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Nurse practitioner

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Template:Globalize/USA A Nurse Practitioner (NP) is an Advanced Practice Nurse (APN) who has completed graduate-level education (either a Master's or a Doctoral degree). Certified Registered Nurse Anesthetist (CRNA)s, CNMs, and CNSs are additional APN roles. All advanced practice nurses are Registered Nurses with additional education and training. To become licensed to practice, Nurse Practitioners hold national certification in an area of specialty (family, women's health, pediatrics, adult, acute care, etc.), and are licensed through state nursing boards rather than medical boards. The core philosophy of the field is individualized care. Nurse practitioners focus on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. Another focus is educating patients about their health and encouraging them to make healthy choices. In addition to health care services, NPs conduct research and are often active in patient advocacy activities.

Nurse Practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, physical therapy, and ordering tests and therapies for patients within their scope of practice. NPs can serve as a patient's primary health care provider, and see patients of all ages depending on their designated scope of practice.

In the United States, nurse practitioners have a national board certification. Nurse Practitioners can be trained and nationally 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 (ONP), Emergency (as FNP or ACNP), Occupational Health (as ANP), etc. In Canada, NPs are licensed by the province or territory in which they practice.

Scope of practice

In the United States, because the profession is state-regulated, care provided by NPs varies widely. Some nurse practitioners work independently of physicians while, in other states, a collaborative agreement with a physician is required for practice.[1][2] The extent of this collaborative agreement, and the role, duties, responsibilities, medical treatments, pharmacologic prescriptions, etc. afford an NP to perform and prescribe again varies widely amongst states of licensure. [3][4][5] practice.[6][7][8][9]

A nurse practitioner's role may include the following:

  • Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g. diabetes, high blood pressure)
  • Obtaining medical histories and conducting physical examinations
  • Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs)
  • Prescribing physical 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

Practice settings

NPs practice in all U.S. states, Canadian provinces and territories and in all Australian states and territories. The institutions in which they work may include:

Education, licensing, and board certification

To be licensed as a Nurse Practitioner, the candidate must first complete the education and training necessary to be a registered nurse, then go on to complete a graduate-level nurse practitioner program. Next, the candidate must pass a national board certification in their area of specialty. Registered nurses initially trained at the associate degree or diploma level must first complete a Bachelor of Science in Nursing (BSN) or enter various programs offering an ADN-to-MN/MSN bridge program, some of which award the bachelor's degree while completing the requirements for the master's.

United States

While not every state includes specific language requiring a master's degree for NPs, the majority of states do require a master's degree, post-master's certificate or a doctoral degree. Further, the current nurse practitioner programs offered by all universities and colleges are at the master's, post-master's, or doctoral level. The current proposal is that all advanced practice nurse programs will require a Doctor of Nursing Practice (DNP) degree by 2015, thus effectively eliminating the MN or the MSN as an entry to practice degree. However, all state Nursing Boards will be required to revise their current Practice Acts in order for this to become mandatory. All U.S. states require national board certification for nurse practitioners before they are permitted to practice and the two biggest certifying bodies, the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP), do require applicants to hold a master's degree, post-master's certificate, or doctoral degree to be eligible to test for certification.

The variety of educational paths for NPs is a result of the history of the field.[10] The first Nurse Practitioner program was created by a nurse educator, Loretta Ford, EdD, RN, PNP, and a physician, Henry Silver, MD, in 1965 at the University of Colorado as a non-degree certificate program. This program trained experienced Registered Nurses for their new advanced nursing roles as Pediatric Nurse Practitioners. In the late 1960s into the 1970s, continued predictions of a primary-care physician shortage increased funding and attendance in various certificate-based nurse practitioner programs. Then, during the 1980s Nurse Practitioner educational requirements were transitioned into graduate-level master's degree programs. Subsequently the national certifying organizations and state licencing boards began to require a master's degree for NP practice. However, already established NPs with certificate-based education were grandfathered in. Once again there are changes presently in the field, and by 2015 all new NPs will need to be trained at the doctorate level as a Doctor of Nursing Practice. Once again already established NPs with lesser education will be grandfathered in.

After completing the education program, the candidate must be licensed by the state in which he or she plans to practice. The state boards of nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a graduate degree in nursing and board certification by an accrediting body (ANCC, AANP). The license period varies by state; some require biennial relicensing, others require triennial.

NPs can pursue additional specialty certification through several organizations, including the following:

Australia

In Australia, Nurse Practitioners are required to be registered by the Australian Health Practitioner Regulation Agency [1]. The Australian professional organisation is the Australian College of Nurse Practitioners (ACNP) [2]

Role in healthcare

The role of Nurse Practitioners is very diverse.[11][12][13][14] Nurse Practitioners are educated under the nursing model which is designed to provide holistic and preventive care engaging the individual as the primary leader in their own care and well-being.[15] Nurse Practitioners bring the nursing history of patient advocacy to partner with the individual for mutually agreed upon treatments and optimal health outcomes. Nurse Practitioners often view the health and wellness of individuals within the family or community system and attempt to incorporate cultural relativism within their treatments and recommendations[citation needed]. NPs are advanced practice nurses who provide high-quality healthcare services similar to those of a physician in primary care.[16][17][18] NPs diagnose and treat a wide range of health problems.(16)

Post-nominal credentials and initials

See also: List of nursing credentials

Post-nominal initials NPs may use are regulated by the state in which they are licensed and include:

  • RN (Registered Nurse)
  • NP-C (Nurse Practitioner - Certified; if certified by the AANP)
  • APRN-BC (Advanced Practice Registered Nurse - Board Certified; no longer awarded, replaced with specialty-specific credentials by the ANCC [3])
  • ARNP (Advanced Registered Nurse Practitioner)
  • ACNPC (Acute Care Nurse Practitioner Certified)[4]
  • ACNP-BC (Acute Care Nurse Practitioner - Board Certified; if certified by the ANCC)
  • CNP (Certified Nurse Practitioner)
  • CPNP (Certified Pediatric Nurse Practitioner; if certified by the Pediatric Nursing Certification Board PNCB)
  • CPNP-PC (Certified Pediatric Nurse Practitioner - Primary Care; if certified by the PNCB [5])
  • CPNP-AC (Certified Pediatric Nurse Practitioner - Acute Care; if certified by the PNCB [6])
  • CRNP (Certified Registered Nurse Practitioner; used primarily in Pennsylvania [7] and Alabama [8])
  • MSN (Master of Science in Nursing)
  • MN (Master of Nursing)
  • MA (Master of Arts in Nursing)
  • PMC (Post-Master's Certificate)
  • CAS (Certificate of Advanced Study)
  • DNSc (Doctor of Nursing Science; equivalent to Ph.D., most D.N.Sc. programs now converted to PhD programs)
  • PhD (Doctor of Philosophy)
  • DNP (Doctor of Nursing Practice; the terminal practice degree for NPs)
  • FAAN (Fellow of the American Academy of Nursing AAN)
  • FAANP (Fellow of the American Academy of Nurse Practitioners AANP)
  • RN(EP) or NP (Registered Nurse - Extended Practice; Manitoba, Canada)
  • RN(NP) (Registered Nurse - Nurse Practitioner; Saskatchewan, Canada)

Specialties

  • ACHPN (Advanced Certified Hospice & Palliative Nurse)
  • ACNP (Acute Care NP)
  • ACPNP (Acute Care Pediatric NP)
  • ANP (Adult NP)
    (Specialty Programs: Adult Cardiovascular Care NP, Adult Primary Care NP, Adult Critical Care NP [9], Adult Acute Care NP [10])
  • AONP (Adult Oncology NP)
  • APMHNP (Adult Psychiatric/Mental Health NP)
  • BC-ADM (Board Certified - Advanced Diabetes Management)
  • BC-PCM (Board Certified - Palliative Care Management, discontinued by ANCC)
  • ENP (Emergency NP)
  • FNP (Family NP)
  • FPMHNP (Family Psychiatric/Mental Health NP)
  • GNP (Geriatric NP)
  • HNP (Holistic NP; APN program [11])
  • NNP (Neonatal NP)
  • OHNP (Occupational Health NP)
  • ONP (Oncology NP)
  • PA/CCNP (Pediatric Acute/Chronic Care NP [12])
  • PCCNP (Pediatric Critical Care NP)
  • PCNP (Palliative Care NP; APN program [13])
  • PMHNP (Psychiatric/Mental Health NP)
  • PNP (Pediatric NP)
  • PONP (Pediatric Oncology NP)
  • WHNP (Women's Health NP)
  • "-C" and "-BC" indicate "Certified" and "Board Certified" by a national certifying organization such as the ANCC or AANP
    (e.g., FNP-BC, NNP-BC, ANP-C, NP-C, etc.)

See also

Look up nurse practitioner in Wiktionary, the free dictionary.

References

  1. ^ http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml
  2. ^ http://weblogs.baltimoresun.com/business/hancock/blog/2010/04/md_should_make_nurse_practitio.html
  3. ^ http://www.aafp.org/fpm/981000fm/nurse.html
  4. ^ http://www.npfreebies.com/Consumer%20perspectives%20on%20nurse%20practitioners%20and%20independent%20practice%20(clip).pdf
  5. ^ http://findarticles.com/p/articles/mi_qa3958/is_200403/ai_n9375726/
  6. ^ http://findarticles.com/p/articles/mi_6880/is_3_10/ai_n32449163/
  7. ^ http://www.mn2020.org/index.asp?Type=B_BASIC&SEC=%7BD9826F26-CBE7-447E-9808-B545C99358EB%7D
  8. ^ http://www.reporternews.com/news/2010/apr/28/nurse-practitioners-role-should-be-expanded/
  9. ^ http://www.texaspolicy.com/pdf/2007-11-PB34-nursepratitioner-mks.pdf
  10. ^ http://www.medscape.com/viewarticle/408388_2
  11. ^ http://66.219.50.180/NR/rdonlyres/ea7e64mshg43je3psc5trtnvz3o5qsps4x4z6s3repzt27i55phrghzjq5fflygbkryhxni3ptre2tgeld4jhldozma/HistoricalBibliographyOnNPAPNDev.pdf
  12. ^ http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0019/30682/LiteratureReview.pdf
  13. ^ http://findarticles.com/p/articles/mi_qa3912/is_200608/ai_n17183187/
  14. ^ http://www.medscape.com/viewarticle/408398_4
  15. ^ http://www.womenshealthchannel.com/nursepractitioner.shtml
  16. ^ Lenz, E.R., Mundinger, M.O., Kane, R.L., Hopkins, S.C., & Lin, S.X. (2004). Primary care outcomes in patients treated by nurse practitioners or physicians: Two-year follow-up. Medical Care Research Review, 61, 332-351.
  17. ^ Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.-Y., Cleary, P.D., et al. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283[1], 59-68.
  18. ^ Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823.

16. http://www.aanp.org/NR/rdonlyres/A1D9B4BD-AC5E-45BF-9EB0-DEFCA1123204/4271/FAQsWhatisanNP83110.pdf

External links

Wikimedia Commons has media related to Nurse practitioners.
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