NR 510 Week 1 Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion
University:
Chamberlain University
NR 510 Week 1 Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion
Paper Instructions
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.”
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.
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Sample Answer
Jessica’s colleague is not correct. No matter if your state allows for full practice, reduced practice, or restricted practice, NPs just as RNs are accountable for providing care according to their scope of practice. Mennella and Heering (2017) state “accountability is the primary outcome of all levels of professional nurse autonomy” (p. 1).
According to Park, Athey, Pericak, Pulcini, and Greene (2018), 21 states and the District of Columbia allow NPs to practice independently and have full practice authority. In NJ NPs have reduced practice authority and must have physician’s sign off on certain care decisions. I worked in LTC in NJ, we had an NP that came in weekly and did wound rounds. She was able to make care recommendations, but we had to call the primary physician to write the order for the needed treatment.
CNP (Certified Nurse Practitioner)
Provide primary health care services to pediatrics, families, and geriatrics.
These NPs can diagnose and treat illness and injuries. They can prescribe medications and diagnostic tests. Depending on the state that the NP is employed they may have to work with a physician on certain aspects of patient care. (www.nursejournal.org)
CRNA (Certified Registered Nurse Anesthetist)
Administer anesthesia care to patients.
These duties include administering anesthesia during medical and dental procedures, follow-up care, pain management and inserting PICC lines. This is a highly skilled position and requires licensing from the American Association of Nurse Anesthetists. (www.anaa.com)
CNS (Clinical Nurse Specialist)
Work in many areas of health care including acute care, home health, and community health settings.
There knowledge and skills are used to apply theory and research to practice improving patient outcomes. In my hospital the CNS works with stroke and palliative care patients. They manage care of these patients and have the ability to prescribe care based on organizational protocols. (www.graduatenursingedu.org)
CNM (Certified Nurse Midwife)
These NPs specialize in women’s reproductive health and childbirth.
They provide preventative and health maintenance, family planning, and all aspects of childbirth. They provide holistic care to the women in their care. This NP position can be stressful, emotional, and include long hours. (www.registerednursing.org).
APN Role Median Salary
- CNP $98,000
- CRNA $154,000
- CNS $80,000
- CNM $91,000
A nurse pracitioner master’s degree program may not be practical for Jessica to complete if she is only given 2 years to complete the degree. Also, if she accepts the administrative position she may find it difficult to complete the intensive practicum required by most programs. However, if she chooses to enroll in a program, she would probably be most suited for a clinical nurse specialist program. In this position she can still have direct patient interaction and can make a positive impact on patient care and outcomes.
Thanks for reading,
Jessica
Resources
- Certified registered nurse anesthetist fact sheet. (2017, October 10). Retrieved from https //www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet.
- Certified nurse midwife. (2017). Retrieved from https //www.registerednursing.org/nurse-midwife/.
- Clinical nurse specialist (CNS). (2018). Retrieved from https //www.graduatenursingedu.org/clinical-nurse-specialist/.
- How to become a CNP certified nurse practitioner. (2017). Retrieved from https //nursejournal.org/nurse-practitioner/how-to-become-a-certified-nurse-practitioner/.
- Mennella, H. & Heering, H. (2017). Professional autonomy and advanced nursing practice. Cinahl Information Systems.
- Nurse practitioner career guide. (2018). Retrieved from https //nurse.org/resources/nurse-practitioner/.
- Park, J., Athey, G., Pericak, A., Pulcini, J., & Greene, J. (2018). To what extent are state scope of practice laws related to nurse practitioners’ day-to-day practice autonomy. Medical Care Research and Review, 75(1), 66-87.
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