Nurse Practitioner: The Evolution of the Nursing Role - Assignment Example

 Nurse Practitioner Introduction With the pressures of healthcare provision and increasing need for meeting the needs of the consumers at the social and political levels, the nursing roles have expanded, and redefinition of boundaries of work at the professional levels demanded legislations in the healthcare front. Although this problem is global, despite considerable debates and resistance, the role of independent nurse practitioners has evolved through this turmoil. It was clear that a reorientation of health services was due to meet the service users' need in a cost effective fashion within the present structure of the available health services mainly in order to facilitate their journey within the healthcare continuum (Sweet, 2005). Nurse practitioners have responded to this social and political need and professional challenge through expansion of the scopes of their practice with action, plan, and rigor. As a result in today’s changing contexts, this professional role has literally evolved into development of skills and expansion of scope of practice so this category of service providers can provide efficient, safe, comprehensive, and accessible care to the patients and the communities (Ashington Audit Group., 2004). Before going into the critical examination of the conditions of this development and its social and political contexts, it would be prudent to define a nurse practitioner. According to Australian Nurse Practitioners Association, nurse practitioners are senior clinical nurses within their specialty of choice with a Masters of equivalent degree and registered with the state nursing boards (Redshaw and Harvey, 2001). Professionally they are experienced with high level of skills suitable for different healthcare settings. The political motive for this role is to support the existing system of patient care while at the same time improving access of people to care that may be adequate or even better for certain clinical conditions. In the Australian context, the nurse practitioners are able to cater to the health needs of the population independently through their clinical skills and are able to meet the health needs of the population at the given level through their ability to recognize the holistic health needs in the context of their environments. In any way, this provision is not designed to provide care that is does not fulfill the competency standards of healthcare delivery. They provide services with accountability within this extended scope of practice in conformity with the evidence that nurse practitioners are quite able to provide quality holistic and opportunistic care to the population both independently, autonomously, and as members of the collaborative care teams that can complement the existing gaps of the healthcare delivery only to facilitate a seamless provision of healthcare (Bigbee & Amidi-Nouri, 2000). In this assignment, the evolution of this nursing role would be examined in the sociopolitical context with critical review of supporting evidence from literature which would also include examination of the positions of other stakeholders in this process. If the role description of the nurse practitioners is examined closely, it will be evident that their skills are backed by experience and education sufficient to achieve competency levels. There is a certifying examination which these practitioners need to pass in order that there may be “assurance of quality beyond basic licensure; identification of nurses who may be directly reimbursable for services; and recognizing achievement and quality of practice” (Hawkins & Thibodeau, 1993, p. 77). It was further observed that despite resistance from many quarters, people accepted this role as one of the modes of access to health care. Since inception, the numbers of these independent nurse practitioners is increasing. Evidence suggests that prescriptive privilege and financial crisis in healthcare budgets have fostered this role, and the current states of affairs indicate that nurse practitioners is becoming a part of mainstream healthcare delivery system, and predictably, it can become one day the primary mode of general and primary healthcare delivery framework for the population (Australian Medical Association. 2005). The independent and autonomous nursing practice has evolved over time under the influence of political and social factors. This was a clear shift from the usual and conventional nurses who were trained to do rule based and activity oriented service to the patients, where expertise was a resultant of repetition of skills and procedures. Constant supervision was a must. It was increasingly envisaged that this work force can turn out to be a group of professionals who can practice independently provided they are trained on the scientific principles that underlie care. Shortage of physicians with resultant limitation on access to care was an important factor for this development. Regarding this role of the nurses, it has been stated that this nurse would be an independent practitioner backed by appropriate education at the Master's level so she can concentrate in a specific area of clinical nursing (The University of Newcastle Australia, 2008). Their roles would be defined by the needs of a client population, the expectation of the society that they belong to, and their respective clinical and skill expertise. The sociopolitical angle may be further stressed when the evolution this role is examined closely. In their independent practice, it is also expected that they would be able to exercise leadership ability and judgment. In this way they can be individual provider of care at the direct care provider level, thus effecting change within the broader healthcare system (Jackson and Daly, 2004). The nurse practitioners are very important stakeholders in this whole process, especially as indicated by the Australian Nurse Practitioners' Association. The Australian Nursing and Midwifery Council has indicated that this advanced nursing role is based on academic learning of advanced medical and clinical content. This is in essence a specialist clinical practice, but it also involves the roles of an educator, consultant, researcher, and administrator. To understand the evolution of this role, one needs to understand that these changes were associated with healthcare reforms (ANMC). These reforms were driven by the need for change in the health care delivery forms due to soaring healthcare costs. Advancement of medical technologies and knowledge, the hospital stays became shorter, and the patients with acute illness were able to be discharged quicker and sicker. These were all associated with fiscal implications, and these all culminated into downsizing of the hospital beds and personnel. However, the focus of care shifted from hospitals to the community where the care delivery could be care at home (Hayes, 1985). When this role developed, this practice role was thus designed to provide leadership, support, and representation to improve the healthcare status of the general population in the community. This did not only look for advancement of independent nursing practice, the main aim of such care delivery pattern was to improve access to healthcare. Since much of the work involved care at the community levels, one of the prime responsibilities was to also implement care that would be congruent with the policy. Therefore, there is a need for monitoring and making recommendations on the policy and positions. It is important to understand that with the level of awareness increasing in the population and healthcare authorities, the nursing would need to be aware about the practitioner role (Gardner et al., 2006). However, it is to be kept in mind that today's nurse practitioner role has evolved over time based on the needs, and these needs were dictated by the social and political environments prevalent over changing time. They can now examine patients and refer these patients as necessary to other healthcare professionals. They can prescribe medications and can even order diagnostic investigations. Their work roles obviously are grounded in the basic values of nursing profession in general. The knowledge, theory, and practice emanate from the social and political need to complement prevalent health care delivery through conventional professionals (ANMC). The ANMC, a major stake holder quite appropriately contends that the "scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorised to practice" (ANMC, 2006). The government is another stakeholder. When the policymakers investigated the gap in the healthcare delivery at the primary level, they were stuck with the scarce availability of physicians who were originally entitled to cater the care (ANMC, 2004). The Productivity Commission enquired into the Australian Health Workforce to find that nurses have immense capacity which mostly was underutilised. There were evident political reasons for that. The hierarchy of traditional doctor-nurse relationship would foster that if government would have promoted traditional roles (Australian Government, Productivity Commission 2006). Evidence indicates that nurse practitioners if trained appropriately may serve better than the doctors even in specialties that need high level of skills such as neonatology. Studies have proved this point over and over again. As indicated by Hall and Wilkinson (2005), the other stake holders relevant to the workplace social atmosphere are the physicians, who still keep considering this role evolution of the nurses as independent practitioners to be unnecessary and risky. However, studies show that nurse practitioners should be treated like junior doctors and would need support, intensive input, and continuing guidance from the consultants to play their roles adeptly. This would help the nurse practitioners to develop their competence and confidence (Hall and Wilkinson, 2005). Although practice nurses are now in vogue and they continue to perform well in their advanced roles, the major stakeholders in this process tend to keep this evolution slow. As a result the development of autonomous practice of the practice nurses has been slow in comparison to other developed countries in the world (Queensland University of Technology, 2008). Where in other countries, nurses of this category could demonstrate leadership abilities and could even participate in large interdisciplinary collaborative care processes with effectiveness and efficiency, the political leaders are still doubtful. The public and policy makers still constantly compare this model to the traditional care model from the contexts of safety and acceptability by the users (Truscott, 2007). While the need for evaluation of implemented care model by practice nurses is not to be ignored, perhaps it is time that all mental barriers of this care delivery structure should be abolished by active governmental, policy, and social interventions so this role of the nurses may flourish (Middleton et al., 2007). There is an inappropriate projection of the fact that nurses as practice nurses may perform as good as or even better than doctors in many studies. This adds to the exaltation of the practice nurses as stakeholders. Indeed there is truth that the patient care outcomes achieved by the practice nurses may be at par with the primary care physicians, but it must be remembered that this fact does not directly cause an increased malleability of the professional boundaries (Laurant et al., 2008). Actually a myriad of external forces such as political, social, economic, and cultural ones influenced the development of nurse practitioner roles. Different stakeholders interpreted these factors in different manners. Since these practice nurses cater to different specialties, each of these groups of nurses and their roles have evolved in different manners based on the variability of circumstances, although the basic driving forces remained the concerns for the patients, community, and humanity (Schober & Affara, 2006). In the Australian context, there are about 300 authorised practitioners across multiple specialties. The importance of the influence of political factors in nurse practitioner role development would be evident from the fact that more than 50% of these nurses are not employed in nurse practitioner positions. This has been attributed to the organizational difficulties in implementing these positions. These impediments are due to lack of awareness and understanding by the decision makers. Many health disciplines fail to understand the importance and utility of this role. The term independent nurse practitioner does not mean that the nurse practitioners are stand alone practitioner, but with this, the very idea of autonomous practice of a nurse practitioner within a multidisciplinary team is jeopardized (Turner et al., 2007). Conclusion The evolving roles of nurse practitioners in Australia have been influenced enormously by the social and political factors. The identified social factors are changing needs of patients and consumer expectations. Fiscal pressures and evolving technologies changed the tradition of medical care, and this led to a shift of care scenario from the hospitals to the community. At the same time, there had been a growth of patient advocacy and changing attitude about the role of the nurses. Simultaneous changes in the academic perspectives led to the changes in the academic accomplishments of the patients. The socio-political changes in the nursing education changed the face of nursing since it was being increasingly evident that the new generation of nurses equipped with critical thinking, clinical reasoning, and system evaluation skills can really accommodate better with the changing patterns and need of practice. These changes led to identification of competencies and the core and relevant areas of specialisation where they can deliver independent and sufficient level of effective care which may be accepted by people. However, it needs to be remembered that implementation of practice nursing care roles had developed within social settings while being guided by political needs. Therefore, it is quite possible that these roles and their evolution will remain dynamic with changes in these parameters, and in future changing needs of the population and society, advances in healthcare, and regulatory and social pressures will dictate further evolution of these roles, but their acceptability can be partly influenced by the grade of competency with which the practice nurses fulfill their roles. Reference Australian Government, Productivity Commission (2006). Australia’s Health Workforce Research Report http://www.pc.gov.au/study/healthworkforce/finalreport/index.html) accessed on November 5, 2009 Australian Medical Association. (2005). 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A discourse analysis of the introduction of Nurse Practitioners in rural and remote Australia. J Adv Nurs. 59(1):38-46. Read More