ADVANCE PRACTICE NURSING 1

Advanced Practice Nursing in the United States: History, Roles & Competency

Enerolisa Paredes Lixandro

NURS613-E1WW

Professor Amy Hoover

June 17, 2018

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Advanced Practice Nursing in the United States: History, Roles & Competency

Nursing is one of the most recent health care professions. It was during the

Nightingale’s war that the first formal education program for nurses was developed. In

1893, the rapid industrialization and immigration helped the development of nursing. Given

the high amount of disease present in the country, nurses would provide an array of

services. They would provide physical care for the European immigrants; necessities such

as ice, sterilized milk, medicines and food. They would also refer them to outside medical

facilities where patients could encounter more resources. Since the 1960s Nurse

Practitioners have worked as healthcare providers in the medical setting. In the turn on the

20th century boundaries in healthcare have changed as more diverse treatments became

available. Changes in state and federal laws have increased the opportunities available for

different health care professions. Even though nursing is a young branch of healthcare, it

has continued to grow and develop into an important part of health care.

Most health management organizations are composed of directors, executives,

department administrators, primary care managers followed by service providers. This

hierarchy in the health care setting has evolved so that quality in patient care can improve.

Patient care managers and service providers have grown and work in an interdisciplinary

manner so that communication can be establish between different providers. Still, for Nurse

Practitioners there are laws and regulations that imped certain functions depending on the

state. States such as California, Texas, and Florida have very restrictive laws and

regulations for Nurse Practitioners. On the other hand in, Colorado, Montana and New

York they can either fully practice or have reduced practice laws (AANP, 2018). In 2015,
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nurse practitioners in New York were no longer required to have a collaborative agreement

with a physician or submit patient charts to a physician for review. They are still required to

do so if they have less than 3,600 of practice. One of the inconveniences of these new

regulations is that for Nurse Practitioners (NPs) it is becoming more difficult to find

agreements with physicians if they need to consult one. This can be detrimental to the care

of patients since an interdisciplinary relation is optimal for the betterment of the patient.

There are different specialties or roles in which Nurse Practitioners can specialize,

such as Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Certified Nurse

Midwives and Acute Care Nurse Practitioners. Clinical Nurse Specialists assess and treats

illness in specialty areas of care. They can work with geriatric critical care, pediatric health

and adult care. Certified Registered Nurse Anesthetists are usually found working with

patients that need obstetrical, surgical and trauma care. They work in collaboration with

many different types of physicians. A Nurse Midwife works with women during pre-

conception, pregnancy, delivery and post-partum care. Lastly, Acute Care Nurse

Practitioners treat patients in need of short-term care, they are usually working in outpatient

centers and emergency rooms. As an Advanced Practice Registered Nurse they can often

diagnose health problems, do physical exams and manage treatment as well as prescription

of medication, according to the U.S. Bureau of Labor Statistics.

There are competencies for an Advance Practice Nurse, these are the essential

features of advanced practice nurse, and they are the scope and standards of practice for

nursing. The competencies are: expert coaching and guidance, consultation, research skills,

clinical and professional leadership, collaboration and ethical decision-making skills. By

utilizing these sets of skills Nurse practitioners are able to demonstrate expert knowledge,

demonstrate the ability to utilize other specialties and interact with different staff members.
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Advance Nurse Practitioners (APN) have very valuable roles in regards to Health

policies and delivery of care. APNs are prepared clinicians that focus on health and illness

management and are positioned to lead the way. They are able to do this by molding and

reinforcing health policy priorities. They spend more time with than any other provider in

direct care and in contact with the patients and their families. They also have a deep

understanding on how the system fails to provide access to affordable and high-quality care

to American regardless of their status (U.S. Department of Health and Human Services,

2014). Despite all the strength that they posses, they undervalue their political power. They

have an array of distinct traits that influence and help transform the nursing profession for

the better. Nurses have a more holistic perspective for patient care. They take notice on the

mental, emotional, spiritual and environmental state of the patient making sure that they are

balanced. This is important for the management of each individual since every aspect can

affect his or her health.

Thankfully, health policies have been shifting in the United States. This has aid in

the increase of care in under-served areas, outer cites and quite rural regions. A family

nurse practitioner is taking an independent role, they are able to implement nursing

interventions and in that matter educate and evaluate patients towards prevention; by

encouraging and changing lifestyle that otherwise would contribute to an increased risk of

chronic disease.

There is no question that nurses can take roles in advance, improve and increase the

value of health. Still, new ways of approaching the practice by changing the focus of the

disease is needed. Creating a team-based approach with patients and their families in order

to understand their culture, in a way that can meet the patients needs in essential. By

attaining resources that can be spread through the community is needed so patients can be
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aware of the care and support that is available for them. This type of approach increases the

wellness of the population over all by promoting healthy living. Keeping track of their

outcomes, and improvement is a great tool so they can observe their changes over time.

This technique requires the work of a multidisciplinary team where all departments work to

ensure the wellness of the patients. We must remember that we are all working towards the

same goal, delivering great patient care. “Nurses can no longer take a back seat—the time

has come for nursing, at the heart of patient care, to take the lead in the revolution to

making healthcare more patient-centered and quality-driven” (Salmond, 2015, p. 282)

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References

Cooke, L., Gemmill, R., & Grant, M. (2008). APN Core Competencies: A Framework for
Developing and Testing an APN Discharge Intervention. Clinical Nurse Specialist
CNS, 22(5), 218–225. http://doi.org/10.1097/01.NUR.0000325366.15927.2d
Keeling, A., (May 31, 2015) "Historical Perspectives on an Expanded Role for Nursing"
OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 2, Manuscript 2.,
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https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment
Melanie Swan, Sacha Ferguson, Alice Chang, Elaine Larson, Arlene Smaldone; Quality of
primary care by advanced practice nurses: a systematic review, International
Journal for Quality in Health Care, Volume 27, Issue 5, 1 October 2015, Pages
396– 404, https://doi.org/10.1093/intqhc/mzv054
Salmond S. (2015). Nurses leading change: The time is now! In Forrester D. A., editor.
(Ed.), Nursing's greatest leaders: A history of activism (Chap. 12). New York, NY:
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Xue, Y., Ye, Z., Brewer, C., & Spetz, J. (2016). Impact of state nurse practitioner scope-of-
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Outlook, 64(1), 71-85. doi:10.1016/j.outlook.2015.08.005