Role Developmental Phases of Advanced Practice Nursing

Subject: Nursing
Pages: 4
Words: 1197
Reading time:
5 min
Study level: Master


The role of advanced practice nurses has been a matter of increased discussion among scholars, healthcare professionals, and policymakers. Currently, all the stakeholders have reached a consensus concerning benefits that advanced practice nurses (APNs) can bring to primary care. However, several barriers on federal, state, and organizational levels reduce the effectiveness of APN practice. In particular, there are variations in the scope of practice of APNs depending on the state, despite the uniformity of training (Poghosyan, 2018). According to Peterson (2017), only 44% of states adopted laws that allow the full scope of practice to APNs. Finally, on the organizational level, poor workplace culture, lack of understanding of APNs’ role, and negative relationships with physicians and administrators create barriers for effective APN practice (Schirle et al., 2020). In other words, due to the rapid development of APN roles, some authorities fail to adopt appropriate laws to reflect them. The purpose of the present paper is to describe different developmental phases of APN practise as seen through the eyes of an experienced APN.

Background Information

Four Phases of Development Advanced Practice Nursing

According to Hamric et al. (2014), there had been three developmental stages of APN practise before the current role was assumed. The first stage was characterized by the fact that the increasing complexity of care and growing patient needs led to the appearance of specialty in nursing care (Harmic et al., 2014). The second phase was associated with organized training that created experts in the specialty (Harmic et al., 2014). During the third stage, the growing knowledge base and rapidly expanding the scope of practice called for standardization in APN practice (Harmic et al., 2014). In the current stage, APN practice reached its maturity and started to develop towards inter-disciplinarity to meet the complex needs of patients (Harmic et al., 2014). Even though the fourth phase is considered final, new stages in the development of APN roles may emerge in the future.

Information about the Interviewee

The interview was conducted with an APN who graduated and was certified in 2000 as an Adult Gerontologist Nurse Practitioner in New York. Currently, the New York state has reduced scope of practice in comparison with the states like Arizona or Washington. She believes experience is crucial for skill acquisition and developing competency in advanced practice nursing. She strongly supports the fact that extensive experience as a registered nurse is needed to facilitate the transition to the ANP. She has a strong desire to improve the current advanced practise nursing, which made her a passionate advocate of widening the scope of advanced practice nursing in the state.

Advance Practice Stages

Stage One

Before becoming an APN, the interviewee received significant experience as a registered nurse. She explained that she was encouraged to make the rounds with her mentor every morning. Her responsibility was to prepare the list of patients who needed to be seen by the doctor, prepare all the lab results, remove dressing from wounds for evaluation, and take patients’ vitals. Additionally, before becoming an APN, she worked as an emergency room nurse and as a nurse supervisor. In 2000, the hospital she worked in experienced significant difficulties with accessibility and quality of care. The hospital faced an increased number of patients, growing complexity of care, storage of medical staff, and the growing elderly population with increased mortality. Thus, an APN in gerontology was needed to close these gaps.

The stage described above clearly represents the first phase of advanced practice nursing, as the development of specialty can be seen here. According to Harmic et al. (2014), “in stage 1, the specialty develops in response to changing patient needs, needs that are usually the results of new technology, new medical specialties, and/or changes in the healthcare workforce” (p. 113). Even though the interviewee did not mention any changes in technology, all the other factors that affected the development of specialty were present. During this stage, the interviewed APN experienced significant stress for two reasons.

On the one hand, her scope of practice was unclear to all the medical personnel. Doctors were not cooperative, making her feel like an intruder in their everyday routine. According to Schirle et al. (2020), the problem of the lack of understanding of APNs’ roles is still a significant problem in the US. On the other hand, she had insignificant knowledge in gerontology to meet all the needs of patients due to the lack of standardized training. She was trained by the institution, which was not enough to address the complexity of the needs of older adults. The limited orientation led to increased stress, lack of confidence, and a sense of dissatisfaction. She had to rely on her experience as a registered nurse and build rapport with colleagues and patients quickly to address the problems.

Stages Two and Three

After becoming an APN, the interviewee continued to receive specialized training in gerontology by going to seminars and reviewing professional and scholarly journals. She explained that the knowledge base on gerontology was growing fast, which made it difficult to keep up with the pace. However, she explained that seminars gradually became very structured, which allowed her to acquire the desired qualifications. At that time, the interviewee experienced significant barriers to advanced practice due to legal limitations, as APNs were not allowed to prescribe medications, write death certificates, or work independently.

This period of her practice covers the second and third phases of advanced practice nursing evolution. She visited seminars, which gradually became very structured. This is the sign of organized training for the specialty and its gradual standardization. Moreover, this period was associated with gradual standardization of the scope of practice, which gave APNs more freedom in providing care. This period was crucial for the interviewee, as it helped to build on her experience and become a highly-qualified professional.

Stage Four

Currently, the interviewee feels more relaxed in the role of a gerontology APN, as she has enough experience, an extensive knowledge base, a clear understanding of her role, and established relationships with colleagues and patients. She explained that her current challenges are connected with building a network with other APNs, nurse managers, physicians, social workers, dietitians, and other specialized professionals. This collaboration aims to care for patients effectively, providing both patients and their families with the necessary information to make informed decisions.

The current stage of the interviewee’s practice is the fourth stage of advanced nursing practice described by Harmic et al. (2014). In this stage, APN roles are relatively clear, and the scope of practice is wide, which allows the independent practice. In this stage, APNs act as leaders who can build interdisciplinary teams to provide holistic care to patients. Such collaboration ensures the safe transition of patients and improves patient outcomes.


The present paper described the phases of evolution of advanced nursing practice based on the experience of one person. In twenty years, the role of APNs has evolved to meet the growing healthcare needs of the US population. Currently, APNs have become experts in their specialties, which allows improving the quality and access to care. APN roles may evolve in the future to help the country care for its citizens.


Campaign for Action. (2021). State practice environment for nurse practitioners. Web.

Hamric, A., Hanson, C., Tracy, M., & O’Grady, E. (2014). Advanced practice nursing (5th ed.). Elsevier.

Peterson, M. E. (2017). Barriers to practice and the impact on health care: A nurse practitioner focus. Journal of the advanced practitioner in oncology, 8(1), 74-79.

Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics, 36(1), 43-46.

Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2020). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health Care Management Review, 45(4), 311-320.