Scientific and social changes of the 21st century have brought a radical change in the Health care delivery system. Nursing is an important component of the health care delivery system and the role of a nurse in inpatient welfare has no boundaries for praise. The Nursing profession has evolved through time to establish a firm role in the medical domain based on strong ethical, moral and professional principles. The nursing practice has undergone a positive shift from that of a vocation to a professional status today. That is to say, nursing has a more active role to play in the health care delivery system than in the past, and nursing, as a profession is ‘Accountable’ today (Patricia, 2005). The Advanced Practice Nurse (APN) is generally the most independent nursing professional. An advanced practice nurse is a Master’s degree candidate in nursing, advanced education in pharmacology and physical assessment with a certification in the specialized area of practice (ANA, 1996). The APN can work in a primary acute or restorative care unit. An APN is a clinician-educator, care manager, consultant, and researcher in her area of expertise.
The Literature Review
The evolving role of advanced practice nurses in surgery has been elucidated by Denise (1998). According to the research article, The American Nurses Association (ANA) has recognized four advanced practice roles namely certified RN anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and nurse practitioner (NP). A Clinical nurse specialist (CNS) is an APN with nursing expertise in a specialized area of practice and traditionally in a hospital setting. The CNS can be a specialist in specific diseases like diabetes mellitus, cancer or cardiology, gerontology, and other specific fields. The nurse practitioner works usually in an outpatient, ambulatory, or community-based setting. They provide care for clients with complex problems, providing a more holistic approach, attending to symptoms of non-pathological conditions. The nurse may work with a specific group of patients or with clients of all ages and health care needs. The nurse practitioner categories include adult, family, pediatric, obstetrics, gynecology, and geriatric nursing. An adult nurse practitioner (ANP) gives primary, ambulatory care to adults with a non-emergent acute or chronic illness.
They work in unison with primary care physicians. A family nurse practitioner (FNP) provides primary ambulatory care for families under a family physician. The FNP manages the illness of the family by direct care. A pediatric nurse (PNP) provides health care to infants, neonates, and children. PNPs practice in hospitals, ambulatory care, emergency care, and physician’s places (Patricia, 2005). A Women’s Health Nurse Practioner (WHNP) provides primary ambulatory care to women seeking gynecological care. An acute care nurse practitioner works in coordination with a doctor or house staff physician in an acute care unit. The acute care nurse is a generalist, based in internal medicine focusing on the care of the patient in acute care settings. A Geriatric nurse practitioner (GNP) is an ANP with a specialization in care of the older adult. GNPs are trained in the needs of old adults with an emphasis on care on functional status. A certified nurse-midwife (CNM) is a Registered Nurse (RN) who is well trained in midwifery. The practice of nurse-midwifery involves independent care of women during pregnancy, labor, and delivery. A certified registered nurse anesthetist (CRNA) is a registered nurse who has training in anesthesiology.
- These nurses work under the supervision of an anesthesiologist providing surgical anesthesia under guidance (Patricia, 2005). Debra Castner (2001) has reviewed the role of APN In nephrology. It appears to her that the role of the advanced practice nurse (APN) has often been associated with rural and underserved populations. The APN role was started with a willingness to treat patients when physicians were in short supply or lacked interest in providing care in certain geographical locations (Sherwood, Brown, Fay, & Wardell, 1997). She sees an active role for the APNs today when there is a shortage of nephrologists, a growing end-stage renal disease (ESRD) population, and an expansion of dialysis units adding to the difficulty of providing quality care. The author wants APNs to bill directly for their services and has their title inserted into the state regulations for dialysis providers. According to the article, advanced practice in nephrology can be very diverse where the APNs may work as direct clinical providers or in various other educational, research, or management roles.
- The role of the Primary Care Advanced Practice Nurse in evaluating and monitoring childhood cancer survivors for a second malignant neoplasm has been elucidated recently (Pamela et.al , 2002). The authors have made recommendations for the advanced practice nurse’s role in the primary care setting regarding health promotion activities and surveillance strategies for survivors across the life span. The database search has produced 73 research articles published in English between 1990 and 2000 that were significant to the purpose of the study. The results have also identified genetic or familial factors, radiation therapy, and chemotherapy as risk factors for the development of a second malignant neoplasm. Each theme has been analyzed, and guidelines developed for primary care advanced practice nurses, which integrates health promotion and surveillance activities for this patient population.
The role of the Advanced Practice Nurse in pediatric home care has been elucidated by Mary Lee Kerrins (2001). This research article provides firsthand insight into advanced practice pediatric nursing in the home health care setting. According to the article, the role of the advanced practice registered nurse in pediatric care has expanded to include such practice areas as school-based health clinics, child protective agencies, and home care in the past few years.
The role of the Advanced Practice Nurse in Diabetes care has been well documented (Davida, 2003). The article details the complexity of diabetes care and the emergence of APNs in diabetes care due to the emerging concept of diabetes as a self-care disease and the understanding that patients provided 90% of their diabetes care. The article describes in detail the new technologies available for the APNs to support the clinical management of diabetes like blood glucose meters and insulin pumps. The article highlights the support and education the Advanced Practice Nurses provide to the patients and stresses the importance of the clinical expertise of the nurses in providing care.
The article goes on to demonstrate without a doubt that when an advanced practice clinician is involved with patient care, the patient receives high-quality care that integrates self-care management with a high level of clinical expertise. With an explosion in the rates of diabetes and obesity in the United States, the research concludes that Diabetes care providers will be called on to provide optimal outcomes using a cost-effective approach and the increasing numbers of advanced diabetes managers will serve as role models and leaders of diabetes care teams, functioning as consultants, educators, managers, clinicians, and researchers (Davida, 2003).
The nursing profession today demands more responsibilities than in the past with the essential elements of accountability, autonomy, and leadership. Accountability means that a nurse is responsible, professionally, and legally for the nursing care provided. She is accountable for keeping competent in technical skills. Autonomy is an element of the nursing profession today. Autonomy means that a nurse is independent reasonably and self-governing in making decisions in practice. There are independent measures a nurse can initiate without medical orders. The nurse is a ‘client advocate’. She protects the human and legal rights of the patient under her care, based on his/her cultural and religious affiliations.
The nurse is a ‘Care Giver’ helping the patient regain health through the process of healing. Healing is not just curing the illness, but a process that addresses the holistic health care needs of the patient including emotional, spiritual, and social well-being. The nurse is the pivot of all communications in the health care delivery system. Communication includes documentary communication for legal safeguards and also communication with patients and their families. The process of communication is vital to give effective care, take decisions, coordinate manage patient care, assist in rehabilitation and offer comfort. As a clinical decision-maker, a nurse coordinates the activities of other members of the Health Care team like physiotherapists or nutritionists. The nurse takes these decisions alone or in collaboration with the patient or patient family on care aspects, evaluation of care results, and the best approach for the desired result.
The nurse-physician collaborative model is a model, which shows a radical shift from the past. In such a model, the health care organizational structure is decentralized and the nurses and physicians function collaboratively to make clinical decisions. The definition of nursing offered by the American Nurses Association (ANA) in fact, stresses the Nurse’s commitment to the diagnosis and treatment of human responses to illness (Patricia, 2005).
Evidence-Based Nursing is another practice method that provides nursing practice with a strong application of scientific methods. This enables the practice to proceed by a process of skeptical questioning rather than by embellishment with rhetoric (Baum, 2003). This includes the accuracy and precision of diagnostic tests, prognostic markers, therapeutic, rehabilitative, and preventive regimens.
Arderican Nurses Association (ANA) 2000. Web.
Baum Neil H., “Support your decisions with Evidence based Medicine”, “Urology Times”, 2003.
Davida F. Kruger, ‘Advanced Practice Care: Advanced Practice Care in Diabetes: Epilogue’, Diabetes Spectrum 16:49-50, 2003.
Debra Castner, ‘The “Coming Out” of the Advanced Practice Nurse’, Nephrology Nursing Journal, 2001.
Denise M. Hodson, ‘The evolving role of advanced practice nurses in surgery’, AORN Journal, 1998.
Kruger DF, ‘Our changing health care environment. Diabetes Spectrum 10:3–4, 1997. Kruger DF, Childs B: Advanced practice nurses in diabetes care’. Clinical Diabetes 16:183–184, 1998.
Mary Lee Kerrins, ‘The Advance Practice Nurse Role in Pediatric Home Care’, Home Health Care Management & Practice, Vol. 13, No. 5, 403-405, 2001.
Pamela C. Kolb Smith, ‘The Role of the Primary Care Advanced Practice Nurse in Evaluating and Monitoring Childhood Cancer Survivors for a Second Malignant Neoplasm’, Journal of Pediatric Oncology Nursing, Vol. 19, No. 3, 84-96, 2002.
Patricia A Potter, Anne Griffin Perry, ‘Fundamentals of Nursing’, 6th edition, Mosby 2005.
Sherwood, G., Brown, M., Fay, V., Wardell, D. ‘Defining nurse practitioner scope of practice: expanding primary care services.’ The Internet Journal of Advanced Nursing Practice 1997.