Advanced Practice Nursing Roles

From its origins, the field of advanced practice nursing (APN) has both evolved and changed in drastic clinical, legal, and technological ways. The APN profession has developed in distinct ways across local, state, national, and international levels. The purpose of this paper is to describe all the differences of nursing while adding the background, history, and analyses of the APN field to describe the important roles played by advanced practice nurses today.

The APN field has many attributes contributing to patients’ desire to be disease and symptom free. Seeking to meet challenges patients must overcome, APN provides many specialty categories, including the clinical nurse specialist, certified nurse midwife, certified nurse practitioner, and the certified registered nurse anesthetist. (DeNisco & Barker, 2013). These and other specialized roles are unique in their outcomes and seek to advance patient health in any setting. The APN field uses evidenced based practice to achieve goals to continue its advancement, which in turn helps maintain quality of life by implementing safe, effective, and quality care. (Keeling & Biglee, 2005). The validity to support the purpose of this paper is therefore backed by the measured outcomes.

Historical Background

The purpose of the advanced practice nurse in general is to enhance life, which history shows nurses have accomplished in many different ways. The APN field dates to the American Civil War, where nurses aided different specialized doctors with minor procedures. (Keeling & Biglee, 2005). This trend became popular and placed nurses with more specialists, which in turn created care sections, such as anesthesia nurses, midwifes, and general nurse specialists. Although there were many challenges in promoting the need for nurse specialists, it became recognized as the normal standard of functioning in medicine.

The advanced practice nurse was more readily used in World War II than in previous decades. From those expanded roles, advanced practice nurses have been increasingly implemented in primary, secondary, and tertiary care of the sick, injured, and diseased. (DeNisco & Barker, 2013). The APN field has developed over the decades to facilitate care on a global level and has created health trends to prove the need and effectiveness of the care. By the 1960s, advanced practice nurses were involved in so many different specialties that the health care system began utilizing advanced practice nurses as primary care givers. (DeNisco & Barker, 2013). This greater independence for the APN field created new advances, technology, and medical practices to deliver care with less physician oversight.

As the years progressed, so did the growth of the APN field, which began focusing on improved patient health care policies. The APN field continues to uphold the roles and responsibilities of advanced practice nurses. (Benton, 2012). APN is no longer seen as a subordinate role, and now requires a broader scope of education and care experiences. (Keeling & Biglee, 2005). From an unlicensed assistive role to an authoritative and policy influencing model, today’s advanced practicing nurses maintain greater professional stature, which promotes patient wellness in collaboration with all levels of the healthcare team.

Levels of APN Role Aspects

The nursing profession has many aspects and comes into contact with a wide variety of specializations. These specializations not only include one aspect of treatment, but also include treating patients as a whole. The other spectrum of nursing integrates the perception of nursing, technology in nursing, legal aspects, and levels of collaboration. (Sheer & Wong, 2008). The complex relationships between APNs and allied health care professionals are indicated within local, state, national, and international levels of nursing.

The Local Level

The local level of nursing is most likely the widest used integration. Keeling and Biglee (2005) indicate this type of level can includes many factors creating positive or negative changes mostly related to patient goals, treatments, diagnosis, and a continuum of care. The local level is focused on the dynamic practice which may include experience, evidenced based knowledge, and adaption to different healthcare settings. The local level also may include utilizing their advanced practice nursing skills to evaluate diseases or performing specialized procedures. (Keeling & Biglee, 2005). As the nursing field changes, however, advanced practice nurses may have to broaden their scopes of practice by furthering education to achieve the specialized levels, such as family nurse practitioners.

The State Level

The state level of nursing interacts with the legislative actions, interests, and outcomes benefiting the advanced nursing profession. This is not merely a casual group talking about potentially useful ideas; rather, it uses real data to make measured changes aiming to promote better patient and community health care. (Keeling & Biglee, 2005). In addition to providing professional guidance, the influence nurses have on state legislatures protects professional interests as it seeks to improve patient outcomes. (Benton, 2012). Changes in laws are monitored and bills are tracked, helping inform nurses how their lobbying efforts can affect positive financial, safety, and legal changes in healthcare.

The National Level

The national level of nursing creates an even more powerful scope of care, using evidence-based practices to guide regions in adapting to new healthcare advances. The National League for Nurses (NLN) focuses its energies on protecting the nursing profession and health care innovation. The NLN further provides updates on education, certifications, and other factors helping promote best practices. The NLN therefore empowers nurses to take action on critical healthcare topics, maintain safe practices, and advocate to legislators on a national basis.

The International Level

Internationally, APN disseminates important updates on technology, data, and policy approaches that different countries may consider integrating within their own regions. Although communicated to wide nursing audiences, different countries have specific traditions, cultures, and ethical practices that advanced practice nurses must consider when implementing recommended change. (Benton, 2012; Sheer & Wong, 2008). Nurses work within layers of local, state, and national systems of support. To be effective for patients at the granular level, internationally recommended practices of nursing care must be integrated into layers of local, state, and national systems of support. Since no single system of care works universally, mutual alignment enhances safe and effective health care. (Benton, 2012; Sheer & Wong, 2008). Advanced practice nurses play a unique and powerful role in bringing those support systems together in locally distinct ways that provide meaningful support for all patients’ well-being and universally better health outcomes.

The Current State of APN Role Aspects

As applied to different geographies, APN roles can be surprisingly different. Each area of nursing role development is influenced by distinct political systems of support, requiring advanced nursing professionals to find and leverage their unique position and viewpoint in healthcare.

The Current Local and State Levels

Local levels of nursing are associated with a scope of practice, which allows advanced practice nurses to engage in diagnosing and treating different diseases and conditions. The APN field facilitates high levels of care within a multitude of settings and age groups. Locally, the hospital setting utilizes the techniques and experiences of advanced practice nurses to promote health and create outcomes that are measured to be effective.

Supporting local health initiatives, the New Jersey Board of Nursing interacts with and accepts other states’ accreditation. Laws governing APN scope of practice in New Jersey are therefore as enforceable as other states at any level. (N.J. Div. Consumer Affairs, 2011). In this regard, APN coordination has helped hospital practice advance, so that adequate staffing and equipment are provided to patient populations. (Benton, 2012). Complaints filed by nurses at the state level have resulted in policies tailored to better meet the health needs of patient populations. Ongoing compromises between hospital officials, the New Jersey Department of Health, the New Jersey State Board of Nursing, and APN advocacy groups continue to yield positive results.

The Current National Level

The current national perspective integrates different aspects surrounding education and standards acceptance. The hospital under current examination works with different national organizations to provide updated education, technology, mentorship, and diverse nursing level integrations. Standards acceptance is promoted with hospital level participation in nursing theories, leadership roles, independent practices, and establishing nationally comparable competencies. (DeNisco & Barker, 2013). New Jersey’s healthcare delivery system is both passed to hospitals and adapted to national standards of care. In this way, the national aspect works to help New Jersey add to the quality of care the APN field delivers to its patients.

The Current International Level

International roles can be compared and contrasted to those found in the state of New Jersey. The international nursing community can integrate their own unique resources and practices with those learned from our local, state and national programs. (Sheer & Wong, 2008). The Korean advanced practice nurses have had weeks of local hospital-based opportunities to train, evaluate, learn, and absorb information. While the overall experience has been positive between groups, interactions have been often difficult, due to language and treatment barriers. While maintaining traditional Korean standards of care, international level nursing goals have been to learn how to apply APN techniques from our local perspective. Hopefully, these difficult integration goals have been met.

Conclusions

The APN field is designed to create outcomes moving patients from illness to wellness. Measuring quality and using evidence-based practices allows healthcare providers to promote ongoing treatment, diagnosis, and achieve better patient outcomes. Through many challenges, the APN field continues to create and implement improved standards education, technology, and policy objectives seeking to improve and sustain improved health.

Despite significant improvements, however, nursing must continue to overcome often complex barriers to achieving better patient outcomes. APN identified roles are an important start, but do not by themselves result in positive change where it matters most. Although evidence-based practices are proven to be effective, there are new ideas, aspects, and modalities to learn. Advanced practice nurses should work hard to integrate the best of local, state, national, and international perspectives in their practices. In this light, by upholding the APN field’s best practices, individual advanced practice nurses can promote both their professional interests and improve patient health.

References

Benton, D., (January 31, 2012) Advocating globally to shape policy and strengthen nursing’s influence. OJIN: The Online Journal of Issues in Nursing, 17(1), Manuscript 5. doi:10.3912/OJIN.Vol17No01Man05

DeNisco, S. M., & Barker, A. M. (2013). Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed.). Burlington, Mass: Jones & Bartlett Learning

Keeling, A. W., & Biglee, J. L. (2005). The history of advanced practice in nursing in the United States. In A. B. Hamric, J. A. Spross, & C. M. Hanson, (Eds.), Advanced practice nursing: An integrative approach (3rd ed.) (Chap.1). St. Louis, MO: Elsevier Saunders

National League for Nursing. (n.d.). Retrieved from https://www.nln.org

New Jersey Board of Nursing Laws. (2011). Retrieved from State of New Jersey Division of Consumer Affairs website: http://www.state.nj.us/lps/ca/laws/nursinglaws.pdf

Sheer, B., & Wong, F. K. (2008). The development of advanced nursing practice globally. Journal of Nursing Scholarship, 40(3), 204-211. doi:10.1111/j.1547-5069.2008.00242.x