Advanced practice nursing An advanced practice nurse is a nurse prepared with advanced knowledge in the nursing education and diagnosis and evaluation of required care. At this level, the nurses hold a postgraduate degree in nursing and can act as a specialist or a general practitioner. The nurse is at almost same level as the doctor only that their field of concentration is on the well-being of the patients. In the last two decades, there has been an increase in the number of APNs as the local and global number of nurses continue to dwindle (Hamric, 2014, p.14). The expanding populations of elderly persons and those with chronic diseases, an increasing volume of information and regulation, new technologies, and other innovations have increased the complexity of care delivery and clinical decision-making. Some of these trends have created favorable conditions for APNs. According to the American Nurses Association, contemporary nursing practice has six essential features namely inclusion of the full range of human experiences and a practice based on the integration of objective and subjective experience. On top of that, they should have the ability to apply scientific knowledge, and the provision of a caring relationship that facilitates health and healing (Hamric, 2014, p.25). One of the licensing and credentials difficulties facing APNs is the variance in board regulation from state to state. In some states, only the board of nursing governs advanced practice nursing; in others, the boards of nursing and medicine; and in still others jointly administer it, the boards of nursing and pharmacy govern it. There is also the multiplicity of role for APNs, which is confusing to policy makers and regulators. For instance, at CMS where major designations for Medicare and Medicaid reimbursement, set the standard for all reimbursement of APNs across the country. In addition, discrepancies in advanced practice nursing definition ADVANCED PRACTICE NURSING 3
and licensing criteria among states make mobility difficult for APNs in terms of prescriptive authority and reimbursement. APNs are primarily answerable to individual state boards of nursing. Credentialing of APNs ensures that they meet competency and safety standards that will protect the public (Hamric, 2014, p.234). For there to be uniformity in the credentialing of APNs, regulations should entail all stakeholders to avoid the problem of second licensure. The notion of second licensure is unwelcome among the health professions but given the various routes of entry into the nursing profession, it seems as the only way to ensure a minimum set of competencies or requirements. Credentialing refers to the refers to the regulatory mechanisms applied to individuals, programs or organizations for the purpose of meeting standards, protecting the public and improving quality. Elements for accreditation in the APN field include a masters, or doctoral in a nursing related course. An accreditation of APN programs, national certification and in some states recertification and finally licensure. These conditions make one a fully accredited advanced practice nurse (Hamric, 2014, p.345). Credentialing involves the furnishing of documentation necessary for authorization by a regulatory body or institution to engage in a certain activities and use a certain title. It seeks to assure the public that the individuals meet proposed standards and are ready to perform duties implied by the credential. State regulations affect APNs in the sense that at times they have to get a second licensure from the state. National certification is only one part of credentialing and many states use it as one vehicle to ensure a basic level of competency to practice. Nonetheless, certification alone is insufficient to provide a credential to perform as APN. Regulatory groups commonly request evidence of the primary criteria of graduate education, national certification, and patient focused practice. Oversight of specialty education for APNs will help deal with the specific of approval of specialty advanced ADVANCED PRACTICE NURSING 4
practice nursing content. The clearest oversight models are those administered by the ACNM and the AANA, which oversee and review CNM and CRNA educational programs and their review, is separate from the overall graduate nursing accreditation processes from other bodies (Hamric, 2014, p.398). Certain regulatory barriers exist for APNs and this limit the number of people who are interested in joining the field. The rigorous process of acquiring accreditation is not for the faint hearted. Furthermore, the mandatory practice requirements that are the number of adequate clinical practice hours between the year of recertification to ensure that APNs are remaining clinically current and competent through regular practice (Hamric, 2014, p.616). Each certification process clearly spells out the clinical hour practice requirement for specialty. On top of that, there is collaborative practice arrangement where there is a collegial agreement between the APN and physician that defines parameters of practice for the APN. The specificity of the collaborative practice depends on the trust and respect between the collaborating APN and physician colleague. Other barriers and problems include the mandatory requirement of national provider identifier number, which identifies health care providers. Profession is the daily occupation that a person engages themselves in. for instance APN is a profession that involves the taking care of patients and administering the right medication to them. Professionalism on the hand, involves performing of duties with a lot of care and a lot of knowledge. It also entails handling matters wisely and taking time to listen to what the other party in the conversation wants. Professionalism in the APN field may involve the listening of patients needs and maintaining patient confidentiality in their private matters. It involves the handling of all patients in an equal manner without favor and giving them the right diagnosis and ADVANCED PRACTICE NURSING 5
treatment. APN has evolved over time to become a pillar in the medical care world. In the 19 th
century, the field of nursing involved the nurse taking care of patients and ensuring they took medicine on time. The first half of the 20 th century not only witnessed growth but also the classification of nursing into different subdivisions such as midwives and aesthetes. From 1960, there was expansion of nursing with many schools constructed at this time. There was emergence of clinical, pediatric nurses. There was allocation of more duties to the nurse that is from a mere helper to an assistant of the physician. In the 80s, the practice stood on its own literally that is there were separate classes and completely new concepts. Societal forces including wars, the economic climate, and health care policy have influenced APN history. Providing care to people in underserved areas by default fell under nursing throughout the twentieth and early twenty-first centuries. Moreover, history is clear that the concept of expanding the scope of practice for nurses was in relation to that assignment.
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References Hamric, A. B., In Hanson, C. M., In Tracy, M. F., & In O'Grady, E. T. (2014). Advanced practice nursing: An integrative approach.