Chapter 2: Emerging Roles of the Advanced Practice Registered Nurses Flashcards
FACTORS PROMOTING ROLE DEVELOPMENT
Changing patient needs and populations
Reimbursement and managed care
Movement from institutional to community practice
Growing need for patient advocacy
Pressure to decrease medical resident hours
Changing attitudes about the role of the nurse
direction of change
Movement into higher education and now to the doctoral level
Emphasis on critical thinking, evidence-based practice, and systems evaluation
Changing patterns of practice
Identification of core and specialty competencies
The 4 major groups of APRN’s in the US
Clinical Nurse Specialists (CNS)
Certified Registered Nurse Anesthetists (CRNA)
Certified Nurse Mid-wives ((CNM)
Certified Nurse Practitioners (CNP)
Several factors have influenced the emergence and acceptability of advanced practice roles:
Growing numbers of elderly patients - “baby boomers”
Increased complexity of illness in hospitalized patients
Reduction of medical residents’ clinical work hours
Need for greater access to care for all citizens
Primary care physician shortage
APRNs FACT SHEET (2019)
There are more than 290,000 NPs licensed in the US
More than 30,000 new NPs completed their programs in 2018-19
89.7% of NPs are certified in Primary care
41.7% of full-time NPs hold hospital privileges
95.7% of NPs prescribe medications
Median base salary for full-time NPs was $110,000 in 2019
The average age of NPs is 47 years
Number of Advance Practice Nurses
Clinical Nurse Specialists 8,395
Certified Registered Nurse Anesthetists 49,113
Certified Nurse Mid-wives 8,332
Certified Nurse Practitioners 186,656
distributition of NP
family 65.4%
adult 12.6%
adult-gero primary care 7.8%
acute care 5.5%
ped primary care 3.7 %
adult-gero acute care 3.4%
womens health 2.8%
psych 1.8%
gerontology 1.7%
hospice 1.5%
SCOPE OF PRACTICE
The Scope of Practice is described by the functions performed by the APRN and the minimal competencies needed
Each state has a legislative and regulatory stance on issues affecting advanced practice within its jurisdiction
The Legal Scope of Practice includes prerogatives for diagnosing, prescriptive authority, and reimbursement
Scopes of Practice are defined by the professional organizations and enacted into law at the state level
Regulation occurs at the state level, however educational and certification prerequisites are in place
EFFORT TO DEVELOP CONSISTENT STANDARDS ACROSS STATES
Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education
Must be regulated in one of the four roles and in at least one of six population foci
Education must include advanced physiology/pathophysiology; health assessment; pharmacology; and appropriate clinical experience
CLINICAL NURSE SPECIALIST (CNS)
Master’s or doctoral education
The CNS role of expert practitioner, educator, consultant, manager and researcher
Unit- or population-based practice in a variety of settings with complex patients
Well-documented impact on patient outcomes
Identified as APRN
THE CNS JOB MARKET
Multiple studies have demonstrated the positive outcomes of CNSs to patient care outcomes and patient satisfaction
More studies to evaluate the CNS economic impart and ability to generate income and save costs are needed
At times the benefits of the CNS are not identified due to such reasons as their inability to bill for hospitalized in-patients, and that many are salaried employees
Sacrificed to the pressure to decrease health-care costs
Role is frequently ambiguous and confusing
CERTFIED NURSE PRACTITIONER (CNP)
Front-line healthcare provider in both primary and urgent care settings
Ensure continuity of care, decrease health care costs, and optimize health outcomes for patients (Villasenot & Krouse,2016)
Largest group of APRNs and have prescriptive authority in all 50 states and District of Columbia (Phillips, 2016)
Master’s or doctoral preparation
2
Recognized by law in every state
Identified as APRN
THE NP JOB MARKET
Movement into the middle-class mainstream
Role understood by the public
Role is clear-cut, unambiguous
Proven value
Proven cost efficiency and therapeutic effectiveness
Call for NPs grows with the cutback in funds for medical education
THE NURSE-MIDWIFE (CNM)
CNM’s are primary health-care providers to women throughout the life span
Perform physical exams, prescribe medications, order lab tests, provide prenatal care, gynecological care, labor and birth care, health education and counseling to women.
Master’s or doctoral level
Recognized by law in all 50 states
Associated with birthing centers, but 98% of U.S. births occur in hospitals
Identified as APRN
NURSE ANESTHETIST (CRNA)
CRNAs are anesthesia specialists with authority to practice in all 50 states and the District of Columbia
They work in urban and rural settings, and provide more than 50% of the anesthesia administered in rural areas
41% of CRNAs are men
CRNAs are suffering considerable pressure from anesthesiologists, must work under supervision
By 2022, the entry-into –practice educational requirement will be at the doctoral level
Identified as APRN
