Advanced Practice Nursing connotes a level in the nursing practice that utilizes experience, knowledge, and comprehensive skills in the nursing care. It is the application of the mentioned competencies to the nurse/patient relationship. The use of this high degree of experience, knowledge, and skills serves to achieve the best outcomes in patient care through a thorough analysis of a health care problem, seeking solutions to solve it and making the best decision in regards to patient care (Lowe, Plummer, O’Brien & Boyd, 2012). The primary domains that constitute to the APN (Advanced Practice Nursing) include professional leadership, education, direct and comprehensive care.
The primary roles of the advanced practice nurses include providing and coordinating patient health care. In many circumstances, the nurses can also give a primary care. Numerous advanced practice-nursing roles exist in a clinical setting. The functions include conducting physical exams of the patient, diagnosing patients, carrying out exams like the developmental tests, psychological and psychosocial tests. The advanced practice nurses are responsible for ordering for lab tests where they can interpret the results provided to them. These nurses develop differential results; they keep patient records and make sure that there is patient confidentiality. They participate in research studies, provide counseling to the patients, and assess the progress of the different patients (Fitzgerald, Kantrowitz-Gordon, Katz & Hursch, 2012).
Different types of the advanced practice nurses do exist. The forms include a nurse practitioner, nurse educator, nurse administrator, and a nurse informatics among others. In the given examples, a nurse practitioner’s role comprises conducting many different physician’s tasks. The nurse practitioner serves to evaluate the patient’s health by doing physical exams, ordering lab tests such as electrocardiograms or x-rays and interpreting them (Jokiniemi, Pietila, Kylma & Haatainen, 2012). The nursing practitioners (NP) have the mandate to prescribe medications to the patients. The main population groups that the nurse practitioners serve are the children and elders and mainly specialize in a given field of nursing, and that is the main reason as to why many NPs are board-certified in a given specialty.
A nurse educator, on the contrary, has a significant role of teaching the nursing students in any of the levels in nursing including preparing the students who want to enroll nursing diplomas, associate degree, and master’s degree that all intend to provide an advance in the nursing practice(Lowe, Plummer, O’Brien & Boyd, 2012). Some of the nurse educators have a role of teaching continuing nursing education while others are generalists who serve to provide knowledge on the basic nursing subjects. The Nurse educators are required to work part-time in clinical settings to retain their skills.
The nurse administrators’ primary role is to manage and supervise all the other nurses meaning that their responsibilities can be a lot. The nurse administrators manage and oversee all the other nurses making sure that the patients are getting quality and sustainable health care. The nurse administrator, therefore, is responsible for the recruitment, hiring, training, and developing of the advanced practice nurses. They are also responsible for allocating shifts and carrying out an evaluation of the performance of the nurses (Jokiniemi, Pietila, Kylma & Haatainen, 2012). Another role associated with the nurse administrator includes acting as a liaison between the nurses and the different sectors in health care system. Budgeting for the health care department and setting up of policies is also a role of the nurse administrator. They should be capable of coming up with essential strategies regarding how the hospital setting should run.
On the contrary, to the three different types of advanced practice nurses mentioned, the nurse informaticist consists of experience and advanced skills in information technology. The skills of these nurses make it possible for them to serve the competent project managers by providing them with facts that they can use to make significant decisions in regards to the healthcare system. Some of the roles of the nurse informaticists include the assessment and the selection of the technology that the hospital setting is going to use, designing of training programs for the nurses and identifying the end-user requirements, which they can later customize depending on the need (Jokiniemi, Pietila, Kylma & Haatainen, 2012).
An emergency nurse practitioner is yet another type of the advanced practice nursing that interests me. The primary functions of the emergency nurse practitioner entail ordering for x-rays, ordering scans for patients with head trauma, prescribing the best treatment method for the injured patients, requesting the transfer of the patients whose cases are not an emergency to other sections of the hospital and ordering for lab work. In the past decade, the number of patients taken to the emergency rooms has increased by approximately 20 percent which means that there is the need for more emergency room nurses (ER nurses) (Dunphy, Winland-Brown, Porter & Thomas, 2015). Many of the patients taken to the ER have primary care needs that require the ER nurses to have competent skills in this area.
In the year 2011, the ER nurse practitioners lead to a revenue of approximately 90,000 dollars. Nurses should be able to have about ten years of experience before they decide to further their education and become an advanced practice nurse in the emergency room sector (Lowe, Plummer, O’Brien & Boyd, 2012). Moreover, before a nurse can be a member of any the ER nurse practitioners school, they must have met several requirements. For instance, the nurse should have license as a registered nurse, which gives her the chance to perform her duties. Some of the ER school requires the nurses to complete some classes in natural sciences for one to get an admission. Before access to further education to become an ER nurse practitioner, the nurse should have attained a 3.0 GPA in the undergraduate education (Lowe, Plummer, O’Brien & Boyd, 2012). Completing the undergraduate statistics course and acquiring the minimum required score on the Graduate Record Examination is also essential. Letters of recommendations are also part of the requirements before one joins any school for the ER nurse program.
The possible organizations available for the membership of the Emergency room nursing include the Emergency Nurses Association and the American Association of Critical Care Nurses. The Emergency Nurses Association is an organization that aids the nurses who want to work in the emergency room by providing publications, research, professional development, and ways to prevent injuries in the emergency nursing profession. On the other hand, The American Association of Critical Care Nurses offers the best quality resources to increase the nurses’ competency in regards to the caring and enhancement of the patients in emergency settings.
The nurse practitioners have been working in the emergency care for about five years. Regardless of the extended period of experience of the ER nurse practitioners, there is still no established competency to verify the capability of the nurse practitioners to provide quality healthcare for the patients in the emergency setting. For this reason, ENA (The Emergency Nurses Association) set forth some crucial competencies as the basis for all the nurses who want to take part in the advanced practice nursing. These skills include, the effective management of the ill status of the patient, direct provision of emergency care practices, the capability to perform the skin, wound care, head, ear, nose eye, chest, abdomen, neck, and spine, back and throat procedures. The capability of the nursing practitioner to interpret the diagnostics of the patient and their ability to remove the foreign bodies including soft tissues and orifices is core.
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Leadership is yet another critical competency needed in the ER advance practice. Quality health care in the emergency room requires sufficient leadership traits that can be able to get all the ER nurses to work together towards the sustainable health for all the patients. A variety of leadership attributes for the advanced practice nurses do exist. The ER nurses who are leaders should be able to have a relevant vision regarding the future and share it with the group of emergency room nurses (Marshall, 2010). The ER nurse practitioner leaders should be able to have self-confidence and be ready to take risks regarding the healthcare systems. They should be prepared to fall and get themselves together after every failure. The ER nurse practitioner leaders should be able to build a good rapport at work through excellent communication amongst the team members.
Self-reflection is an important attribute required for the ER nurse practitioners as it helps them to reflect on the experiences they have and learn from them. The ER nurse practitioners should be self-confident too and take the risk of trying out different things in the nursing career regardless of the fact that they might fail occasionally (Marshall, 2010). If a leader fails a couple of times, then they should be able to put maximum effort in attaining the desired goal by working with others most effectively. Leadership is an essential competency, which requires the ER nurses to be able to mentor, empower, and innovate the team members and the patients. The ER nurses should be able to communicate and negotiate with the insurance companies and the policy makers among others to attain improved working conditions and provide better care for the patients.
The attributes that I recently possess include, self-reflection that enable me to get better at the nursing practice, excellent communication skills and the capability to work as a team to achieve the desired health outcome for the patient. Self-confidence is the attribute that I need to develop since every failure seems to scare me from trying harder to achieve my desired goals in the nursing practice. Another way to improve my confidence is through building knowledge, through further education. Knowledge is powerful which can significantly reduce fear and build self-confidence.
An ER nurse practitioner can use different leadership styles to work together with the other team members in the emergency room. The transformational leadership is the preferred style that can bring a positive change in advanced practice nursing .A transformational leadership style entails the utilization of vision, mental stimulation, and inspiration that helps to motivate both the team members and the patients towards the required change. The transformational leadership style emphasizes on team building, collaboration amongst the employees in the hospital settings and motivation (Marshall, 2010). Both the employees and the patients are encouraged to work smart and provide the best performance that can result in a sustainable health for the patients.
The primary focus of the transformational leadership style includes employees who are willing to follow the ways of an inspiring ER nurse leader, prioritizing in the creative thinking and innovation in the team and optimism of the ER nurses. A transformational leadership style is beneficial because it encourages self-motivation. Self-motivated ER nurse practitioners get their tasks completed without the expectation of rewards (Marshall, 2010). The method may not work well only if the nurse leader lacks the needed characters or attributes to bring out the best in the team.
Research conducted by the Robert Wood Johnson Foundation (RWJF) shows that the baby boom generation consists of approximately 78 million individuals most of which have already attained the age of 65 (Newbergh, 2017). As this population group gets old, many of them will get chronic illnesses like hypertension and cardiovascular diseases that might require emergency nurse practitioners among other advanced practice nurses to solve the problems. Similarly, a large number of the nurses in this age group may retire soon leaving the millennial who might not have the sufficient experience, skills, and knowledge needed. Similarly, as the number of experts in the nursing field retires and new chronic illnesses continue to emerge, the need for further education to cater for the changing patient needs continue to increase. Therefore, one of the critical health issues highlighted by the RWJF is the inadequacy in the nursing education.
The manner in which the nurses received their education in the last century (including the baby boomers) is no longer efficient in dealing with the dynamic health conditions in the present time. The needs of the patients and the care environments are more complicated in the contemporary world, and the advanced practice nurses need to acquire the relevant competencies required to deliver the quality care (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The need for these nurses to fill up the advanced practice roles, which keep on expanding as the days elapse, and to get an insight of the technological tools and systems is core. In an attempt to respond to these prerequisites of a good health care system, the nurses are required to attain higher levels of education. The higher levels of education need to use new ways that can be able to prepare the advanced practice nurses.
Consequently, providing a sustainable and long-term health for the members of the society requires the higher education of the nurses, which will help in the building of knowledge necessary to tackle the healthcare problems presented to the advanced practice nurses. There is need to enhance higher education of the nurses before the nurses attain their licenses.
The RWJF in the year 2008 launched an initiative program intended to last for two years that would respond to the education need that would transform the nursing profession. The initiative identified most of the problems that hinder the education system in the nursing field such as the lack of resources and worked towards finding solutions to these issues that would consequently elevate the nursing education (Newbergh, 2017). Health policies contained in acts such as the American Recovery and Reinvestment Act enacted in the year 2009 entail approximately 500 million dollars for the education of health professions.
Most of the education provided for the nursing practitioners focuses more on the acute care rather than the primary care and long-term health care (Dunphy, Winland-Brown, Porter, & Thomas, 2015). This learning in most cases fails to include the intricacies of health care coordination and the transitions. It fails to support the required set of skills needed for negations with the healthcare team. Therefore, the solution to these problems regarding education in the nursing field includes a reexamination of the policies and updating the education systems in a manner that the education provided to the nurses match with the changing needs of the patients.
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There is the need for the development of new educational models and methods that can be able to solve problems in both the acute and primary care. These education models should be able to increase the competencies to higher levels offering a foundation for better decision-making and management of knowledge in the nursing field (Fitzgerald, Kantrowitz-Gordon, Katz & Hursch, 2012). Changes made in the existing education policies would result in a better sustainable health care for the patients.
In conclusion, advanced practice nursing is crucial in the nursing field. The roles that the advanced practice nurses perform in the different health settings highly depend on the type of the APN including nursing practitioners, nursing administrators, nursing informaticists and the emergency room nurse practitioners. Leadership is a critical competency in the advanced practice nursing and having the right attributes is core to providing quality health care to the patients. The transformational leadership style is the best style that an advanced practice nurse can use to make sure that there is proper implementation of the health care tasks. A primary problem that faces the advanced practice nursing is the inadequate education. However, this problem can be solved through reexamination and updating of the systems or the formulation of education models that match the needs of the patients.
- Dunphy, L. M., Winland-Brown, J., Porter, B., & Thomas, D. (2015). Primary care: Art and science of advanced practice nursing. FA Davis.
- Fitzgerald, C., Kantrowitz-Gordon, I., Katz, J., & Hirsch, A. (2012). Advanced practice nursing education: challenges and strategies. Nursing research and practice, 2012.
- Jokiniemi, K., Pietila, A. M., Kylma, J., & Haatainen, K. (2012). Advanced nursing roles: a systematic review. Nursing & health sciences, 14(3), 421-431.
- Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of advanced nursing, 68(3), 677- 685.
- Marshall, E. S. (2010). Transformational leadership in nursing: From expert clinician to influential leader. Springer Publishing Company.
- Newbergh, C. (2017). The Robert Wood Johnson Foundation’s Commitment to Nursing. Hcfgkc.org. Retrieved 3 November 2017, from https://hcfgkc.org/wp content/uploads/2015/11/hcf-rwjf-commitment-to-nursing.pdf