Advanced Care Nurse - Essay Example

A Critical Analysis of the Advanced Care Nurse The purpose of medicine is, in general, to treat patients who are suffering from an illness until they are healthy. Traditionally the clinical (ie. treatment) part of healthcare has belonged to the province of doctors, while caring for the patients before, during and after treatment has been the territory of nurses. This paper will consider those nurse practitioners "who have emerged in the last two decades as a response to changing demands in healthcare" (White, 2001, specifically those who have started to take on added responsibilities within a community care setting, The development of advanced nurse practitioners who can perform many of the day-to-day functions that used to be performed by doctors is a timely adaptation to the British medical system. These nurses are often concentrated in those areas where "the needs of disadvantaged communities are being addressed particularly in areas where is little response to a general practitioner" (White, 2001). This role is increasingly expanding to include "clinical diagnosis and treatment with the inherent possibility of a need to prescribe" (White, 2001). However, currently only Health Visitors and District Nurses can prescribe; and even then from a rather limited formulary. At some point the needs and the ability contradiction must come to a crisis within the NHS. If advanced care nurses are to have some of the responsibilities of a doctor, they also need some of the powers to treat, and this include the ability to prescribe drugs. As McGrath (1990) suggests, the advanced care primary nurse is a highly cost efficient figure, both in terms of education cost and in services provided. Advanced nurses increasingly follow a clinical career path, as opposed to the care path that used to be the norm. However, as advanced nurses become increasingly clinical practitioners, they should not lose sight of the unique care-based role that probably attracted them to the vocation in the first place. Advanced nurses can offer both to the healthcare system. One recent study showed how the combination of clinical expertise and care-based training could actually improve overall life expectancy for serious ill patients (Naylor, 2004) The study sought to answer the following question: In elderly patients admitted to hospital with heart failure, does a 3-month, comprehensive, transitional care intervention reduce readmissions and improve quality of life and functioning (Naylor, 2004) The answer was apparently a quite overwhelming "yes". An advanced practice nurse who was able to devote far more time to the unique symptoms of the individual patient was able to improve their long term prognosis considerably. One year after the index admission, the APN TC group had a lower rate of hospital readmission, death, and comorbidity related readmissions. They had a slightly improved quality of life, although this was within the margin of error. Such programmes seem to suggest that care that is tailored to the individual patient, but which also has the clinical expertise of the doctor behind it, may be successful in treating patients and limiting readmission. This will helpful both to actual patients and to the overall system through placing less burden upon hospitals through readmission and comorbidity complications. This hospital-to-community type of nursing reflects a greater clinical emphasis for advanced nurses. This is reflected both in their practice and in new types of communication and scholarship that is appearing that is written by advanced nurses for advanced nurses. A good example of this new type of clinical research is found within the British Journal of Community Nursing. In the most recent issue (July, 2006) a number of different articles appear: titles include "The Management of deep vein thrombosis in lymphodema", "Promoting quality of life for patients with moderate to severe COPD" and "Long-term management of patients with multiple sclerosis." There are several important aspects to such articles. First, they represent a growing corpus of work that is aimed at the specific challenges and opportunities experienced by the advanced nurse. They mix together scientific-based clinical treatment with more humanistic approaches to overall quality of patient life. Second, they are usually written by the advanced nurses themselves. In previous years, most nursing textbooks and even advanced nursing techniques were developed under the aegis of doctors, with the secondary (but definitely submissive) input of nurses after the fact. This is no longer the case, and the Journal illustrates that advanced nurses are becoming clinical practitioners in their own right, with a set of practices, responsibilities and concentrations that is unique to them. One recent challenge to advanced care nurses has been the economic cutbacks that have been occurring within the healthcare industry. As a recent editorial by Tom Pollard asks, "Is the number up for district nursing" (Pollard, 2006). The answer would seem to be that community nursing, particularly using advanced care nurses, is not on the way out, but rather is going through a period of transformation. The new CNO Bulletin (DH, 2006)informs practitioners that "the number of primary care trusts (PCTs) in England will reduce from 303 to 152 from October . . . from July, the number of strategic heal authorities (SHAs) will fall from 28 to 10 and the existing 29 ambulatory trusts will mere into 12 bodes" (DH, 2006). The report suggests that the reforms will provide even more opportunities for nurses to "improve care, influence the way services are run, and improve their own career paths." (DH, 2006). Community matrons and specialist nurses will now have the opportunity to set up and run their own services in "areas such as health promotion and supported self-care for people with long term conditions." (DH, 2006). The role of these new nursing leaders is highly complex: an advanced nurse in control of a local clinic will be responsible for patient care, supervising more junior nurses, the outsourcing of various services such as food/laundry and a host of other activities. The advanced nurse often becomes a manager, while his/her primary role will still be to care for patients. These are perhaps contradictory roles that may create pressures within the nurses that need to be addressed if retention is not to become an issue. The emphasis should always be placed on the nurse as clinical provider and care expert: if other responsibilities take away from this then her effectiveness within the clinical setting will be diluted. It is thus clear that a degree of autonomy is appearing that will enable nurses to further improve their clinical practice and also their influence within the NHS as a whole. Part of the need for these changes comes from the changing demographics of the population. As Chris Beasley suggests, "this shift in context from hospitals to the community, to illness prevention and promotion of public health is essential . . . " (Beasley, 2006) because of the changing demographics that will double the number of people over the age of 85 needing medical and social care. The concept of the "Essence of Care":- that people feel they have been treated well with regard to their privacy and emotional well-being - is an integral part of the ethos of the advanced care nurse. This is a treatment of the whole person rather than just an aggregate of symptoms. Advanced nurses will have a particular responsibility for the care of an increasingly aging population that may not have severe life-threatening diseases but who are likely to have a number of chronic conditions that will make their quality of life rather depleted. The nurse will have an essential to play: Last month's bulletin reported on A New Ambition for Old Age - Next Steps in Implementing the National Service Framework for Older people. This builds on the role of existing nurse leaders such as as modern matrons, ward sisters, and directors of nursing, strengthening their responsibility for ensuring that older people are treated with respect and that consideration for dignity is embedded in all working practices. (Beasley, 2006) The idea of a "framework" will bring the advanced care nurse to the forefront. Many old people will want to stay at home and visit smaller clinics for the management of their chronic illnesses. The advanced care nurse is an ideal position to provide such care. As long as at least some relaxation in the prescription laws comes about, the nurse will be able to tend to the day-to-day care of this aging population in a far more satisfactory and comprehensive manner than large hospitals. The idea of "dignity" has become somewhat lost within the increasingly complex (and powerful) technology used within medicine. The idea that a patient is merely a set of symptoms that are presented to the healthcare facility, and that those symptoms are then fitted into the closest matching disease paradigm, with consequent treatment, needs to be tempered by the whole person approach. The idea of a "people-centered" or "patient centered" approach to healthcare is one that is often paid lip-service to, but which becomes lost in the mire of current bureaucratic systems and theoretical frameworks of care. One of the dangers of the amalgamation of different health regions into much larger ones is that such systems will come to dominate the practice of advanced nurses: they will be lost in paperwork rather than concentrating on patients. This is something that should be avoided at all costs. As increasing number of advanced care nurses move into leadership positions within their particular regions and clinic, a distancing from the actual patients will perhaps be a inevitability. One facet of advanced nurses that the government needs to address is that these practitioners should be rewarded in a manner that will enable them to stay within a "hands-on" clinical role rather than moving into office-work. As advanced nurses take on more and more of the responsibilities of a doctor, they should be rewarded accordingly. Such ideas are of course easier to postulate in theory than to put into practice with the current economic crunch that is being felt within the healthcare industry in general and the NHS in particular. To conclude, the concept of the advanced primary nurse fits in with the overall development of the healthcare system, giving more autonomy to those healthcare providers who are not doctors. These nurses in some sense challenge the strict division between doctor and nurse that has existed since the idea of the "nurse" was first developed about 150 years ago. The average nurse in this generation needs to have the knowledge and expertise that was required of a doctor just a generation ago, and with the increased specialization of many doctors (and corresponding dearth of GPS/junior doctors) the gap in general practice needs to be filled from somewhere. Advanced nurses are doing more than just filling a gap however: they bring their unique perspective to both clinical and care field. The study of heart patients who were involved in transitional care guided by advanced nurses may well be a beacon towards the future of healthcare. Combining the clinical expertise (scientific) basis of medicine with a more qualitative, care-based system as has been practiced for centuries will be the best course towards future healthcare improvement. Advanced nurses face a number of challenges in the years to come, but with a little foresight these may become opportunities to contribute to the healthcare system, and to advance their own careers, in unique manners. ______________________________________ Works Cited Beasley, Chris. "Voicepiece". Department of Health, "The CNO Bulletin". June 2006 Boot, R. "Leadership Challenges for the Nurse Practitioner Faculty". Spring House corp. no.4, pp.52-53. British Journal of Community Nursing, v.11., no. 7, July 2006. Department of Health, "The CNO Bulletin". June 2006 McGrath, S. "The Cost Effectiveness of Nurse Practitioners". Nurse Practitioner 15 (7) pp. 40-42. Naylor, MD. "Advanced practice nurse directed transitional care reduced readmission or death in elderly patients admitted to hospital with heart failure". Evidence-Based Nursing, 2004; 7:116. Pollard, Tom. "Is the number up for district nursing" The Journal of Community Nursing, vol. 11, no. 7, July 2006. www.cancer.org Weisman, Avery. On Dying and Denying: A Psychiatric Study of Terminality. Behavioral Publications, New York: 1972. White, Morag. Nurse Practitioners/Advanced Practice Nursing in the UK. RCN: 2001. Woods, Dillon. Where Souls Meet: Communicating with the Terminally Ill. Windemere, London: 2000. Read More