Historical Development of Advanced Practice Nursing and Evidence-Based Practice

Historical Development of Advanced Practice Nursing and Evidence-Based Practice

NR 510 Week 1: Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion 2

Jessica, a baccalaureate prepared registered nurse, has been practicing for 8 years. Throughout her nursing career, she has worked in pediatric, surgical, and emergency departments. She worked as a floor nurse, a charge nurse, and she was recently offered a position in Nursing Administration. A stipulation for becoming a nurse administrator is that Jessica must attain a Master of Science in Nursing degree within 2 years of accepting the position. The offer prompted Jessica to contemplate her career. She is interested in returning to college, and wants to have greater impact on patient care but isn’t sure she will find that in an Administrative role, nor is she sure is ready for the responsibility of becoming a Nurse Practitioner. Jessica has decided to explore the advance practice roles available in nursing in order to determine the best MSN track for her. Jessica must choose one role (CNP, CRNA, CNS, CNM) and apply to a program, but she is unsure about the different roles and their individual scopes of practice. One colleague states, “You know, Jessica, working as an NP is great because you can diagnose and write prescriptions, and the accountability will fall on the physician you are working with.”

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Discussion questions:

  • Is Jessica’s colleague right? Why or why not?
  • Explore the four APN roles, and compare and contrast the pros and cons of each role against each other in order to determine the best choice for Jessica. Consider issues such as work environment, level of accountability, patient population, salary, and scope of practice. Include each role of the APN on the list, and be certain to provide appropriate rationales and citations.

NR 510 Week 1: Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion 2

As their scope of practice and autonomy increases, NPs are being held legally accountable for their actions (Iglehart, 2013). Nurse practitioners must pass classes and certification requirements regarding understanding the legal obligations of prescribing medications (Iglehart, 2013). Regardless of an NPs scope of prescriptive authority, the standard of practice and care is to ensure that any medication prescribed is compatible with other medications a patient is taking and that the correct medication is prescribed. The $525,000 settlement awarded to Sherry Huelskamp (Huelskamp v.Patients First Health Care, LLC) in 2014 against nurse practitioner Barbara King for prescribing the wrong medication  emphasizes these standards.

The four APN roles currently defined in practice are Nurse Practitioners (NP), Clinical Nurse Specialists (CNS), Certified Nurse-midwives (CNM), Certified Nurse Anesthetists (CNA). A CNS typically works in a specialized area of nursing practice defined by parameters, such as disease, setting, population (Judge-Ellis & Wilson, 2017). The CNA is restricted to administering pre- and post-anesthesia care to patients for surgery and other procedures. The CNM provides healthcare services to women, such as gynecological services, pregnancy and childbirth care, postpartum services, etc. Jessica will do well in the NP role because of her nursing background and the ability of the NP to serve the same patient populations as the other APN roles. Furthermore, the CNM, CNS, and CNA roles are too restrictive in that nurses who work in these specialized areas of the nursing practice provide distinct services. According to the U.S. Department of Health and Human Services, the most common type of APN is the nurse practitioner (Judge-Ellis & Wilson, 2017). NPs are trained to provide a wide range of primary and acute health care services. NPs diagnose and treat medical conditions, as the scope of practice has expanded to allow NPs to perform many of the same medical services as a physician to include writing prescriptions in approximately 20 states (Judge-Ellis & Wilson, 2017). The median annual salary for NPs is $103,000 (Judge-Ellis & Wilson, 2017). In the other APN roles, Jessica would have to obtain further training if she wanted to expand her scope of practice.

NR 510 Week 1: Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion 2 References:

Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners, risks and rewards. New England Journal of Medicine368(1935). Retrieved from DOI: 10.1056/NEJMhpr1301084

Judge-Ellis, T., & Wilson, T. R. (2017). Time and NP practice: Naming, claiming, and explaining the role of nurse practitioners. The Journal for Nurse Practitioners139(9), 583-589. Retrieved from DOI: Historical Development of Advanced Practice Nursing and Evidence-Based Practice https://doi.org/10.1016/j.nurpra.2017.06.024

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