This is because they are able to make more significant contributions to the care of patients and the overall running of the organization. Their positive attitude is further influenced by their ability to make decisions that affect the care of patients, families and communities as well as the entire organization. Their roles as leaders and change agents further give them more satisfaction in their work. Moreover, advanced nurse practitioners are accorded autonomous similar to that given to physicians. They can therefore make diagnoses and prescriptions independently. In many cases and situations, they play the role of physicians. This is particularly true in vulnerable populations and underserved areas such as rural, marginal and remote areas where there are critical shortages of physicians. As a result, advanced nurse practitioners play a significant role in health promotion which further increases their job satisfaction (Williams & Valdivieso, 1994).
Outcome and Descriptive Research Related to Advanced Practice Nurse
Advanced practice nursing is a recent concept in nursing. Hence, there are limited research studies that have been conducted on the field of practice. Descriptive research on advanced nursing practice include the study by Bureau of Labour Statistics (2006-07) which stated that the demand for APNs is likely to grow for the next decade and more due to the growing need for efficient healthcare services especially in the underserved areas. While the key competence of APNs role is that of direct clinical practice, their set of skills varies from one patient population to another depending on their needs. The researcher further argued that APNs have deeper and broader knowledge, have greater complexity of expertise and are more autonomous than registered nurses.
A number of outcome research studies related to APNs have been reported. MacDorman and Singh (1998) carried out a study to examine any disparities between births delivered by Certified Nurse Midwives and physicians. The researchers controlled for social and health risk factors. They found that the CNM deliveries had 19 percent less infant deaths, 3 percent less neonatal mortality and 31 percent less infants with low birth weights than the deliveries conducted by physicians. The conclusion made was that advanced nurse practitioners provide a safe and feasible option in maternity care. On the other hand, Mundinger, Kane and Lenz (2000) carried out a study to examine the differences in the outcomes of patients assigned to physicians and those assigned to nurse practitioners. The NP in the study had the same level of autonomy as the physicians. The researchers found no difference in the outcomes of patients between the two groups. The conclusion was that advanced nurse practitioners are as good as physicians in the delivery of health care.
Advanced nurse practitioners are registered nurses with advanced knowledge and expertise. ANP is a recent concept in health care but one whose recognition is growing at a rapid pace. ANPs play significant numerous roles in the healthcare setting. Their roles go beyond primary care giving to leadership, consultation, advocacy, mentorship, teaching, coaching and bringing about change. Advanced nurse practitioners have significant freedom and independence in their work thus enabling them to enjoy their work. Due to the high degree of competence and expertise, advanced nurse practitioners can take the place of physicians. As a result, they are the driving force behind the health promotion of vulnerable populations and areas that are underserved by physicians. The roles played by advanced nurse practitioners are highly likely to grow as their significance becomes more recognized by healthcare organizations and systems.
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