|This section needs additional citations for verification. (October 2013)|
Nurse practitioners manage acute and chronic medical conditions (both physical and mental) through comprehensive history taking, physical exam, and the ordering of diagnostic tests and treatments. NPs (within their scope of practice) are qualified to diagnose medical problems, order treatments, prescribe medications, and make referrals for a wide range of acute and chronic medical conditions. NPs can serve as a patient's primary health care provider and they can see patients of all ages depending on their specialty (e.g., family, adult, pediatrics, geriatrics, etc.). NPs can also specialize (with commensurate training and experience) in other areas of medicine (e.g., cardiology, dermatology, oncology, pain management, orthopedics, OB/GYN, etc.). Similar to all medical professions, the core philosophy of the nurse practitioner role is individualized care that focuses on the patient's medical issues as well as the effects of illness on the life of the patient and his or her family. Like all health care providers, NPs make prevention, wellness, and patient education their priority. Since they are nurses, NPs tend to focus more on holistic care (i.e., treating the mind, body, soul), and they spend more time counseling and educating patients. In addition to providing health care services, NPs may conduct research, teach, and are often active in patient advocacy activities and in the development of health care policy at the local, state, and national level. To become licensed to practice, nurse practitioners must first graduate from an accredited graduate/doctoral level program. After completing the required education (MSN or DNP), the nurse practitioner must pass a national board certifying exam in a specific area (e.g., family medicine, women's health, pediatrics, adult medicine, acute care, etc.), which coincides with the type of program from which they graduated. After achieving board certification, the NP must apply for additional credentials (e.g., APRN license, prescriptive authority, DEA registration number, etc.) at the state and federal level. Nurse practitioners must have a certain amount of continuing education credits in order to maintain certification and licensure. NPs are licensed through State Boards of Nursing, found through the National Council of State Boards of Nursing. NPs must function within their scope of practice, which is set by State Boards of Nursing. NPs may or may not be required to practice under the supervision of a physician (either directly or via a collaborative practice agreement). In many states, NPs can practice independently without physician supervision. Additionally, in many states, NPs can operate their own offices, clinics, etc. and directly bill insurance companies and Medicare for their services.
According to the International Council of Nurses, an NP/advanced practice nurse is "a registered nurse who has acquired the knowledge base, decision-making skills, and clinical competencies for expanded practice beyond that of an RN, the characteristics of which would be determined by the context in which he or she is credentialed to practice."
In addition to the nurse practitioner role, the three other advanced practice registered nurse (APRN) roles include the certified registered nurse anesthetist (CRNA), Certified Nurse Midwife (CNM), and Clinical Nurse Specialist (CNS). Each APRN role is distinct and involves different educational and certification requirements, but the scope of practice for all APRN roles is mandated by State Boards of Nursing.
Nurse practitioners can be educated and certified in areas of family health (FNP), pediatrics, including pediatric acute/chronic care, pediatric critical care, pediatric oncology and general pediatrics (PNP), neonatology (NNP), gerontology (GNP), women's health (WHNP), psychiatry & mental health (PMHNP), acute care (ACNP), adult health (ANP), oncology (FNP, ACNP, ANP, PNP or ANP) emergency (as FNP or ACNP), occupational health (as ANP or FNP), etc. In Canada, NPs are licensed by the province or territory in which they practice.
The advanced practice nursing role began to take shape in the mid-20th century United States. Nurse anesthetists and nurse midwives were established in the 1940s, followed by psychiatric nursing in 1954. The present day concept of the APN as a primary care provider was created in the mid-1960s, spurred on by a shortage of medical doctors. The first official training for nurse practitioners was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965, with a vision to help balance rising health care costs, increase the number of health care providers, and correct the inefficient distribution of health resources. There was some confusion about the varying titles and abilities of advanced practice nurses as the role was developed, which has persisted as the authority and responsibilities of the NP have evolved over time.
Scope of practice
In the United States, because the profession is state-regulated, care provided by NPs varies widely and is limited to their education and knowledge content. Some nurse practitioners seek to work independently of physicians while, in other states, a collaborative agreement with a physician is required for practice. The extent of this collaborative agreement, and the role, duties, responsibilities, nursing treatments, pharmacologic recommendations, etc. again varies widely amongst states of licensure/certification. practice.
The scope of practice for NPs is limited outside the United States and varies even more widely than the state-by-state discrepancies. The International Council of Nurses outlines the following general characteristics of advanced practice nursing: · Integrates research, education, practice and management · Politically seeks a high level of professional autonomy and even independent practice · Case management/personal case load · Advanced health assessment skills, decision-making skills and nursing diagnostic reasoning skills · Recognized advanced nursing clinical competencies · Provision to acquire consulting services from other more highly trained medical providers · Plans, implements and evaluates programs · Recognized first point of contact for clients
The "Pearson Report" provides a current state-by-state breakdown of the specific duties a nurse practitioner may perform in the state. A nurse practitioner's role may include the following:
- Medical diagnoses, treatment, evaluation, and management of acute and chronic illness and disease (e.g., hypertension, diabetes, dyslipidemia, anemia, asthma, depression, anxiety, obesity, osteoarthritis, smoking cessation, thyroid disorders, wound care, musculoskeletal disorders, etc.)
- Obtaining medical histories and conducting physical examinations
- Ordering and performing diagnostic studies (e.g., lab tests, x-rays and EKGs)
- Requesting physical therapy, occupational therapy, and other rehabilitation treatments
- Prescribing drugs for acute and chronic illness (extent of prescriptive authority varies by state regulations)
- Providing prenatal care and family planning services
- Providing well-child care, including screening and immunizations
- Providing primary and specialty care services, health-maintenance care for adults, including annual physicals
- Providing care for patients in acute and critical care settings
- Performing or assisting in minor surgeries and procedures (with additional training and/or under physician supervision in states where mandated; e.g. dermatological biopsies, suturing, casting)
- Counseling and educating patients on health behaviors, self-care skills, and treatment options in coordination with occupational therapists and other healthcare providers.
- Community clinics, health centers, urgent care centers
- Health maintenance organizations (HMOs)
- Home health care agencies
- Hospital clinics
- Hospice care
- Physician offices
- Nursing homes
- Private & public schools, universities and colleges
- Veteran's administration facilities
- Retail-based clinics
- Nurse-led clinics
- Bedside nursing in hospitals
- Walk-in clinics
Education, licensing, and board certification in the United States
Education to become a nurse practitioner (NP) requires advanced coursework and clinical rotations beyond that required of the RN. In addition to maintaining the "nursing model," NPs are introduced to the "medical model" and learn to focus primarily on disease and medical diagnosis. Nurses practitioners do not use nursing diagnosis; they are taught to use differential diagnosis and medical treatments. However, NPs retain their nursing skills (i.e., the nursing model) and approach the patient in a holistic manner while employing the medical model to diagnose and treat disease. Curriculum for NP programs includes, but is not limited to, courses in epidemiology; health promotion; pathophysiology; physical assessment; pharmacology; differential diagnosis and laboratory/radiography diagnostics; statistics and research methods; health policy; role development and leadership; acute and chronic disease management (e.g., adults, children, women's health, geriatrics, etc.); and, clinical rotations, which varies depending on the program. MSN programs also require a thesis or clinical research project. There are a variety of paths to becoming a nurse practitioner in the United States. Typically, the process begins with obtaining a Bachelor of Science in Nursing (BSN, 4 years), followed by a Masters of Science in Nursing (MSN, usually 3 years). DNP programs usually require an additional 2–3 years of study beyond the MSN. Doctor of Nursing Practice (DNP) programs require advanced coursework in biostatistics; research methods; quality improvement and outcome measures; care of special populations; evidence based practice; informatics; organizational management; and, a project/dissertation and practicum. There is currently an initiative to require the DNP as the entry level practice degree for nurse practitioners. Admission to a MSN program is competitive and requires an undergraduate degree (usually the BSN), licensure as a RN, and completion of the Graduate Record Exam (GRE). Admission to a DNP program requires a graduate degree (usually the MSN) and licensure as a RN. There are programs that eliminate the need for a MSN and allow the student to progress from a BSN directly to a DNP. Some APRNs (e.g., nurse practitioners) may choose to pursue the Doctor of Philosophy (PhD) as a terminal degree. The PhD in nursing focuses more on research and teaching, while the DNP focuses more on clinical practice.
Registered nurses initially trained at the associate degree or diploma level must first complete a Bachelor of Science in Nursing (BSN) or enter a program offering an ADN-to-MN/MSN bridge program. Some of these bridge programs may award a Bachelor's degree while the candidate continues to complete the elements of their Master's or Doctorate degree.
In Australia, Nurse Practitioners are required to be registered by the Australian Health Practitioner Regulation Agency. The Australian professional organisation is the Australian College of Nurse Practitioners. (ACNP) 
- International Council of Nurses. "Nurse Practitioner/Advanced Practice Nurse: Definition and Characteristics". Nursing Matters Fact Sheets. Retrieved 11 December 2011.
- "Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services". ISPUB. 2001-06-09. Retrieved 2011-08-31.
- Hancock, Jay (2010-04-14). "Jay Hancock's blog: Md. should make nurse practitioners independent". Weblogs.baltimoresun.com. Retrieved 2011-08-31.
- Lyndia Flanagan (1997-02-07). "Nurse Practitioners: Growing Competition for Family Physicians? - Oct 1998 - Family Practice Management". Aafp.org. Retrieved 2011-08-31.
- "Prescriptive Authority and Barriers to NP Practice | Nurse Practitioner | Find Articles at BNET". Findarticles.com. Retrieved 2011-08-31.
- "Nurse Practitioner Legislation would have reduced barriers to care | Maryland Nurse | Find Articles at BNET". Findarticles.com. Retrieved 2011-08-31.
- "MN2020". MN2020. Retrieved 2011-09-29.
- "John Crisp: Nurse practitioners' role should be expanded » Abilene Reporter-News". Reporternews.com. Retrieved 2011-08-31.
- "Pearson Report" www.pearsonreport.com
- Martin, Greg. "Education and Training: Family Physicians and Nurse Practitioners". American Academy of Family Physicians. Retrieved 29 November 2012.
- Website - Australian Health Practitioner Regulation Agency
- Website - Australian College of Nurse Practitioners
|Look up Nurse practitioner in Wiktionary, the free dictionary.|
|Wikimedia Commons has media related to Nurse practitioners.|
- The Nurse Practitioner: The American Journal of Primary Health Care
- AANP Standards for NP practice in retail based clinics
- CNS and NP Practice in Canada