NUR 513 Topic 1 Discussion Question One

NUR 513 Topic 1 Discussion Question One

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?

Topic 1 DQ 1: Evolution of the Advanced Registered Nurse Role

The transformation of the advanced registered nurse role has been a multifaceted journey that reflects the dynamic nature of nursing. This evolution has been particularly prominent as nursing rapidly adapted to the ever-changing healthcare landscape. From the traditional role of the Registered Nurse (RN), nursing has evolved into a spectrum of distinct categories, encompassing Certified Registered Nurse Anesthetists (CRNAs), Certified Nurse-Midwives (CNMs), Clinical Nurse Specialists (CNSs), Nurse Practitioners (NPs), and more recently, the Doctor of Nursing Practice (DNP) (DeNisco & Barker, 2016).

10 Ways High School Students Can Prepare for a Nursing Career

While we often perceive significant shifts in scope and expectations between the 20th and 21st centuries, some aspects of the advanced registered nurse role have remained remarkably consistent. For instance, Clinical Nurse Specialists (CNSs) have been delivering advanced care to patients with complex cases across various healthcare settings since the 1960s. The CNS role originated in response to a societal need for nurses capable of providing advanced care, particularly for psychiatric populations.

As this role was implemented and gained traction, its utility became increasingly evident. Consequently, nursing schools began to educate nurses across various specialties, expanding the reach of CNSs to areas such as oncology, medical-surgical, pediatrics, and critical care nursing (DeNisco & Barker, 2016). This transformation marked a pivotal moment in the evolution of the advanced registered nurse role.

Similarly, Nurse Practitioners (NPs) have played a crucial role in delivering care to vulnerable populations, both in rural and urban areas, since the 1960s. The inception of the NP role was a response to the shortage of primary care physicians available to serve pediatric populations, particularly in underserved areas. This role proved to be an essential solution to addressing the healthcare needs of these communities.

In summary, the advanced registered nurse role has undergone significant transformation over time, expanding into various specialized categories and playing an increasingly vital role in the evolving healthcare landscape. While some elements of these roles have remained consistent, they have continuously adapted to meet the dynamic demands of healthcare, making advanced registered nurses invaluable contributors to the delivery of quality care to diverse patient populations.

Today, nurse practitioners (NPs) constitute the largest group among advanced practice nurses. Over 192,000 NPs hold licenses and practice with varying degrees of prescriptive authority across all 50 states. Nurse practitioners are highly educated and possess board certification in a diverse array of specialty areas, including pediatrics, family care, adult gerontology, women’s health, and acute care (DeNisco & Barker, 2016).

Midwives play an indispensable role in the field of healthcare. The initiation of midwifery schools in the 1920s was a response to the high mortality rates and poverty prevalent in Kentucky, which, in turn, generated a pressing demand for midwives in rural communities (DeNisco & Barker, 2016). Midwives continue to be a crucial presence in various nursing contexts, particularly when pregnant women prefer a non-hospital setting for childbirth.

The need for midwives remains as vital as ever, as they provide essential care and support during the childbirth process. Their expertise and compassionate care have a profound impact on maternal and neonatal health outcomes, making them a valuable component of the healthcare system.

Nurse anesthetists hold a pivotal role in the realm of nursing as they are responsible for administering anesthesia during surgical procedures. These professionals function as licensed independent practitioners, offering autonomous care and collaborating with surgeons, dentists, podiatrists, and anesthesiologists. Nurse anesthetists have a rich history of providing anesthesia care, particularly during wartime.

During conflicts such as World War I, World War II, the Korean War, the Vietnam War, and more recently, the conflicts in the Middle East, nurse anesthetists have been at the forefront, ensuring that U.S. military personnel receive essential anesthesia care (DeNisco & Barker, 2016). Their contributions to healthcare delivery have been consistent and invaluable.

The role and responsibilities of advanced registered nurses will undoubtedly continue to evolve in response to the ever-changing landscape of the American healthcare system, driven by advancements in technology and the imperative for ongoing education. Nurse educators play an indispensable role in this process by keeping registered nurses informed about the latest policies and procedures, ensuring that they remain current in their practice and provide high-quality care to their patients. This evolution and adaptability are key to meeting the dynamic demands of healthcare in the 21st century.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570

Peer Responses

Re: Topic 1 DQ 1

You bring up a great point about the difficulty with being an advanced practice registered nurse (APRN). Even though its been 20 years since the Institute of Medicine released their report “The Future of Nursing: Leading Change, Advancing Health” recommending that nurses work to the full extent of their education and training, some people and regulatory bodies are still hesitant to allow this (Institute of Medicine, 2011).

My mother was a Nurse Practitioner (NP) trained in acute cardiovascular care. I remember how frustrated she would get because the physician she worked under wouldn’t allow her to do certain procedures or tests that she was capable of performing because he would rather her handle the paperwork. I find it sad that it has been such a struggle for nurses to break through these barriers to be able to do what they are capable of. I also think it does the patients a huge disservice.

References

Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209881/

Re: Topic 1 DQ 1

I really enjoyed your post and the inclusion of some of the nontraditional APRN roles. Many of these nonclinical, or nontraditional roles do require knowledge and experience beyond the bachelor’s degree level of education. I was surprised to learn that all Nurse Administrators are not required to have a graduate level degree (DeNisco & Baker, 2016).

Nurse Educators are another vital nontraditional APRN role that is tasked with preparing the nursing workforce in a clinical setting (DeNisco & Baker, 2016). There has been debate about the content that should be taught to future nurse educators; whether its advanced clinical knowledge or teaching techniques.

In my mind both components seem necessary to adequately do the job. I agree that the National Council of State Boards of Nursing (NCSBN) should reassess the current APRN roles. I think you hit the nail on the head when saying that reevaluating the APRN roles would better serve nurses and patients alike with our ever-evolving healthcare system.

Porter-O Grady and Malloch (2018) stated that “an understanding of change and innovation is not an option for nurses but rather it is a professional obligation” (p.52). This professional obligation to transform and innovate extends to the NCSBN and their duty to redefine the APRN role.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett   Learning. ISBN-13: 9781284072570

Porter-O Grady, T. & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones &. Bartlett Learning. ISBN-13: 9781284146530

Re: Topic 1 DQ 1

The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).

These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016).

The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline. This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016).

Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators.

DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570

Re: Topic 1 DQ 1

Advanced registered nurse roles and responsibilities will forever be evolving due to changes in policy such as health care acts, aging populations, and the overall need for advanced registered nurses. Furthermore, the responsibilities of advanced registered nurses have already started to expand. Densico and Barker 2016, shed light on the importance that barriers for advanced practice nurses be identified and resolved.

In some states, nurse practitioners (NPs) do not work in primary care due to some state restrictions; however, the Institute of Medicine (IOM) released a report stating that NPs be allowed to practice independently with full autonomy. There have been many reports validating that NPs provide high-quality care, while also being extremely cost-effective.

Moreover, according to Denisco and Barker, “the Health Resources and Services Administration (HRSA) has projected a large increase in demand for nurses, from approximately 2 million full-time equivalents in 2000 to approximately 2.8 million in 2020” (2016). The demand for nurses in the year 2020 came from the idea that people born in the 1960s (baby boomer generation), would put a strain on the healthcare system due to their size in population and the fact they were an aging generation.

However, no one would fathom that the actual demand for nurses in 2020 would be due to a pandemic. Shifts in scope of practice and expectations have already been seen in the 21^st century. Mainly focusing on expectations, universities have started to phase out nurse practitioner programs and replacing NP programs with doctoral nursing programs (DNP). This is partly because DNP programs provide more resources and opportunities to bring forth better health outcomes for patients. However, NP vs. DNP does not change scope of practice.

References

DeNisco, S., & Barker, A. (2016). Advanced practice nursing: essential knowledge for the profession (Third). Jones & Bartlett Learning. https://doi.org/ISBN978-1-284-07257-0

According to the American Nurses Association, the advanced registered nurses are the primary care givers and play a critical role in provision of preventive care services to the general public. They include nurse specialists, nurse anesthetists, and nurse midwives (ANA, 2022). The notable advancement has been achieved through tremendous transformation in the past century.

For instance, the current role of advanced registered nurses is based on the basics 20th century practices of nurse midwives and nurse anesthetists. Over time, four different advanced practice nursing roles have emerged; the nurse midwife (CNM), the nurse anesthetist (CRNA), the clinical nurse specialist (CNS), and the nurse practitioner (NP) (Hanson & Hamric, 2003).

Over the years, the role of advanced registered nurses has transformed in three distinctive phases. The first phase in evolution of the role was initiated by changing patient needs and treatment opportunities. In this case, the introduction of anesthetic agents offered the foundation for CRNA role (Hanson & Hamric, 2003). Initially, the nurse was supposed to make an evaluation of the patient’s status prior to selecting the appropriate analgesic treatment.

Nursing education and training is the key factor in the second phase of evolution. In the early years of the 20th century, nursing roles involved activities that were not valued by physicians and in instances where physician supply was insufficient. This led to evolution of advanced registered nursing roles through education. For example, the introduction of the nurse practitioner certification project in 1965 helped prepare nursing practitioners offer comprehensive care and provide preventive health services to manage common health problems (Keeling, 2015).

Finally, the need for standardization and the emergence of graduate education has transformed the role of advanced registered nurse. In the past 50 years, the demand for specialized education has greatly expanded these roles. Since the 1990s, three nursing specialties have evolved the expectation of master’s level education. These include CNS, NP, and CRNA (Hanson & Hamric, 2003). As a result, migration from one role to another by practitioners is a common practice.

References

ANA. (2022). Advanced Practice Registered Nurse (APRN). Retrieved september 14, 2022, from American Nurses Association: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Hanson, C. M., & Hamric, A. B. (2003). Reflections on the Continuing Evolution of Advanced Practice Nursing. Nurs Outlook 51, 203-211.

Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing . Online Journal of Issues in Nursing, 20(2).

Advanced practice registered nurses (APRNs) are masters prepared nurses responsible for providing clinical care to patients in different healthcare settings. Traditionally, the role of APRN was commonly associated with clinical roles and specialties that included clinical nurse specialists, nurse practitioners, certified nurse midwives and certified registered nurse anesthetist.

The American Association of Colleges of Nursing (AACN) in 2004 defined the advanced nursing practice as “any kind of nursing intervention which impacts healthcare outcomes for individuals or populations (Brykczynski, 2023). These include direct care of individual patients, management of care for populations and administration of nursing as well as health care organizations. However, the roles of advanced nurses have continued to transform based on the changes and situations in the health sector, especially the need to expand access to healthcare services for populations.

The shortage of physicians in the 1970s led to the federal government funding the establishment of more APRNs through training so that they can bridge the gap, especially in rural areas. The implication is that many APRNs can now diagnose and treat patients for different conditions as some states recognize them as primary care providers (DeNisco, 2019). The transformation in healthcare delivery models in 20th and 21st centuries has also led to a system that focuses on patient based on the concept of patient-centered care. Imperatively, the roles of advanced practice nurses have expanded as evidence shows that they should be allowed to practice to full extent of their training and education. Today, APRNs work collaboratively with other professionals to deliver quality care to individual patients and health populations.

The caring patterns of the advanced registered nurses will continue to shift because of the transforming healthcare system that focuses on value-based care and other innovative care delivery models. Advanced registered nurses will continue to expand their practice as they become specialists to cater to diverse patient needs (Zaccagnini & Pechacek, 2019). Working in teams will expand their roles as patient managers and leaders at the organizational level, especially with attainment of terminal degrees like PhD and DNP.

References

Brykczynski, C. L. M. K. A. (2023). Role development of the advanced practice nurse. Hamric & Hanson’s Advanced Practice Nursing-E-Book: An Integrative Approach, 98.

DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession: Essential Knowledge for the Profession. Jones & Bartlett Learning.

Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new model for advanced practice nursing. Jones & Bartlett Learning.

Over the past century, the function of the advanced practice nurse has evolved significantly. Beginning in the 1960s, the major function of the nurse practitioner was to offer primary care in underserved communities (DeNisco, 2021). Over the subsequent decades, NPs pushed to shift the political and socioeconomic perspective of society, opening the path for NPs to be viewed as more than just a cost-effective method of providing healthcare to the underprivileged. In the 1980s and 1990s, NP education migrated to the university environment as a master’s-level program.

Realizing that education also leads to credibility, NP education followed the adage “education is power” (DeNisco, 2021). Nonetheless, misunderstanding regarding the APRN’s role continued into the early 2000s. As a result, a consensus model was developed to define the qualifying roles and education of an advanced practice registered nurse (APRN).

As nursing is a profession that requires lifelong learning, it is not surprising that nurses desired to further their education by pursuing PhD degrees. The American Association of Colleges of Nursing (AACN) formally accepted the Doctor of Nursing Practice degree, which is currently recognized as the highest practice degree, in order to reduce misunderstanding regarding the range of available doctoral degrees.

The role of the APRN is presently developing before our eyes. Anesthesia is administered to surgical patients by CRNAs instead of an anesthesiologist. Similarly, ACNPs are replacing internists in intensive care units and emergency departments across the nation. Additionally, nurses are educated to treat patients, not diseases. The cornerstone of nursing enables patients to be active participants in their treatment, hence enhancing patient outcomes and health care compliance.

This holistic approach to patient care, combined with the NP’s extensive education and practical experience, will certainly make the NP the preferred primary care practitioner over the MD. As a personal objective for the nursing profession, I want nurses to have a voice in the political arena. Historically, nursing has been administered and perceived as an employee work group; hence, nurses’ engagement and presence in the political and public sector have been insufficient. (Weberg et al., 2019) I’d love to see the day when the public views APRNs and MDs in the same light, when the nurses’ unique perspective, education, and approach to patient care can be a driving force for our local and national public policy.

References

DeNisco, S. M. (2021). Advanced Practice Nursing: Essential Knowledge for the Profession (4th Ed.). Jones & Bartlett Learning.

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in Nursing Practice: Changing the Landscape of Health Care (3rd ed.). Jones & Bartlett Learning.

NUR 513 Topic 1 DQ 1 

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes? 

Re: Topic 1 DQ 1

Historically, when one spoke of advanced practice nursing, they meant one of four roles; certified registered nurse anesthetist (CRNA), certified nurse mid-wife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). In 2004, the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as “Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy” (Denisco & Barker, 2016).

Since this definition came out many other nursing roles, such as nurse administrators and public health nurses have also been thought of as advanced practice nursing roles. Whereas advanced practice nursing used to be mainly reserved for clinical practice, it is now branching out into non-clinical roles. With the ever-expanding role of nurses coupled with the push to expand access to and decrease costs of health care there will likely be many new roles developed for nursing practice. These roles will require advanced degrees even if they are not in clinical areas, therefore, they too should be thought of as advanced practice nursing. 

Reference

Denisco, S.M. and Barker, A.M. (2016). Advanced Practice Nursing: Essential Knowledge for the Profession. Jones and Bartlett Learning. https://www.gcumedia.com/digital-resources/jones-and-bartlett/2016/advanced-practice-nursing_essential-knowledge-for-the-profession_3e.php 

I agree with you that nursing practice is any form of nursing intervention that is meant to influence the care outcomes. The nurse practice has been evolving overtime especially with the transformation of the healthcare systems and healthcare policies. In the current healthcare industry where the focus is on the patient, what is commonly referred to as patient centered approach has ensured that the patient is given autonomy to choose on the best care practice that is appropriate and improves the patient’s health condition (American Association of Nurse Practitioners, 2019).

This has called upon the nurse training institutions to shift and adapt to the new and emerging trends in healthcare. The advanced nursing role has been the significant part that the Affordable Care Act aims to enhance health promotion measures among the aging US population (Woo et al., 2017). The research findings reveal that the advanced nursing role would be one of the professions at a highest demand by the year 2022. 

References 

American Association of Nurse Practitioners. (2019). Scope of Practice for Nurse Practitioners. American Association of Nurse Practitioners; AANP Website. https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners 

Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1). https://doi.org/10.1186/s12960-017-0237-9 

A code of ethics within nursing is imperative to maintain the dignity of the patient and the integrity of the APRN no matter what population or patient one may be providing service to. When an RN decides to seek further education and advance their practice into an APRN practice, they dive into more specialized patients and populations. Although the foundation of the code of ethics for APRN’s may be the same, this divergence into specialties means applying those ethics to each role very differently.

A clinical nurse specialist in a pediatric setting may respond to ethical dilemmas very differently than a Family Nurse Practitioner (FNP) . One such example would be one of non-maleficence, the avoidance of harm to a patient (Haddad & Geiger, 2022). Although practitioners that work in pediatrics in some capacity know they are not only treating the patient but supporting the family as well, a pediatric CNS may see a problem specific to how to it affects just the patient whereas an NP may see the greater picture as to how the health problem affects the whole family unit. The CNS and the FNP may make different choices or suggest different directions of treatment because of their different training and experience.

An FNP may make a treatment suggestion knowing the family unit or because of the knowledge of the barriers or strengths in the community as they are often located in primary care. A CNS may make a treatment suggestion or plan to the healthcare delivery system of all those patients that present with that issue as they often serve as “expert consultants” to nursing staff or work to improved delivery of care within the healthcare system (Explorehealthcarecareers.org, 2022).

One such example could be with controller medications in a pediatric patient with asthma. The FNP may take into consideration the abilities of the parents to adhere to 20 minute nebulizers everyday in a two year old and may suggest a less effective but more complied with treatment plan of metered dose inhalers if the benefit outweighed the cost. A CNS may suggest a change to the system of asthma management and/or advise this family/patient to figure out a way to adhere to best practice of inhaled nebulized mediation. In either case, the primary goal is in respect to Provision 2 of the nursing code of ethics, “the fundamental commitment of nursing to the uniqueness, worth, and dignity of the patient” (American Nurse’s Association, 2015). APRN’s in this situation is to maximize the treatment plan for a child with asthma.

Re: Topic 1 DQ 1 

The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).

These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016). The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline.

This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016). Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators. 

DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.  

References 

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570 

I agree with your statement that the advanced nurse practice numbers have soared high in the 21st century compared by the 20th century. The current Covid-19 pandemic has however, proved that health and wellness is a collective responsibility (Kovac, 2020). In this context both the patient and the nurse are at risk of contracting the disease regardless of age, gender or religious underpinnings hence adequate precautionary measures should be taken. The advanced nursing role has taken up active role in preventive measures of the disease by offering the routine guidelines of hygiene the emerging trends in the spread and severity of the disease.

The concept of preventive care is one of the key pillars in the patient protection and well-being. The advanced nurse role requires the nurses to carry out educational programs, seminars and workshops that are meant to help the public on the need of maintaining our bodies for optimal health and reduced chances of hospitalization. The one situation where the advanced nurses’ practitioners have shown resilience is the tackling of the covid-19 pandemic. Countries that embraced strict, firm and taken early hard precautionary measures have known to be safer with very low reported cases in the country (Trnka et al., 2021) 

 References 

Kovac, M. (2020). The Covid-19 pandemic: collective action and European public policy under stress. Central European Journal of Public Policy, 0(0). https://doi.org/10.2478/cejpp-2020-0005 

Trnka, S., Long, N. J., Aikman, P. J., Appleton, N. S., Davies, S. G., Deckert, A., Fehoko, E., Holroyd, E., Jivraj, N., Laws, M., Martin-Anatias, N., Roguski, M., Simpson, N., Sterling, R., & Tunufa’i, L. (2021). Negotiating risks and responsibilities during lockdown: ethical reasoning and affective experience in Aotearoa New Zealand. Journal of the Royal Society of New Zealand, 1–20. https://doi.org/10.1080/03036758.2020.1865417 

 This week : CAT (150 WORDS) 

This week : We will discuss how the role of advanced registered nurse transformed over time, considering various shifts in scope and expectations in the 20th and 21st centuries. We will also discuss different ways that will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes. Here is a CAT ( classroom assessment technique question for you to get additional participation points). Please respond in addition to your 2 main dbqs dq1 and dq2. 

CAT #1 

Explore the 4 APRN roles ? of your personal interest. 

The APRN roles which are the advanced roles include; certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), clinical nurse specialist (CNS) and certified nurse practitioner CNP). The advanced nurse roles have been traditionally entailing focus on the clinical procedures, advocating for better patient care, being case managers (Hu & Forgeron, 2018). Additionally, ADP is also expected to work in consultation and collaboration with other healthcare professionals.

The roles entail a wide scope of practice and ideally, the learning is meant for advancement on the already available information. However, in the current situation the healthcare industry is approaching a new era as emphasized in the affordable care act which we still don’t know what will happen. The affordable care act insists on offering medical care that built on patient centeredness and care that is preventive rather than curative (Courtemanche et al., 2018). This is meant to tackle the rising number of the elderly population that is battling serious chronic illnesses that are associated with old age  

References 

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on Health Care Access and Self-Assessed Health After 3 Years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 004695801879636. https://doi.org/10.1177/0046958018796361 

Hu, J., & Forgeron, P. (2018). Thinking, educating, acting: Developing advanced practice nursing. International Journal of Nursing Sciences, 5(2), 99–100. https://doi.org/10.1016/j.ijnss.2018.04.006 

An advanced registered nurse assumes a variety of roles within the healthcare field, such as nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. Focusing primarily on the role of nurse practitioners (NPs), it’s important to note that NPs have become increasingly prevalent in the healthcare sector. This evolution is driven by changing requirements for licensure, accreditation, and certification, reflecting the rising demand for their services (Penn Nursing, n.d).

In the 20th century, a significant factor reshaping the NP’s role was the shortage of healthcare services, particularly in underserved rural areas and inner cities. This shortage was exacerbated by the specialization of physicians, which left a gap in primary care. In response, primary care physicians began collaborating with registered nurses possessing clinical expertise to address the needs of children and families (Penn Nursing, n.d). Additionally, the introduction of Medicare and Medicaid expanded access to healthcare for low-income individuals, including children, women, the elderly, and those with disabilities. This increased demand for primary care services and enabled nurses to assume more extensive roles, working closely with primary care physicians (Penn Nursing, n.d).

The demand for healthcare and healthcare professionals led to the establishment of the first nurse practitioner training program in 1965. Loretta Ford, in partnership with physician Henry Silver, designed this program to foster collaboration between physicians and nurses rather than seeing nurses as substitutes for physicians (Penn Nursing, n.d).

Early in the 20th century, nurses had relatively few regulations governing their practice. The Henry Street Settlement (HSS), formed in 1893, consisted of a group of 12 nurses who made home visits, providing not only healthcare but also services like ice, sterilized milk, and meals. They even dispensed physician-prescribed medications, obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). However, in 1903, the state nursing registration act raised questions about what nurses were permitted to do. For example, could they administer prescribed medications? This act emphasized the evolving boundaries of medical and nursing professions (Keeling, 2015). The HSS expanded significantly over the years, with nurses making over 300,000 home visits a year by 1926, treating various illnesses (Keeling, 2015).

The boundaries between medical and nursing professions continued to evolve as new treatments emerged, and legislative acts at the state and federal levels regulated the practices of medicine, pharmacy, and nursing (Keeling, 2015). In the 21st century, nurse practitioners practiced across a wide range of healthcare settings, including hospitals, clinics, urgent care facilities, nursing homes, schools, and public health departments. They provided healthcare services autonomously and in collaboration with other healthcare professionals, adhering to a code of ethics and employing evidence-based practices. Their scope of practice included assessing, ordering, performing, supervising, and interpreting diagnostic and laboratory tests, making diagnoses, initiating and managing treatments, and prescribing medications and non-pharmacologic treatments (Scope of practice for Nurse Practitioners, 2022). The scope and expectations of nursing roles have expanded significantly over the years.

As the healthcare landscape undergoes transformations, the roles of advanced registered nurses will also evolve. The Affordable Care Act of 2010 shifted the focus of healthcare from acute and specialty care to primary care, with an emphasis on care coordination and prevention/wellness, aimed at preventing chronic conditions (National Academy of Sciences, n.d). With an increasing number of insured individuals, there is a growing demand for nurse practitioners to bridge the gap between physicians and physician assistants (National Academy of Sciences, n.d). In the United States, there are 287,000 primary care physicians, 83,000 nurse practitioners, and 23,000 physician assistants, reflecting the need for a diversified healthcare workforce (National Academy of Sciences, n.d). The education and roles of nurse practitioners continue to evolve, equipping nurses to enter the workforce with qualifications to provide an even broader range of services. Nurse practitioners collaborate with a team of providers, integrating various skills and coordinating care, including nutrition services, physical therapy, and social work (National Academy of Sciences, n.d). The progress made by nurses since the time of Florence Nightingale, nearly 150 years ago, demonstrates their continued growth in the healthcare field.

References:

Keeling, A. W. (2015, May). Historical perspectives on an expanded role for Nursing. Retrieved August 4, 2022, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Historical-Perspectives-Expanded-Role-Nursing.html

National Academy of Sciences. (n.d.). Transforming practice – the future of Nursing. Retrieved August 4, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK209871/

Penn Nursing. (n.d.). Nurse practitioners: Shaping the future of Health Care. Nursing, History, and Health Care. Retrieved August 4, 2022, from https://www.nursing.upenn.edu/nhhc/nurse-practitioners-shaping-the-future-of-health-care/

Scope of practice for Nurse Practitioners. American Association of Nurse Practitioners. (2022). Retrieved August 4, 2022, from https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

Advanced registered nurses play a multifaceted role, encompassing various specialties like nurse midwives, nurse anesthetists, nurse practitioners, and clinical nurse specialists. In this discussion, we’ll primarily focus on the role of nurse practitioners (NPs), who have experienced significant growth in the healthcare field. This expansion is in direct response to the increasing demands of the public for their services, leading to evolving requirements for licensure, accreditation, and certification (Penn Nursing, n.d).

The 20th century witnessed a revolutionary change in the NP’s role, primarily due to the inadequacy of healthcare services. The emergence of medical specialization resulted in a shortage of primary care physicians, particularly affecting underserved rural areas and inner cities (Keeling, 2015). In response, primary care physicians, who were not specialists, started collaborating with registered nurses possessing clinical expertise. This collaboration aimed to identify and address the healthcare needs of children and families (Penn Nursing, n.d). Furthermore, the introduction of Medicare and Medicaid expanded access to healthcare for low-income individuals, such as children, women, the elderly, and those with disabilities. This augmented the demand for primary care services and allowed nurses to assume more extensive roles, working in parallel with primary care physicians (Penn Nursing, n.d).

The growing demand for healthcare services and professionals prompted the development of the first nurse practitioner training program in 1965. This program, spearheaded by Loretta Ford in collaboration with physician Henry Silver, sought to bridge the gap between physicians and nurses, emphasizing a collaborative relationship rather than a substitution of physicians (Penn Nursing, n.d).

Early in the 20th century, there was minimal regulation governing nursing practices. The Henry Street Settlement (HSS), founded in 1893, comprised a group of 12 nurses who conducted home visits, delivering not only healthcare but also services such as ice, sterilized milk, and meals. These nurses also routinely administered physician-prescribed medications, obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). However, this practice was questioned in 1903 with the passage of the state nursing registration act, which declared that nurses should not be considered as having the authority to practice medicine or undertake disease treatment (Keeling, 2015). This act raised several questions about what nurses were allowed to do, particularly regarding the administration of prescribed medications, which had been a routine part of their home visits. Over the years, the HSS expanded significantly, with nurses conducting over 300,000 home visits annually by 1926, providing care for illnesses like pneumonia, polio, measles, influenza, and tuberculosis (Keeling, 2015).

The boundaries between medical and nursing professions continued to evolve as new treatments became available, and legislative acts at the state and federal levels regulated the practices of medicine, pharmacy, and nursing (Keeling, 2015). In the 21st century, nurse practitioners worked in a wide range of healthcare settings, including hospitals, clinics, urgent care facilities, nursing homes, schools, and public health departments. They provided healthcare services independently and in coordination with other healthcare professionals, adhering to a code of ethics and employing evidence-based practices. Their scope of practice encompassed various responsibilities, such as assessing, ordering, performing, supervising, and interpreting diagnostic and laboratory tests, making diagnoses, initiating and managing treatment, and prescribing medication and non-pharmacologic treatments (Scope of practice for Nurse Practitioners, 2022). The scope and expectations of nursing roles have expanded significantly over the years.

As healthcare undergoes continuous changes, the roles of advanced registered nurses will also evolve. The Affordable Care Act of 2010 redirected healthcare focus from acute and specialty care to primary care, emphasizing care coordination and prevention/wellness to combat chronic conditions (National Academy of Sciences, n.d). With the rise in the insured population, there is a growing demand for nurse practitioners to bridge the gap between physicians and physician assistants (National Academy of Sciences, n.d). In the United States, physicians represent the majority of primary care providers, but nurse practitioners and physician assistants play a crucial role in meeting the healthcare needs of the population (National Academy of Sciences, n.d). The education and roles of nurse practitioners continue to evolve, equipping nurses to enter the workforce with qualifications to provide an even broader range of services. Nurse practitioners collaborate with a team of providers, integrating various skills and coordinating care, including nutrition services, physical therapy, and social work (National Academy of Sciences, n.d). The progress made by nurses since the time of Florence Nightingale, nearly 150 years ago, demonstrates their continued growth and adaptation in the ever-evolving healthcare landscape.

The evolution of the Advanced Practice Registered Nurse (APRN) role has been an ongoing journey marked by significant changes over time. The definition of what it means to be an APRN has continuously evolved, gradually gaining clarity. Initially, this role emerged as a means to provide primary care to underserved populations. A notable early example was the work at the Henry Street Settlement House in New York during the late 1800s. It wasn’t until 1965 that the official title of Nurse Practitioner was established. With the formalization of this role, the APRN category came to encompass four distinct roles: Nurse Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist (DeNisco, 2021).

In the latter part of the 20th century and the early 21st century, the number of Nurse Practitioners, as well as the availability of Master’s and Doctorate level education programs for Nurse Practitioners, has experienced remarkable growth. This expansion has addressed the critical need for more primary care providers, as a significant 87% of Nurse Practitioners are educated in primary care (DeNisco, 2021).

In addition to the four specialized roles mentioned earlier, the realm of Advanced Practice Nursing (APN) has expanded to include a broader range of nursing roles. These encompass nurse educators, nurse leaders, quality and safety specialists, informaticists, and other vital positions. The future of our healthcare system will likely depend heavily on the expertise, skills, and education of these advanced roles. One significant challenge to overcome is the long-standing issue of inconsistent practice standards and varying licensing rules that exist from state to state. Achieving clear and consistent guidelines for APRN practice across the entire country will be a key step in strengthening our professional voice and enhancing our ability to lead healthcare through the present and future challenges we face.