The Role of Advanced Practice in Nursing - Case Study Example

Running head: Role of advanced practice in nursing The Role of Advanced Practice in Nursing (school) The Role of Advanced Practice in Nursing Introduction The advanced practice nurse is one of the welcome additions to the field of health care. Their practice has been complemented by the latest and the most diverse skills and specializations in the nursing and health care practice and their expertise have managed to improve patient outcomes in the general health care delivery. The premise about the advanced practice nurse is that she is a leader and change agent in the provision and development of evidenced based nursing care in her area of expertise. This statement shall be analysed in this research paper with particular focus on the advanced practice nurse as a leader and as a change agent. Scholarly articles shall be utilized in order to attain a comprehensive discussion of this subject matter. Personal nursing experiences shall also be integrated into this paper in order to help substantiate the discussion. This paper is being undertaken in order to undertake a thorough evaluation of advanced practice nurse and its crucial role in the health care practice. Discussion Advanced practice nurses are defined or described in a variety of ways. The Nursing Scope and Standards of Nursing define advanced practice nurses as those “having advanced specialized clinical knowledge and skills through master’s or doctoral education that prepares for specialization, expansion, and advancement of practice” (as cited by Jansen & Zwygart-Stauffacher, 2010, p. 5). In this case, specializing refers to the act of concentrating or focusing one’s practice into a part of the greater nursing practice. Specializing in maternal and child care may be one of the areas of advanced practice nursing. It is focused on the care given to the pregnant mother, and subsequently her delivery and child care. It focuses on what the mother and child evidently needs and how the nurse can alleviate such needs. Advanced nursing practice includes the expansion of skills and knowledge – beyond that which is normally covered by nursing practice, sometimes even overlapping the usual boundaries of medical practice (Jansen & Zwygart-Stauffacher, 2010). In the practical setting, this may include the advancement of nursing practice into radiology or diagnostics. Traditionally, the reading and interpreting laboratory and radiography results was the province of radiologists and diagnosticians; but now, some fields of advanced practice nursing now include radiology nursing and diagnostics. This strongly represents the advances in the nursing practice, where the nursing care has gone beyond independent nursing care, but how it has grown to more specific and evidence-based skills as well. The advanced practice nurse is a leader and change agent in the provision and development of evidenced based nursing care in her area of expertise. Her specialization and expansion is “characterized by the integration of theoretical, research-based, and practical knowledge that occurs as part of graduate education in nursing” (Jansen & Zwygart-Stauffacher, 2010, p. 5). In essence, advanced practice nursing is about incorporating research, theories, and evidence-based practice in the nursing post-graduate academe. It has maintained a focus of practice on what is best for the patient, not on what practice traditionally dictates. Areas in advanced practice nursing include specializations and advancements for nurses as nurse-midwives, nurse anaesthetists, nurse practitioners, and clinical nurse specialists (Jansen & Zwygart-Stauffacher, 2010). These advancements and specializations are under the graduate nurse programs in major universities and nursing schools and they help mould the nursing practice into the diverse and highly professional practice it is today. Advanced nursing practice has allowed nurses to be leaders and change agents. As evidenced by various studies which shall be discussed henceforth, advanced nursing practice has allowed the nursing profession to break free of its traditional bonds. In a position statement published by the Robert Wood Johnson Foundation (2002), the role of advanced practice nursing in palliative care was highlighted. The statement emphasized the role of the advanced practice nurse as a change agent especially in pointing out the cost-effective response which can be carried out in palliative care. The statement pointed out that as members of an “interdisciplinary team of health care providers, APN’s have the knowledge and expertise to make substantial contributions to meeting the patient and family members’ needs while maintaining social and fiscal accountability” (Robert Wood Johnson Foundation, 2002, p. 5). These are important changes to the traditional roles of nurses in the patient’s lives. In effect, the advanced practice nurse is a change agent in improving the usual care administered to chronically ill patients. The advanced practice nurse who specializes in palliative care serves the roles of clinical nurse specialist. The role of the advanced practice nurse in this case includes that of educator, consultant, researcher, and leader. Consequently, as other health practitioners focus on end-of-life care, the advanced practice nurse caters to a wide range of human experiences without any restrictions (Robert Wood Johnson Foundation, 2002). Through advanced practice knowledge, nurses are able to deliver optimal care in relation to the physical, emotional, social and spiritual needs of the seriously ill patient. As other health practitioners focus on the care they can render to the patient at the end of his life, the advanced practice nurse helps the patient affirm life and to improve the quality of his life (Robert Wood Johnson Foundation, 2002). In my current practice, I have witnessed how palliative care nurses have carried out interventions such as setting up social activities for their patients. I have witnessed how they have coordinated with other practitioners in order to make the life of patients more comfortable. In essence, the emotional quality of these patients has been improved and as a result, these patients have somehow managed to remain optimistic up to the last days of their lives. In a study by Donnelly (2006), the author sought to attain a more comprehensive understanding of advanced practice nurses based on advanced theoretical concepts, as well as added elements from other health care disciplines. As a leader, the advanced practice nurse provides services independently and differently from the traditional nursing practice (Donnelly, 2006). They were keen to point out that in order for them to improve their nursing services advanced practice nurses had to gain clinical experience. In order to achieve such experience, these nurses needed to be more involved in the nursing practice. Through experience, nurses are able to determine when a patient’s vital signs are failing – even without having to conduct procedures for vital signs monitoring (Donnelly, 2006). As a leader, the advanced practice nurse, is the first in gaining as much experience as possible. Through experience and expertise, the advanced practice nurse is able to utilize her clinical judgement and reasoning; to blend care and cure; to preserve caring; to be a patient’s advocate; and to embrace research as a necessary part of evidence-based care (Donnelly, 2006). In effect, Donnelly’s study was able to highlight the fact that advanced practice nurses are leaders in “developing nursing practice through providing clinical leadership by maintaining a commitment to develop nursing practice, using authority and power to influence clinical policy and decisions; and providing clinical development (Donnelly, 2006). Through the values and perspectives of advocacy, holism, nursing experience, and added medical functions, advanced practice nurses are able to lead the nursing care services beyond the traditional realms of health care delivery. In the practice, I was able to note how advanced practice nurses inspire other nurses to be better at their craft – to gain more skills beyond those which are gained from their baccalaureate courses. Advanced practice nurses display professional skills and techniques which motivate improvements in the nursing practice and in the general health care delivery. In a study by McCauley, Bixby, and Naylor (2006), the authors sought to establish the roles of advanced practice nurses in health care delivery. Their study sought to evaluate whether, among elderly patients with heart failure, these advanced practice nurses coordinating care between the different health practitioners were able to improve patient outcomes, reduce hospitalizations, and minimize costs of care (McCauley, Bixby, & Naylor, 2006). In the course of their research, the authors were able to establish that the advanced practice nurses were able to educate the patients in relation to their condition, symptoms, and self-management tools. Through the application of advanced practice nursing, better patient-provider communication patterns were established; moreover, caregiver and community resources were gathered in order to improve patient compliance to the treatment plan (McCauley, Bixby, & Naylor, 2006). This study was able to point out that advanced practice nurses also serve as leaders for patients – in teaching them about their health, their disease, and in ultimately assisting them in improving their health outcomes. In my practice, I was able to note how advanced practice nurses often spend time with their patients, taking time to instruct them about their disease. In the process, patients were able to understand their diseases better and to understand why certain foods and activities were prohibited for them. As a result, these patients felt like they had more control over their disease and their general health outcomes. Advanced practice nursing plays a crucial role in changing the traditional nursing practice. In the traditional sense, some patients often do not get adequate nursing care. Advanced practice nursing helps to improve access to treatment. Nurse practitioners are now assigned to work specifically in the community and rural settings, including community health centres, nursing homes, hospitals, physician’s offices, and even in the business settings (Florida Coalition of Advanced Practice Nurses, 2008). In effect, advanced practice nursing has managed to improve access to health care in the most basic geographical settings. Advanced practice nursing has also managed to improve the affordability of health care services. Surveys and studies have established that the cost per care episode of advanced practice nursing is lower by atleast 20% of the traditional medical care (Florida Coalition of Advanced Practice Nurses, 2008). These nurses are also cost effective in terms of preventive care because of their expertise in counselling, patient education, and case management. Moreover, the advanced knowledge and skills of advanced practice nurses have also managed to decrease physician workload – allowing the latter to focus on other patients and on more specific needs of these patients (Florida Coalition of Advanced Practice Nurses, 2008). In my practice, it has come to my attention how the presence of advanced practice nurses has made the role and functions of physicians easier and more efficient. These physicians work more efficiently with advanced practice nurses and they are able to improve patient outcomes and how they are able to care for more patients in the shortest time possible. Advanced practice nursing is also an important change agent in traditional nursing practice in the sense that it helps improve quality outcomes. Assessing the 40 year history of the advanced practice nursing profession reveals that these advanced practice nurses have performed as well as physicians in terms of improving patient outcomes, attaining proper diagnosis, managing chronic illnesses, and improving patient satisfaction (Florida Coalition of Advanced Practice Nurses, 2008). In one of these studies, the practice of a family practice physician was compared with a nurse practitioner’s practice, it was revealed that patients managed by the advanced practice nurse had 57% fewer total emergency department visits, and 62% less inpatient days (Jenkins & Torrisi, 1995). In my practice, I noticed that advanced practice nurses were able to develop closer relationships with their nurses because the nurses were likely to spend more time with them. I believe that by spending more time with their patients, these nurses were able to monitor their patient more and to guide them towards a better health status In their paper, Bryant-Lukosius, et.al., (2004) discussed about the role of advanced practice nurses, and their discussion has managed to establish that advanced practice nursing is highly autonomous as it fully utilizes nursing theories and knowledge in the practice of nursing. Inherently, advanced practice nurses are change agents and involve the “collaboration and consultation with health care providers and decision-makers (Bryant-Lukosius, et.al., 2004, p. 521). The roles which advanced practice nurses play in healthcare covers different integrated roles which refer to direct and indirect expert practice, education, research, and consultation (Bryant-Lukosius, et.al., 2004). As a change agent, the advanced practice nurse becomes the bridge between the different health professionals. With her greater knowledge and expertise, she relates better with other professionals and in the process coordinates with them better. Consequently, this process of coordination and collaboration allows for health professionals to better understand each other and their role in the patient’s treatment and recovery. Puskar’s (1996) study focused on the role of advanced practice nursing in the field of psychiatry and mental health. Her study pointed out the increasing cost of the health care system, the limited access to health care, as well as the decreasing quality of health services (Puskar, 1996). The study was able to point out that advanced practice nursing in the field of psychiatry effectively addressed the issues of high cost, limited access, and decreasing quality of health services by providing patients with access to psychotherapy and physical assessment skills in a less costly and more efficient set-up (Puskar, 1996). The nurse psychiatrist specialization enabled referrals of mentally ill patients needing more specialized care to mental health specialists. Nurse psychiatry was able to provide health promotion and preventive services for medical issues; it was able to provide routine physical health assessment; and finally it was able to ensure primary health care for routine health problems. Consequently, this area of advanced practice nursing effectively reduced hospital costs for patients and provide them short-term psychotherapy and psychoeducation (Puskar, 1996). The changes in the nursing practice have mostly been due to the introduction of advanced practice nursing in various areas of nursing care including psychiatry. In effect, nurse practitioners are able to offer a wider array of services as they draw on their various skills in order to deal with chronic mental illnesses, heart diseases, diabetes, and similar long-term care illnesses (Puskar, 1996). Advanced practice nursing makes possible the expansion of roles and the improvements in patient outcomes. Conclusion The advanced practice nurse plays a variety of roles in the care of patients. She offers specialised and advanced skills and knowledge in various fields of nursing, and in so doing, she ensures that patients gain the most efficient health services based on evidence and patient preferences. The advanced practice nurse is a leader because she coordinates and collaborates with the other members of the health care team in order to deliver the cost-effective, quality, and evidence-based health services to the patient. As a change agent, she makes adjustments in the nursing practice in order to make the delivery of nursing care more specific and more patient-centred. Consequently, the role of the advanced practice nurse is to ensure that the practice of nursing is updated, evidence-based, cost-effective, accessible, of top-quality, and specific enough to meet particular patient needs. In other words, the advanced practice nurse is a crucial and welcome addition to the medical and health care practice. Works Cited Bryant-Lukosius, D., DiCenso, A., Browne, G., & Pinelli, J. (2004) Advanced practice nursing roles: development, implementation and evaluation. Journal of Advanced Nursing, 48(5), pp. 519–529 Donnelly, G. (2006) The Essence of Advanced Nursing Practice. Internet Journal of Advanced Nursing Practice, volume 8 (1). Retrieved 01 October 2010 from http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol8n1/essence.xml Florida Coalition of Advanced Practice Nurses (2008) Advanced Practice Nurses: Improving Access to Health Care and Containing Costs. Florida Nurse. Retrieved 01 October 2010 from www.floridanurse.org/Resources/documents/ARNPWhitePaper.pdf Jansen, M. & Zwygart-Stauffacher, M. (2010) Advanced Practice Nursing: Core Concepts for Professional Role Development. London: Springer Jenkins, M. & Torrisi, D. (1995) Nurse practitioners, community nursing centers and contracting for managed care. Journal of the American Academy of Nurse Practitioners, pp. 119-123. McCauley, K., Bixby, M., Naylor, M. (2006) Advanced Practice Nurse Strategies to Improve Outcomes and Reduce Cost in Elders with Heart Failure. Disease Management, 9 (5), pp. 302-310 Puskar, K. (1996) The Nurse Practitioner Role in Psychiatric Nursing. Online Journal of Issues in Nursing volume 1(1). Retrieved 01 October 2010 from www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume/No1June96/NursePractitionerRole.aspx Robert Wood Johnson Foundation (2002) Advanced Practice Nurses Role in Palliative Care. Dying Well. 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