Historically, the American Medical Association (AMA) has continuously contended the progression of nursing practice, in particular advanced nursing practice (Keeling & Bigbee, 2005). They have done so by opposing the advances of nursing practice claiming the broader and more specialized roles of advanced practice nurses (APNs), which includes diagnosing and prescribing, encroaches on physician practice and claim nurses are not educationally sufficiently prepared to take on these roles (Summers & Summers, 2007). The medical profession posits APNs should be supervised by physicians in their advance practice roles. Examples of such opposition are evident in for example AMA’s posting of a recent speech given by Nancy Nielsen (2009) stating that the AMA will oppose a proposed bill to allow APNs to classify themselves as primary care providers; or as presented and discussed at the recent 34th AMA Annual Meeting (AMA, 2010), in which a strong opposition to autonomous practice of APNs was discussed and the position of physician supervision of APNs practice was advocated.
This opposition not only hinders the advancement of cost efficient healthcare, it also stands in direct opposition to the newly proposed Patient Protection and Affordable Care Act (U.S. Congress, 2010), which recognizes APNs practice and working relationship with physicians to be one of collaboration, not submission, and recognizes the need for the expansion and recognition of APNs’ role in order to increase the availability of healthcare to all Americans.
In order to allow for APNs to be efficient in providing care to their patients, those APNs diagnosing and treating patients, need to be able to have the authority to prescribe treatments, inclusive of medications, f...
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...Summers, H. J. (2007). Changing poor portrayals of nurses in the media: The center for nursing advocacy. In D. J. Mason, J. K. Leavitt, & M. W. Chaffee (Eds.), Policy & politics in nursing and health care (5th ed., pp. 184-194). St. Louis, MO: Elsevier Saunders.
Tucker, S. (2003). Preparing CNSs for prescriptive authority. Clinical Nurse Specialist, 17(4), 194-199. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12869866
United States of America Congress. (January 5, 2010). In U.S. Government Information (Ed.), An Act (One Hundred Eleventh Congress of the United States of America). Retrieved from http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf
Weinkam, K., Bailey, L., & Goodman, H. J. (Eds.). (2003). What is the RN scope of practice? (The BRN report, pp. 7-9). Retrieved from http://www.rn.ca.gov/pdfs/forms/brnfall2003.pdf
In 2011, Barbara Safriet published an article “Federal options for maximizing the value of Advanced Practice Nurses in providing quality, cost-effective health care” from a legal perspective. The article focused on the benefits of utilizing Advance Practice Nurses to the full extent of their abilities as well as the current barriers that APNs encounter in their practice. The aim of this paper is to discuss two regulatory provisions to full deployment of APNs in current health care system, as well as three principle causes of current barriers to removal of the restrictive provisions for the APN. Furthermore, I will discuss the critical knowledge presented in the article and how it relates the APN practice. This article was incorporated into a two-year initiative was launched Institute of Medicine (IOM) and by the Robert Wood Johnson Foundation (RWJF) in 2008 which addressed the urgency to assess and transform the nursing profession.
The model discusses the impact of new regulations on education for APRN, Licensure Accreditation, Certification & Education Document, certification and practice. The model is implemented to grasp the general understanding and definition of advance practice registered nurse APRN role, inconsistencies with state by state recognition of APRN roles, and determining eligibility for APRN licensure (Consensus Model for APRN Regulation, 2015). The consensus model definition of APRN is a nurse who is educationally rounded to assume the responsibility of assessing, diagnosis, treating, teaching health promotion and disease maintenance, acquired advanced clinical knowledge and skills to provide direct patient care, has passed a national certification examination, and licensed to practice in one of the four roles (Consensus Model for APRN Regulation, 2015).
In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
The medical field is among the largest and ever growing career fields, especially when dealing with Physician Assistants (PAs) and Nurse Practitioners (NPs). In the 1960’s when the physician shortage began, the medical field created the PA and NP positions to fill in the gaps (Curren, 2007, p. 404). This matter has opened up numerous questions as more and more PAs and NPs begin practicing, especially concerning their education level. Many patients are concerned that they will not get the proper care. PAs/NPs are beneficial to everyday life by providing patients with the necessary skills needed to successfully treat them.
In tandem with growing scientific knowledge, programs expanded their length and credit loads. Nurse practitioner specialties such as cardiology and intensive care appeared in graduate programs across the country with educational programs aimed at their specialized knowledge. NAPNAP had been founded as one of the first national specialty nurse advanced practice organizations in 1973. By the end of the 1980s, nurse practitioner care was part of the normal menu of services offered by many health care institutions, supported by the 1986 OTA study that found that NPs “provide care whose quality is equivalent to that of care provided by physicians,” particularly when such care depended on preventative services and communication with patients (Office of Technology Assessment, 1986, 5). In 2003, health care institutions began to hire large numbers of NPs in response to the Accreditation Council for Graduate Medical Education’s Resident Duty Hours standards, which limited the number of hours medical residents could work (Nasca, Day & Amis, 2010). Numerous studies, including a Cochrane review, reports from the Rand Health Foundation, Commonwealth Fund, and Western Governor’s Association all provided positive evidence of the value and quality of NP-provided services. Today, NPs have proven their effectiveness in delivering high quality, lower
Nursing is ever-evolving. Healthcare in general is becoming more sophisticated, which requires an increase in knowledge and education, as well as the need for nursing staff to be able to think critically. As medical advances are at an all-time high, reimbursement from state and private insurance has decreased. These factors lead to a greater need of autonomy and evidence-based research by RN’s (Huston, 2014)
Sullivan-Marx, E. M., McGivern, D. O., Fairman, J. A., & Greenberg, S. A. (2010). Nurse practitioners: The evolution and future of advanced practice. (5th ed.). New York: Springer Publishing Company.
Advanced practice registered nurses play a significant part in extending access to health care by providing primary care and specialty care services to clients. Advanced practices registered are mentors, educators, researchers, and administrators. According to Health Resources and Services Administration, “Ninety-six percent of the NP workforce reported being in clinical practice, providing direct patient care” (Health Resources and Services Administration 2016). Furthermore, “Nearly three percentages were in faculty positions and approximately one percent was in administrative positions”(Health Resources and Services Administration 2016).
The American Nurses Association (2008) has defined the FNP, under the broader title of Advanced Practice Registered Nurse (APRN), as one “who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic i...
Potter, P. & Perry, A. (2009). Fundamentals of Nursing (7th ed.) St. Louis: Mosby Elsevier, 1029-1084.
Nursing is a knowledge-based profession within the health care sector that focuses on the overall care of individuals. According to The American College of Nurse Practitioners (ACNP), “defines nurse practitioners as registered nursed who have received graduate-leveling nursing education and clinical training, which enables them to provide a wide range of preventative and acute health care services to individuals of all ages. They deliver high-quality, cost effective care, often performing physical examinations, ordering tests, making diagnoses, and prescribing and managing medication and therapies”. Nurse Practitioners are able to specialize in a particular area, such as family and adult practice, pediatrics, and women’s health; and refer patients to other specialist when necessary. Some Nurse practitioners work under the supervision of a physician; while others run their own practices.
The American Nurses Association (ANA) developed a foundation for which all nurses are expected to perform their basic duties in order to meet the needs of the society we serve. The ANA “has long been instrumental in the development of three foundational documents for professional nursing; its code of ethics, its scope and standards of practice, ands statement of social policy.” (ANA, 2010, p. 87) The ANA defined nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” and used to create the scope and standards of nursing practice. (ANA, 2010, p. 1) These “outline the steps that nurses must take to meet client healthcare needs.” () The nursing process, for example, is one of the things I use daily. Other examples include communicating and collaborating with my patient, their families, and my peers, and being a lifelong learner. I continually research new diagnoses, medications, and treatments for my patients. As a nurse of ...
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.
O’Brien, B. L., Anslow, R. M., Begay, W., Pereira, S. A., & Sullivan, M. P. (47-57). Fall. Nursing Administration Quarterly, 26(5), 47-57.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.