Term Paper: Advance Nursing Practice

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Advanced Nursing Practice

As healthcare in the United States becomes a more complex and crucial societal element, it will become increasingly important for providers to gain different levels of specialization and education. One area that is growing as a result is the advanced nursing practice. Although this area of advanced nursing practice can involve different areas of study and healthcare provision, in 2004, the American Association of Critical Care Nurses (AACN) broadly defined the term "practice" as "any form of nursing intervention that influences healthcare outcomes for individuals or populations, including the direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy. (2004, p. 2). In its most basic terminology, this level of nursing refers to any nurse that has a Master's degree or, as is becoming more commonplace, a Doctorate in Nursing. These practice degrees are different than the Master's or Doctorate of Philosophy or Research degrees because they are based on the delivery models of service and intervention vs. research and development. The healthcare that such individuals can perform given these graduate degrees are determined on a state-by-state basis, including many services once provided only by physicians. The acceptance of these individuals also varies. A more clearly defined responsibility of this role will be advantageous.

In the United States, cost containment is a major priority in the rapidly changing healthcare system, thus advanced nurse practitioners have increasingly grown over the past couple of decades in their delivery of primary care. Factors promoting this wider scope of responsibilities for this career include: (a) the growing need to limit the country's continually escalating healthcare costs, (b) the current window of opportunity for advanced nursing practice, and - the requirement to use less resources more effectively. Since America has a market-driven healthcare system with a mounting surplus of physicians, these nursing professionals increasingly find themselves directly competing with medical doctors for the same primary care jobs (Harris, 1998).

Because such changes in the nursing practice are so recent, many questions have yet to be answered. The concerns include confusion over the focus of these graduate degrees, the impact of the degrees on educational and economic resources for both students and employers, and the regulatory issues arising from the implementation of these degrees. Controversy exists on the place such degrees do or should play in the future of medical care.

A number of reasons have been given to justify continuing this move toward the practice higher degree nurse. These include the need for safe practice, the growing complexity of healthcare, the requirement for equality with other disciplines, the ongoing explosion and important of knowledge, and the need for more nursing faculty (Fulton & Lyon, 2005). The American Association of the College of Nursing (AACN, 2004) has stated that "nursing has many of the answers to the predominant healthcare dilemmas of the future." Thus, nurses trained at higher graduate levels "with a blend of clinical, organizational, economic and leadership skills are most likely to be able to critique nursing and other clinical scientific findings and design programs of care that are locally acceptable, economically feasible, and which significantly impact health care outcomes" (AACN, 2004).

Another reason for these advanced degrees is "because it is time." Nurses have been long waiting in the wings for their turn, and now is that time for them to gain deserved power. There are compelling reasons to empower nurses. Studies repeatedly show that powerless nurses are ineffective nurses, who are less satisfied with their jobs and more susceptible to burnout and depersonalization. Similarly, there is increasing evidence in the research literature that structural empowerment results in higher levels of job satisfaction and is interrelated with nursing leadership. In fact, nursing leaders need to first empower themselves by establishing empowerment work environment structures before moving forward to offer these same empowering work conditions to staff.

It is now time for nurses to use this power to make their optimum contribution. Empowerment for nurses may consist of three components: a workplace that has the requisite structures to promote empowerment; a psychological belief in one's ability to be empowered; and acknowledgement that there is power in the relationships and caring that nurses provide. (Manojlovich, 2007).

Fletcher (2006) recommends a relational theory approach when stating that nurses must focus on relationships to build power. She argues that relationships are built through dialogue and self-awareness and that the development of this self-awareness "can begin to break the cycle of oppression and lead to changes in the structures that oppress nurses." Benner (2001) similarly stresses that power through relationships and caring is at the core of nursing practice. When nursing embraces caring, empathy, and compassion as components of power, the nurses will be more apt to adopt and accept power as part of their practice.

Many studies have already shown the positive impact of these nurses. For example, Goodridge (2007) finds that "Advanced practice nurses can make significant contributions to the care of this underserved population (Chronic obstructive pulmonary disease COPD) through appropriate, evidence-based assessments and interventions. Symptom management (including dyspnea, fatigue, and cachexia), support of self-management, patient and family education, and advance care planning are key focus areas for advanced practice nurses." In a pediatric area, Adams (2005) finds that these clinical nurses can "assess and document risk factors for child abuse and neglect (CAN) during family assessments."

There are naturally those who say that these nurses are infringing on the turf of physicians, especially those who are concerned with the power being moved from the doctor's court into the nurses -- or at least being shared between the two. However, those who recognize that the future of healthcare necessitates teams of providers taking different forms argue that physicians should gladly relinquish this power.

In a review of 15 studies even a couple of decades ago, nurse practitioners were shown to be able to perform between 75 and 80% of adult primary care services, and up to 90% of pediatric primary care services (Record, 1979). Also, in a review of 26 studies comparing these nurses and physicians, the nurses received higher scores than their doctor colleagues in the areas of amount and depth of discussions on child healthcare, preventive health and wellness; amount of advice, therapeutic listening and support offered to patients; completeness of history and follow-up on history findings; completeness of physical examination and interviewing skills; and patient understanding of the management plan given to them by the provider (Prescott, 1980).

Looking at this issue from a different perspective, in the future more than ever there will be a need for teams of healthcare providers to join their varying area of expertise and knowledge for the betterment of their patients. As the U.S. faces the critical growing challenge of providing all Americans with equal access to quality, cost-effective medical care, health professionals must learn how to focus on a team model of primary care delivery and its advantages. Although specific team members, especially nurses, have changed over the years, the core of the primary care team today includes primary care physicians and advanced nurse practitioners along with other healthcare providers, such as mental health professionals, working together to provide integrated, comprehensive care to patients.

The situation should not be "me" versus "you" where individuals are afraid of losing their power to someone else. It should rather be "me" and "you," where the collaboration of all healthcare providers together can be much larger than the sum of their parts. Unfortunately, there is never going to be a shortage of patients requiring necessary healthcare.

Advanced practice nursing includes a variety of roles in which nurses function at an advanced level of practice. Because this is a fairly new role, there continues to be disagreement as to specific… [END OF PREVIEW]

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