Advanced Nursing Role - Lorna Edwards, South University

Advanced Nursing Role Lorna Edwards South University The development of nursing and the increased complexity of nursing care have changed the role of the nurse to adapt to the specific health needs of the population

The development of nursing and the increased complexity of nursing care have significantly transformed the role of nurses, leading to the emergence of advanced practice nursing roles. These roles are characterized by advanced education, specialized skills, and expanded responsibilities, aimed at meeting the increasingly complex health needs of diverse populations. Historically, the concept of advanced nursing roles originated in the United States in the late 19th and early 20th centuries, with nurse anesthetists, psychiatric nurses, and midwives pioneering specialized training and responsibilities. During the world wars and subsequent conflicts, the importance of advanced nursing roles became more evident as nurses took on responsibilities traditionally handled by physicians, such as administering anesthesia and providing mental health care (Sheer & Wong, 2011). These developments laid the foundation for today's advanced practice registered nurses (APRNs), including nurse practitioners, clinical nurse specialists, nurse anesthetists, and certified nurse midwives.

The evolution of advanced nursing roles has been driven by the necessity to address healthcare workforce shortages, especially in underserved areas, and to improve access and quality of care. As healthcare systems became more complex, the roles of nurses expanded from traditional bedside care to encompass significant autonomous functions, including diagnosing, prescribing, and managing patient treatment plans (Reeves et al., 2017). The implementation of master's and doctoral programs has further consolidated the credibility and recognition of these roles worldwide, highlighting the importance of advanced education in preparing nurses for complex clinical scenarios (Sheer & Wong, 2011). Despite this progress, resistance from some healthcare professionals and role ambiguity remain challenges that impede fully autonomous nursing practice. These issues are rooted in professional dynamics, concerns over role overlap with physicians, and differences in scope of practice regulations across regions.

The Role and Scope of Advanced Practice Nurses

In the United States, advanced practice nurses encompass a variety of roles, including nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse anesthetists, and certified nurse midwives. These professionals operate in diverse settings, ranging from primary care clinics to specialized units such as oncology, emergency medicine, genetics, and outpatient surgical centers. According to Reeves et al. (2017), successful practice in these roles requires not only clinical expertise but also attributes such as caring, communication, and interpersonal skills. These attributes enable APRNs to perform multiple functions, including direct patient care, consultation, education, administration, and research. The scope of practice varies depending on state laws and healthcare policies, with some jurisdictions granting full practice authority to nurse practitioners, allowing them to initiate and manage treatments independently (Buppert, 2014).

Challenges Faced by Advanced Practice Nurses

Despite the expanding roles and recognition, advanced practice nurses encounter several challenges that threaten the effective delivery of healthcare. Ambiguous job descriptions and role confusion often arise during hiring processes, leading to uncertainty about responsibilities and authority. Additionally, nurses sometimes undertake non-role-specific tasks that dilute their clinical focus and hinder the utilization of their full scope of practice (Reeves et al., 2017). Collaboration with physicians and other healthcare providers can be complex due to hierarchical structures, differing perspectives, and regulatory limitations. Furthermore, the scarcity of role models and mentors within healthcare institutions hampers professional growth and leadership development among APRNs. Overcoming these barriers requires ongoing advocacy, policy reform, and fostering interprofessional respect and understanding.

Family Nurse Practitioners: Responsibilities and Contributions

Family Nurse Practitioners (FNPs), a prominent subset of APRNs, possess postgraduate education that enables them to deliver comprehensive nursing and some medical care across all age groups. FNPs are authorized to perform activities traditionally reserved for physicians, such as prescribing medications, ordering diagnostic tests, and implementing treatments, provided they operate within their scope of practice and collaborate with physicians when necessary (Buppert, 2014). This autonomy allows FNPs to significantly enhance access to healthcare, especially in underserved and rural areas where physician shortages are prevalent. They provide holistic care that addresses physical, emotional, and social dimensions of health, emphasizing health promotion, disease prevention, and chronic disease management (Sheer & Wong, 2011).

Roles Beyond Direct Patient Care

Beyond delivering clinical care, FNPs serve as educators, advocates, and researchers. They develop clinical guidelines, promote evidence-based practices, and facilitate systemic improvements. Their role as educators extends to instructing patients on managing chronic conditions and adopting healthy lifestyles. As system advocates, they often work to influence healthcare policies that expand their scope of practice, thereby improving healthcare accessibility and quality (Reeves et al., 2017). Their capacity to integrate research findings into practice ensures that patient care remains current and effective.

Interprofessional Collaboration and Supervision

Effective healthcare delivery relies on collaboration and supervision among healthcare professionals. Consultation involves exchanging information and expertise over a limited period to optimize patient outcomes, while supervision entails ongoing oversight to ensure nursing practice aligns with standards and policies (Reeves et al., 2017). APRNs often juggle both roles, discussing cases with physicians and team members to ensure quality care. However, some barriers to collaboration include hierarchical attitudes, role ambiguity, and legislative restrictions that limit APRNs' independence. These issues can hinder seamless teamwork, particularly in managing complex cases requiring multidisciplinary input (Jones & Bartlett, 2014). Improving interprofessional relationships is crucial for expanding the efficacy of advanced nursing roles and enhancing patient care.

Interview Insights and Future Directions

In a recent interview with Johan Joseph, a Family Nurse Practitioner working with a migrant population in South Florida, several points emerged about the realities of advanced practice nursing. Joseph highlighted that her practice involves managing diverse health needs within resource-constrained settings, emphasizing the importance of cultural competence and adaptability. She also acknowledged challenges such as navigating regulatory environments that limit full autonomy and the need for continuous advocacy to expand practice authority (Joseph, 2019). She emphasized the importance of collaborative relationships with physicians and other health professionals and advocates for more defined roles and mentorship opportunities for emerging nurse practitioners. Her insights underscore the ongoing need for policy reforms to grant APRNs full practice authority, enabling them to meet public health needs more effectively.

Conclusion

The evolution of nursing into advanced practice roles reflects the profession's response to escalating healthcare demands. Advanced practice nurses, particularly nurse practitioners, have demonstrated their capacity to deliver high-quality, comprehensive care across diverse settings. Overcoming ongoing challenges such as role ambiguity and regulatory restrictions is essential to realize the full potential of these professionals. Policies that promote full practice authority, mentorship, and interprofessional collaboration will be pivotal in shaping the future of advanced nursing practice. As healthcare continues to evolve, the role of nurse practitioners and other APRNs will become increasingly vital in ensuring accessible, efficient, and patient-centered care for populations worldwide.

References

• Buppert, C. (2014). Nurse practitioner's business practice and legal guide. Jones & Bartlett Publishers.
• Jones, & Bartlett. (2014). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Library.
• Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Library.
• Sheer, B., & Wong, F. K. Y. (2011). Evolution or Revolution: Can Advanced Practice Nurses Alter the Future of Health Care? Pflege, 24(1), 3–6. https://doi.org/10.1024//a000085
• American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). American Nurses Association.
• Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5th ed.). Elsevier.
• Gross, C. P., et al. (2019). Practice authority and quality of care among nurse practitioners and physicians: A systematic review. Journal of Healthcare Leadership, 11, 125-139.
• Newhouse, R. P., et al. (2015). Advanced practice nurse outcomes: A systematic review. Nursing Economics, 33(7), 307-319.
• American Association of Nurse Practitioners. (2022). State Practice Environment. Retrieved from https://www.aanp.org/advocacy/state/state-practice-environment
• Johan Joseph. (2019). Personal interview conducted October 26, 2019.