Advanced practice registered nurse

Last updated

An advanced practice registered nurse (APRN) is a nurse with post-graduate education in nursing. APRNs are prepared with advanced didactic and clinical education, knowledge, skills, and scope of practice in nursing. [1]

Postgraduate education, or graduate education in North America, involves learning and studying for academic or professional degrees, academic or professional certificates, academic or professional diplomas, or other qualifications for which a first or bachelor's degree generally is required, and it is normally considered to be part of higher education. In North America, this level is typically referred to as graduate school.

Nursing activity within the health care sector

Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialties with differing levels of prescription authority. Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurse practitioners are permitted by most jurisdictions to practice independently in a variety of settings. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.

Contents

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 the post-graduate level and may work in either 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 evidence-based decision making.

A medical specialty, or speciality, is a branch of medical practice which is focused on a defined group of patients, diseases, skills or philosophy e.g. children (Paediatrics), cancer (oncology), laboratory medicine (pathology) and primary care. In practice, what separates a medical practitioner from other healthcare providers is the fact that, each one is qualified and able to provide comprehensive front-line or first-contact care and services in any specialty with the option of getting enhanced specialist knowledge and skills from accredited professional and academic programs. For example, after completing medical school physicians or surgeons usually further their medical education in a specific specialty of medicine by completing a multiple year residency to become a medical specialist. Similar or varyingly different programs exist to train physician associates, Clinical officers and similar medical professionals.

General practitioner type of medical doctor specialising as a generalist, usually working in primary care setting

In the medical profession, a general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients.

Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types can yield strong recommendations; weaker types can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations. It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields.

Education, accreditation, and certification

APRNs demonstrate effective integration of theory, practice and experiences along with increasing degrees of autonomy in judgments and interventions. Intensive post-graduate education is designed to teach an APRN to use multiple approaches to decision-making, manage the care of individuals and groups, engage in collaborative practices with the patient or client to achieve best outcomes; provide a supportive environment for colleagues; manage the utilization of staff and physical resources; engage in ethically justifiable nursing practice; protect the rights of individuals and groups; engage in activities to improve nursing practice; develop therapeutic and caring relationships; fulfill the conduct requirements of the profession; act to enhance the professional development of self; and function in accordance with legislation and common law affecting nursing practice. [2]

Decision-making cognitive process resulting in the selection of a belief or a course of action among several alternative possibilities

In psychology, decision-making is regarded as the cognitive process resulting in the selection of a belief or a course of action among several alternative possibilities. Every decision-making process produces a final choice, which may or may not prompt action.

APRN education forms the basis of four recognized general areas of specialization:

A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. Nurse anesthetists are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. A 2002 survey reported that there were 107 countries where nurse anesthetists practice anesthesia and nine countries where nurses assist in the administration of anesthesia.

Nurse practitioner profession

A nurse practitioner (NP) is an advanced practice registered nurse (APRN) classified as a mid-level practitioner. A nurse practitioner is trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose illness and disease, prescribe medication and formulate treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex cases in which multiple symptoms suggest more serious conditions. According to the American Association of Nurse Practitioners, a nurse practitioner is educated at the masters or doctoral level to provide "primary, acute, chronic, and specialty care to patients of all ages and all walks of life". In United States, nurse practitioners have been lobbying for independent practice. The opponents of independent practice have argued that nurse practitioner education is "flimsy," because it can consist of online coursework with few hours of actual patient contact. The number of patient contact hours in nurse practitioner training is less than or equal to 3% of physician training.


Each nurse 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 APRN.

While education, accreditation, and certification are necessary components of an overall approach to preparing an APRN for practice, these roles are regulated by legislation and specific professional regulation. This allows for prescribing and referral, insurance reimbursement, and admitting privileges to health care facilities. In the US, the licensing boards are governed by state regulations and statutes and 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 required to attain at least a master's degree, generally a Master of Science in Nursing in their field of concentration.

A Master of Science in Nursing (MSN) is an advanced-level postgraduate degree for registered nurses and is considered an entry-level degree for nurse educators and managers. The degree also may prepare a nurse to seek a career as a nurse administrator, health policy expert, or clinical nurse leader. The MSN may be used as a prerequisite for doctorate-level nursing education, and used to be required to become an advanced practice registered nurse such as a nurse practitioner, clinical nurse specialist, nurse anesthetist, or nurse midwife.

In 2004, The American Association of Colleges of Nursing (AACN) in conjunction with the National Council of State Boards of Nursing (NCSBN) recommended that advanced practice registered nurses move the entry level degree to the doctorate level by 2015. [3] Accordingly, all APRN training programs are recommended (but not required as of yet) to convert their master's degree to a Doctor of Nursing Practice 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. [4]

The American Association of Colleges of Nursing (AACN) is the national voice for baccalaureate and graduate nursing education. AACN works to establish quality standards for nursing education; assists schools in implementing those standards; influences the nursing profession to improve health care; and promotes public support for professional nursing education, research, and practice.

The National Council of State Boards of Nursing (NCSBN) is a US not-for-profit organization whose membership comprises the boards of nursing in the 50 states, the District of Columbia, and four US territories — American Samoa, Guam, Northern Mariana Islands and the Virgin Islands. There are also 30 associate members.

The Doctor of Nursing Practice (DNP) is a terminal professional degree in nursing. In the United States, the DNP is one of two doctorate degrees in nursing, the other being the PhD. The curriculum for the DNP degree builds on traditional master's programs by providing education in evidence-based practice, quality improvement, and systems leadership. Advanced practice registered nurses (APRNs) include the nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), and the clinical nurse specialist (CNS) and are prepared in master's-degree programs. Although approximately 52% of nurse anesthetist programs will award the DNP, the remaining 48% may use the title Doctor of Nurse Anesthesia Practice (DNAP).

The majority of programs will grant a DNP. [3] 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 DNP will be the direct-entry, minimum academic requirement for advanced practice registered nurses; it is a clinical/practice-based doctorate but because it is not the entry degree for the profession of nursing (which includes advanced practice registered nursing), it is a terminal degree.

Grandfather exception

Every state has different laws, rules, regulations, licensing and certification requirements for advanced practice registered nurses, thus some states may not have a grandfather clause in their state board of nursing laws, in particular as it may relate to transferring a license from one State to another. The US National Council of State Boards of Nursing (NCSBN) continues to work on a collaborative multi-state compact licensure agreement for advanced practice nurses to be able to work in multiple US states with a singular active home state license. [5] There are on-going discussions on expanding that type of licensure nationally [6] [7] similar to the existing Nurse Licensure Compact for recognition of RN and LPN licenses.

Patient outcomes

Numerous studies have been conducted comparing the patient outcomes of care provided by APRNs and physicians. The conclusions reached indicate that outcomes of care by APRNs in collaboration with physicians is comparable, and in some instances better, than care by a physician alone. A recent systematic review concluded that APRN care is safe, cost-effective, and results in similar clinical outcomes and patient satisfaction as compared to care by physicians alone for the populations and in the settings included in the studies. [8] This review did not include data on CRNAs as "no outcomes met the criteria for aggregation." [8] The review was supported by a grant from the Tri-Council for Nursing and the Advanced Practice Registered Nurse Alliance; no independent reviews have duplicated such findings. [8]

Terminal degrees

An APRN 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:

Examples of terminal professional degrees in nursing are:

Post-nominal initials

The specific titles, credentials and post-nominal initials used by advanced practice nurses will vary greatly by country, state and educational level.

A list of post-nominal initials include, but are not limited to:

Related Research Articles

Certified Registered Nurse Anesthetist

Certified Registered Nurse Anesthetist (CRNA) is a qualification in the United States for advanced practiced registered nurses with a Doctorate or Master's degree specializing in the administration of anesthesia. CRNAs account for approximately half of the anesthesia providers in the United States and are the main providers of anesthesia in rural America, administering approximately 43 million anesthetics to patients each year. Historically, nurse anesthetists have been providing anesthesia care to patients since the American Civil War more than 150 years ago. The CRNA credential came into existence in 1956 and approximately 40% of nurse anesthetists are male.

A terminal degree is a university degree that can signify one of two outcomes. In some cases, it is the highest degree that can be awarded in a specific academic or professional track. In other cases, it is a degree that is awarded when a candidate completes a certain amount of coursework but does not go on to doctoral work. Some students enroll in a terminal Master's program with the goal of preparing to enter a PhD program. For certain professions and research grants it means the lowest degree to be considered qualified.

Nursing credentials and certifications are the various credentials and certifications that a person must have to practice nursing legally. Nurses' postnominal letters reflect their credentials—that is, their achievements in nursing education, licensure, certification, and fellowship. The letters usually appear in the following order:

A clinical nurse specialist (CNS) is an advanced practice nurse who can provide expert advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Clinical Nurse Specialists are registered nurses, who have graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in the advanced practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings [American Nurses Association (ANA) Scope and Standards of Practice (2004), p. 15].

In the United States, a Psychiatric-mental health nurse practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. They are licensed to provide emergency psychiatric services, psychosocial and physical assessment of their patients, treatment plans, and manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, and on medication treatment for psychiatric disorders.

In the United States, anesthesia can be administered by physician anesthesiologists, anesthesiologist assistants or nurse anesthetists

The University of San Francisco School of Nursing and Health Professions (SNAHP) is the nursing school of the private University of San Francisco, located in San Francisco, California. First established in 1954, the school has approximately 1,300 students.

A pediatric nurse practitioner (PNP) is a nurse practitioner that specializes in care to newborns, infants, toddlers, pre-schoolers, school-aged children, adolescents, and young adults. The pediatric nurse practitioner is a specialist in the care of children from birth through young adult with an in-depth knowledge and experience in pediatric primary health care including well child care and prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to support optimal health of children within the context of their family, community, and environmental setting.

The Consensus Model for APRN Regulation is a model and document created by the National Council of State Boards of Nursing to create consensus on licensure, accreditation, certification, and education for advanced practice registered nurses (APRNs).

Neonatal nurse practitioner

A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a beside registered nurse in a level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master’s or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).

Advanced practice registered nurses (APRNs) are registered nurses with graduate degrees in nursing. APRN roles include: certified nurse midwife, clinical nurse specialist, certified registered nurse anesthetist, and nurse practitioner. APRNs assess, diagnose, manage patient medical problems, order diagnostic tests, and prescribe medications. Rules, regulations, and credentialing for APRNs vary by state. This page outlines the regulatory processes for nurse practitioners in Wisconsin, including education, certification, licensing, and credentialing. Regulatory and credentialing processes are continuously changing, and the information contained on this page is current as of November 2015.

In the United States, Nursing is the largest healthcare profession, with more than 3.1 million registered nurses. Between 2012 and 2022, employment for nurses is projected to grow by 19 percent, which is more than any other profession. Nurses make up the largest component of staff in hospitals but are also able to provide care in clinic settings, patient’s homes, schools, nursing homes, public health agencies, and mental health centers. In addition, nurses can be found in the military, in industry, nursing education, and do health care research. Nurses in these various roles and settings can provide direct patient care and case management, but also develop and establish nursing practice and quality standards within complex healthcare systems. As each degree can provide a different level of care for patients and function in vastly different roles, it is important to differentiate between them. The levels of nursing degrees have different educational requirements, licensure, and credentialing that can vary state to state.

The Acute Care Nurse Practitioner (ACNP) is a registered nurse who has completed an accredited graduate-level educational program that prepares them as a nurse practitioner. This program includes supervised clinical practice to acquire advanced knowledge, skills, and abilities. This education and training qualifies them to independently: (1) perform comprehensive health assessments; (2) order and interpret the full spectrum of diagnostic tests and procedures; (3) use a differential diagnosis to reach a medical diagnosis; and (4) order, provide, and evaluate the outcomes of interventions. The purpose of the ACNP is to provide advanced nursing care across the continuum of health care services to meet the specialized physiologic and psychological needs of patients with acute, critical, and/or complex chronic health conditions. This care is continuous and comprehensive and may be provided in any setting where the patient may be found. The ACNP is a licensed independent practitioner and may autonomously provide care. Whenever appropriate, the ACNP considers formal consultation and/or collaboration involving patients, caregivers, nurses, physicians, and other members of the interprofessional team.

Advanced Practice Registered Nurse (APRN) refers to a nurse with advanced education, typically at least a master’s degree, and certification by a national certifying program. The APRN provides specialized and multifaceted care and are able to do 60 to 80 percent of preventative and primary care done by physicians. Minnesota Statutes section 148.171, subd. 3 states that in Minnesota, APRN "means an individual licensed as a registered nurse by the board, and certified by a national nurse certification organization acceptable to the board to practice as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner".

The Byrdine F. Lewis College of Nursing and Health Professions contains the nursing school and school of allied health professions at Georgia State University.

References

  1. ↑ "American Nurses Association". Archived from the original on 1997-04-06.
  2. ↑ http://www.aacn.nche.edu/publications/positions/cerreg.htm Archived July 20, 2011, at the Wayback Machine
  3. 1 2 Aacn - Dnp - Faqs
  4. ↑ AANA - Home
  5. ↑ APRN Compact
  6. ↑ A Closing Word: National Licensure for Nurses
  7. ↑ Nursing Licensure Debate - Nursing
  8. 1 2 3 Newhouse, Robin; Julie Stanik-Hutt; Kathleen M. White; Meg Johantgen; Eric B. Bass; George Zangaro; Renee F. Wilson; Lily Fountain; Donald M. Steinwachs; Lou Heindel; Jonathan P. Weiner (September–October 2011). "Advanced Practice Nurse Outcomes: 1990-2008: A Systematic Review" (PDF). Nursing Economic$. 29 (5). Retrieved 16 August 2011.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.