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This paper will give an overview on the history and role development of Advanced Practice Nurse: Nurse Anesthetist (CRNA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), and the Nurse Executive (CNO). Focus is placed on evolution of…
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Societal Benchmark in Advanced Practice Nursing
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Societal Trends in Nursing and Patient Education Angelique Harris Grand Canyon Nursing Education Seminar I NUR-647E Katie Lemke August 29,2012
Abstract
This paper will give an overview on the history and role development of Advanced Practice Nurse: Nurse Anesthetist (CRNA), Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse Midwife (CNM), and the Nurse Executive (CNO). Focus is placed on evolution of Advanced Practice Nursing. Advanced Practice Nursing has historical relevance that has affected nursing and nursing education.

Societal Trends in Nursing and Patient Education
The evolution and role development of Advanced Practice Nurse (APN) undoubtedly produced a huge influence on the Healthcare system in a very positive way. It remains a general consensus that the real credit for the evolution and practical implementation of APN History of Advanced Practice Nurse goes to the American Civil War 1861. That was when the APN implementation began processing and started developing (Keeling & Biglee, 2009). However, CRNA did not get introduced easily and the process did not go smooth because certain barriers regarding legislation cropped up during the early 1900’s. The nursing staff everywhere was not easily granted rights to administer anesthesia because such rights were questioned by the medical profession. People in the medical profession objected on grounds that the concept of nurses administering anesthesia would imply that they are practicing out of their scope which would not present a very nice image (Keeling & Biglee, 2009). Therefore, legislation in Kentucky (Frank VS South) nurses needed to be licensed to administer anesthesia. With time, things started developing and in 1931 foundation for the American Association of Nurse Anesthetist (AANA) was laid and 1945 the mandatory certification for CNRA’s got established which changed circumstances phenomenally (Ray, 2005). Other factors also assisted in the development like there were no professional nurses at that time and catholic sisters served as nurses. Also during the 20th century, the increase in immigration and trends toward industrialization and urbanization contributed significantly in refining the image of APN role in the healthcare system with the result that other nursing specialties emerged.
The approach of the Nurse Practitioner was such that primary care was provided to the poverty stricken immigrants during World War II so that more worthwhile opportunities got revealed to benefit NP (Keeling & Biglee, 2009). This approach proved to be effective as when physicians had too much on their plates and were too busy to care for all the wounded, the NPs were granted the right to go beyond the realm of caring and handle other things also like advancing on to the role of “curing” which was something definitely new in the healthcare system. When physicians had the time however, the NPs were automatically supposed to step back into the traditional supportive role (Spross & Lawson, 2005).
In 1800’s the history of clinical nurse specialist took another giant leap and great focus was laid on the care and management of the psychiatric patient with emphasis placed on “Moral Treatment.” However, it is suggested that it was not until 1960’s that the role of CNS took a more vibrant and significant turn (Ray, 2005).
In the late 1800’s to early 1900’s it was midwives rather than nurses who assisted with child-birthing process, In 1910 nurse midwives had to become licensed to continue practicing and laws granted midwifery recognition as a profession (Keeling & Biglee, 2009). In the mid 1920’s a class distinction for the use of midwives developed with the upper class using obstetrics and delivering babies in the hospital and leaving midwifery to the poor, in 1941 the American Association for Nurse Midwives was erected (Ray, 2005).
In the 21st century the role of the CNRA is no longer considered a “Subordinate” role, because CRNA works along an anesthesiologist they collaborate responsibilities and independence, Joint Commission has mandated all hospitals have pain management systems in place (Spross & Lawson, 2005). From Inception to present day the advancement of advance nurse practice has greatly improved, the role has largely expanded, most academic centers, emergency rooms, Intensive care are all employing NP’s to help in patient work load. The role of the CNS has expanded as evidenced by the number of nurses currently practicing in this capacity in 1995 estimated 40,000 practicing in the United States. Today’s estimation is 80,000 (Sullivan-Marx, McGovern, Fairman, & Greenberg, 2010).
The role of the CMN relate less to actual clinical role and more to actual clinical role and more to credentialing of the role, according to “American Journal of Maternal/Child Nursing 2001” midwives do not want their roles considered as (APN) Advance Practice Nurse because they fear this title will require them to get a Master’s Degree (Ray, 2005).
Today’s NE is accountable for positive outcomes, todays NE is Graduate prepared nurse who holds responsibility for overseeing all aspects of nursing services and assures the environment of care that is optimal quality care, promotes interdisciplinary approach that maximizes positive patient outcomes, the role of the NE works effectively with other organizational executives (Ray, 2005).
Nurse Practitioners play a major role in participation based health promotion and disease management, the efforts of APN’s and their professional organizations to demonstrate their unique contributions to standardize preparation and scope of practice makes this an ideal moment to consider the history, current developments, and future possibilities (Sullivan-Marx et al., 2010). Efforts to advance health care reform and take its rightful place in the policy debate and implementation of reform was recognized by President Barack Obama in his July 15, 2009 remarks thanking nurse leaders for their role in the debate and support of change (Sullivan-Marx et al., 2010). The profession has over time heavily relied on the education strategies to boost its legitimacy rather than practice, NP’s are central to the functions of the health care system and their history shows their great adaptability and flexibility to meet the health care needs of the nation (Sullivan-Marx et al., 2010).
The United States has a shortage of primary care physicians especially in rural areas, NP’s are ready to step in many states are considering ways to permit NP’s to function with fewer restrictions. The NP”s scope of practice is governed by state laws and regulations that differ in their requirements for physician supervision and prescriptive authority; there are 22 states where APRN’s can practice without physician oversight and 12 states that permit them to prescribe without restrictions (Ray, 2005). In June 2010 President Barack Obama addressed the House of Delegates of the American Nurses Association to announce a number of investments to expand the primary care workforce “These included increased funding” for NP students and for nurse and NP run clinics (Sullivan-Marx et al., 2010).


References
Hamric, A. B., Spross, J. A., & Hanson, C. M. (2010). Advanced Practice Nursing: An integrated approach. (3rd Ed.). Retrieved from St. Louis MO.
Keeling, A. W., & Biglee, J. (2009). The History of Advanced Practice in Nursing in the United States. (3rd Ed.). Retrieved from Elsevier Saunders. St. Louis MO.
Ray, G. L. (2005). Advanced Practice Nursing (APN). Nursing Education, (). Retrieved from http://www.dynamicnursingeducation.com
Spross, J. A., & Lawson, T. (2005). Conceptualizations of Advanced Nursing Practice. .
Sullivan-Marx, E., McGovern, D., Fairman, J., & Greenberg, S. (2010). Nurse Practitioners the Evolution and Future of Advanced Practice. (5th Ed.). Retrieved from Springer Publishing Company, LLC. Read More
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