Advanced practice nurse: Difference between revisions
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*[[Nurse practitioner]]s (NPs) |
*[[Nurse practitioner]]s (NPs) |
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Each specialty, especially NPs, can have sub-specialties or concentrations in specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being APRNs. |
Each specialty, especially NPs, can have sub-specialties or concentrations in a specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being an APRNs. |
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While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state. |
While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state. |
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Revision as of 22:50, 19 May 2010
An advanced practice nurse ('APN) or advanced practice registered nurses (APRN) is a registered nurse (RN) with advanced didactic and clinical education, knowledge, skills, and scope of practice.[1]
APRN defines a level of nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis and evaluation of the care required. Nurses practicing at this level are educationally prepared at post-graduate level and may work in a specialist or generalist capacity. However, the basis of advanced practice is the high degree of knowledge, skill and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidenced based decision-making.
APRN forms the basis for the role of nurse practitioner. The nurse practitioner role is an expanded form of advanced practice nursing which is specifically regulated by legislation and by professional regulation. Legislation may allow prescribing and referral, in addition to admitting privileges to health care facilities.
APRNs demonstrate more effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgements and interventions.
Uses multiple approaches to decision making; Manages the care of individuals and groups; Engages in collaborative practices to achieve client outcomes; Provides a supportive environment for colleagues; Manages the utilization of staff and physical resources; Engages in ethically justifiable nursing practice; Protects the rights of individuals/groups; Engages in activities to improve nursing practice; Develops therapeutic and caring relationships; Full fills the conduct requirements of the profession; Acts to enhance the professional development of self; Functions in accordance with legislation and common law affecting nursing practice14.
The term encompassess four areas of specialty practice:
- Nurse anesthetists (in the United States, Certified Registered Nurse Anesthetists or CRNAs)
- Nurse midwives (in the United States, Certified Nurse Midwives (CNMs)
- Clinical nurse specialists (CNSs)
- Nurse practitioners (NPs)
Each specialty, especially NPs, can have sub-specialties or concentrations in a specific field or patient population in healthcare. Each has a unique history and context, but shares the commonality of being an APRNs.
While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, the licensing boards-governed by state regulations and statutes-are the final arbiters of who is recognized to practice within a given state. While APRNs are educated differently depending on their specific specialty, all APRNs are now trained at the graduate level and are currently required to attain a Master's degree, generally a Master of Science in their field of concentration. Some Advanced Practice Nurses are educated at the doctorate level. However, it will soon be required that all APRNs attain a doctoral degree upon graduation.
In 2008, The American Association of Colleges of Nursing (AACN) in conjunction with the National Council of State Boards of Nursing (NCSBN) recommended that advanced practice nurses move the entry level degree to the doctorate level.[2] Accordingly, all APRN training programs are required to convert their master's degree to a clinical/practice doctorate degree by the year 2015. Although The American Association of Nurse Anesthetists approved this recommendation, it is not requiring program compliance until the year 2025.[3]
The majority of programs will grant a Doctor of Nursing Practice (DNP/DrNP).[4] Because 45% of the nurse anesthesia programs are located in Schools of Allied Health, these programs will award a Doctor of Nurse Anesthesia Practice (DNAP). The Doctor of Nursing Practice will be the direct-entry, minimum academic requirement for Advanced Practice Nurses; it is a clinical/practice-based doctorate and therefore is a professional doctorate or first professional degree.
Grandfather exception
The DNP/DrNP doctoral degree requirement will apply only to those who are not yet licensed and practicing as APRNs. Those currently licensed as Advanced Practice Nurses who hold a Masters degree will be permitted to maintain their current level of formal education and certification.
Some APRNs, who have been in the profession for many years and therefore have been "grandfathered" into the APRN professions. That means that they do not need to meet the current requirement of a graduate degree. For example, the first Nurse Practitioner program was created by a nurse educator, Loretta C. Ford, Ed.D., R.N., P.N.P. and a physician, Henry K. Silver, M.D., in 1965 at the University of Colorado as a non-degree, certificate program training Registered Nurses for advanced roles as Pediatric Nurse Practitioners due to a shortage of primary care physicians.[5] Every state has different laws, rules, regulations, licensing and certification requirements for Advanced Practice Registered Nurses, thus some states may require APRNs to possess a minimum of a Masters degree for licensure and practice and do not have a "grandfather" clause in their State Board of Nursing laws.
Terminal degrees
An Advanced Practice Registered Nurse may earn a terminal degree in several ways. A terminal degree is generally a doctorate. In some fields, especially those linked to a profession (e.g. medicine, nursing, dentistry, law, optometry, architecture, pharmacy, social work, religious ministry, engineering, accounting, education, etc.), a distinction is to be drawn between a first professional degree, an advanced professional degree, and a terminal academic degree. A first professional degree is generally required by law or custom to practice the profession without limitation. An advanced professional degree provides further training in a specialized area of the profession. A first professional degree is an academic degree designed to prepare the holder for a particular career or profession, fields where scholarly research and academic activity are not the work, but rather the practice of a profession. In many cases, the first professional degree is also the terminal degree because usually no further advanced degree is required for practice in that field even though more advanced professional degrees may exist.
Examples of terminal degrees in research are:
- Doctor of Philosophy (Ph.D.)
- Doctor of Education (Ed.D.)
- Doctor of Science (D.Sc.)
- Doctor of Nursing Science (D.N.Sc., DNS)
Examples of terminal professional degrees are:
- Doctor of Nursing Practice (DNP/DrNP)
- Doctor of Nurse Anesthesia Practice (DNAP)
Post-Nominal Initials
The specific titles, credentials, post-nominal initials, and so on, Advanced Practice Nurses utilize will vary greatly by country, state, license-type, academic degrees, and board certifications. A list of post-nominal initials include, but are not limited to:
- APRN - Advanced Practice Registered Nurse (Refers to the four recognized general areas of specialization: CRNA, NP, CNM, and CNS)
- C.R.N.P - Certified Registered Nurse Practitioner
- A.R.N.P. - Advanced Registered Nurse Practitioner
- CRNA - Certified Registered Nurse Anesthetist (there are no periods after each letter)
- C.N.M. - Certified Nurse Midwife
- C.N.S. - Clinical Nurse Specialist
- A.P.R.N. - Advanced Practice Registered Nurse
- F.N.P. - Family Nurse Practitioner
- P.N.P. - Pediatric Nurse Practitioner
- W.H.N.P. - Women's Health Nurse Practitioner
- N.N.P. - Neonatal Nurse Practitioner
- P.M.H.N.P. - Psychiatric & Mental Health Nurse Practitioner
- Psy.N.P. - Psychiatric Nurse Practitioner
- G.N.P. - Gerontological Nurse Practitioner
- A.C.N.P. - Acute Care Nurse Practitioner
- A.N.P. - Adult Nurse Practitioner
- O.N.P. - Oncology Nurse Practitioner
- C. or B.C. - Certified or Board Certified (i.e., APRN-BC, FNP-BC, FNP-C, GNP-C, ANP-BC)
- N.P.-C. - Nurse Practitioner - Certified
- C.S. - Clinical Specialist
See also
References
Deutsches Netzwerk für Advance Nursing Practice www.dnapn.de