The Advanced Practice Nurse - Essay Example

Introduction The evolvement of the advanced practice nurse (APN) has been one of the greatest developments in the discipline of nursing. Advanced practice nurses (APNs) are experts when it comes to providing care to patients. They integrate current and comprehensive advanced knowledge into the clinical practice to provide evidence-based or theory-driven care. They act as leaders and change agents in provision of evidence-based nursing care in their area of expertise. To enhance our understanding of the APA role and its contribution to healthcare, we will find out what APNs say regarding the nature of their work and examine both the outcome and descriptive research related to APN practice (Carberry and Fleming 2009). APN has grand access and perceptive of how a specific illness is experienced at the individual level and how the illness is perceived from the health and pathophysiological viewpoint. For example, in pain management, APN applies advanced knowledge of neurobiological methods of pain management, pharmacological and corresponding psychoanalysis to lessen the pain of patients with severe, terminal and cancer pain. APN also conducts an in-depth physical assessment to accurately diagnosis a particular disease and offer appropriate prescription. This includes collecting information from a range of sources, analyzing results from the laboratory and investigating the diversity of patterns that develop from the interaction of a collection of biopsychosicial factors. There has been development of advanced assessment tools ensure accurate physical assessment of the disease. Medication monitoring and prescribing is another component of the expert care provided by APN in disease and symptom management (Caldwell 2006). Risk identification and health and welfare promotion has been another role of APN. For example, in most chronic care settings, the APN identifies the patients who are at the highest risk and require high-resource utilization within 24 hours of admission. The APN considers the following factors when identifying the patients who are at high risk; age, severity of disease, clinical diagnosis, and history of frequent admissions, fixed financial resources, lack psychosocial support, cognitive deficit and inability to cope with the disease (Dawes 2005). The other critical component of APN clinical practice is coordination of care of complex and vulnerable population by organizing, coordinating services and facilitating communication among interdisciplinary team members. The APN also promotes a family-centered care and services to bring about cooperation between the patient/family and team members. For example, the APN ensures a coordinated, devoted and comprehensive approach to care and encourages open lines of communication between all disciplines in cases when the patients/families are struggling with end-of-live decisions (Hamric 2005). The APN also advocates fro the importance of family members assuming care giving roles fro their patients. To support this, they assess the needs for family members’ care giving roles and teach them how to take care of their patients. An important element of coordination of care is the facilitation of patients and families in the course of care to guarantee “faultless” provision of care (Wilson 2005). Apart from facilitating system access and identifying patients at high risks, APN also carry out case management. In case management, the APNs utilize their medical knowledge to appraise, supervise, communally plan and synchronize health care services to counter the personalized requirements of the versatile patients and families care. As a case manager, the APN centers on health renovation and maintenance that accentuates the significance of empowering patients and families to utilize self care management. The APN employs interdisciplinary and interagency cooperation in case management (Thomson 2007). The APN also carry out outcomes management to coordinate care to manage complex and vulnerable populations. In the outcome management structure, the APN acts as an “attending nurse” for a population of patients by ensuring interdisciplinary care delivery and outcomes measurement. APN is also involve in discharge planning for patients which is aimed at preparing the patients and their families for the subsequently stage of care and helps in making arrangements for that transition. The APN also coordinate care by offering direct neighborhood follow-up by conducting home visits and telephone management. This has contributed to early discharges from the acute care setting preventing overcrowding of patients in the wards (Maria 2009). Clinical practice focused on educating and promoting interdisciplinary staff has been described in most literatures as another feature of the APN practice. The most critical elements of this substantive area of the APN practice are education, cooperation and consultation. APN plan, execute and assess teaching-learning skills and knowledge for the staff nurse and other members of the interdisciplinary team. The different teaching-learning approaches used by the APN include official classes and presentations, relaxed bedside education, competency-based orientation programs, teaching in circles and patient care conferences. The APN also uses mentoring, role modeling and preceptorship to educate recruit nurses (Running 2006). To bridge the gap between knowledge and practice in order to support clinical expertise of staff in meeting patients’ and families’ needs, the APN performs case consultation. In this way, the expertise of the APN is maximized and the other employees are helped to acquire new perspectives and strategies such as caring for patients with complex wounds, disruptive behavior, persistent pain and mental health problems (Levin and Feldman 2006). Advanced practice nurses also uses administrative consultation in their clinical practice. In this case, the nurse mangers solicit the professional assistance of APN in solving problems as regards achieving the organization set goals and objectives. In administrative consultation, the APN help in arranging meeting for employees to communicate which include notifying them of important organizational changes, help in conflict resolution among employees and evaluating and making recommendations as regards purchasing products like specialty beds, exposure prone operation equipments and clinical computer systems (Department of Health 2008). Advanced practice nurses also works together with other nurses and disciplines in their clinical practice. They regularly cooperate with nurse managers to provide opportunities and an environment for the employees to meet professional needs and goals. The APN and the nurse manager collaborate to eliminate obstacles, offer guidance and promote professional development of employees. Other joint APN-nurse manger responsibilities include financial planning, employment, maintenance, development of employees and evaluation of employees. The APN also collaborate with researchers from other disciplines during their research process. In this way, advanced practice nurses generates ideas for the study, offer access to patient/family population, acquire political skills and knowledge which can help the research team and incorporate the research finding into practice. APNs have also begun writing about collaborative models with university institutions to teach nurses at both the undergraduate and graduate levels (Malloch and Porter-O’Grady2006). Advanced practice nurses also play a critical role in promoting change and innovation to ensure optimum delivery of patient care across the field of healthcare. APNs have been actively involved in planning, executing and evaluating new programs to satisfy the needs of patients, families, society, nurses and organization. Examples of these programs are pain management program and disease management such as management of heart failure, hypertension and diabetes (Pearson 2007). APNs have also been active in practice change at the organizational level through initiating modern models of nursing practice and patient care. Advanced practice nurse practice models and those directed towards improving quality of patient care in a variety of setting have been initiated and executed. Apart from launching nursing models of research utilization and evidenced-based practice nursing, the APNs have cultivated a climate within the clinical setting that values research in their efforts to integrate research into practice (Mirr and Zwygart-Stauffacher 2006). Advanced practice nurses have also been responsible for the development of research-based protocols, clinical pathways, guidelines and policies in their institution. For example, APNs have advocated for policies changes as regards physical assessment and treatment of pain. They have also advocated for policy changes as regards visitation and involvement of families in patient care. This has seen families given the option of being present when their patient is undergoing an exposure prone operation (ICN 2005). APNs have also being involved in promoting quality delivery of patient care. As a result, they have developed indicators and methods to measure patients’ care satisfaction. APNs predict, make out and prioritize areas of nursing practice which need to be improved and are accountable for instigating unit-based quality improvement studies to ensure quality care delivery. For example, they have initiated studies directed towards improving outcomes for patients receiving analgesia and patients with nosocomial infections (Dicenso 2005). Despite all these development and improvement in the role of advance practice nurse, there are various challenges which impact negatively on quality care delivery. They include role ambiguity and confusion, lack of understanding about the work of the APN by other nurses, healthcare professionals, administrators and consumers. The fact that much of the work of the APN is done “behind the scene” of direct patient care may have contributed to the lack of clarity of the APN role (Mantzoukas and Watkinson 2006). The increased role diversity has led to increase anonymity, which has seen many APNs shift from direct expert care provision to meet other role requirements. The APN hence need to find creative ways to interact directly with patients and families and to act as role models for the other nurses and members of the interdisciplinary team specialized expert nursing care, even when their work takes them away from the bedside and despite the many facets and challenges of their role. Marketing has been recommended in most literature as being the best tool for promoting the APN role and value. Improved direct interaction with patients and families is an easy and vital element of patient care but has been ignored as a marketing strategy which can lead to better understanding of the APN role, especially by consumers. Provision of direct expert advanced nursing care is compensated by insurers. There is no compensation mechanism for indirect advanced nursing care. As a result, APNs who do not spend much of their time providing direct expert care are perceived as fiscal liabilities by a number of administrators. This has led to incessant arguments among APNs in their efforts to demonstrate their value in the organization. As patient insight increases, hospital patients’ length of stay reduces and scientific knowledge needed for safe nursing care grows, it is also imperative to provide bedside leadership. Critiques of APN role argue that the expert direct care provided by APNs do not differ from that of registered nurses who have not done a masters degree in nursing, although there are well thought-out as expert practitioners. Hence, APNs must continue to define their role as expert direct care providers and reassume a direct leadership role at the bedside (Weaver 2005). Despite the fact that outcome information has been discussed in most articles, only a few have included data-based data. There has also been limited use of rigorous research designs, both quantitative and qualitative, to understand the role of APN and the impact of APN practice on patient outcomes and costs of care. It is important to find out how and where information regarding APN practice and outcomes is distributed (Latter 2007). There are few articles related to nursing administration, where as most papers presentations about APN practice and outcomes can only be found in annual national conferences. To market the unique contribution of APNs in improving clinical and fiscal outcomes of patients, families and communities, it is important to disseminate knowledge regarding APN practice to a broader audience, including health care administrators, other healthcare professional and the community (Jones 2005). Despite the fact that the flexibility of the APN practice has been associated with role ambiguity and improper utilization of the APN expertise, it has enabled APNs to react to the changing healthcare environments. APN role has been created to meet the ever rising multifaceted needs of patients and the societal healthcare needs. Increase APN role diversity has made it difficult for educators to formulate APN curricula than can train students effectively with the competencies required to take such complex role. Apart from the advanced knowledge associated with specialty populations, it is critical to develop an understanding of the organization, the system and change, as well as developing communication theories “connected” to collaboration and consultation (Furlong and Smith (2005). It is also imperative to understand the research process and to apply it in different ways such as quality improvement and evidence-based practice in the clinical setting. Soon we will see a situation whereby master’s nursing education is completely replaced by a doctorate nursing education as most universities across the country are planning for and some have even executed doctorate nursing programs (Schober and Affare 2006). Conclusion and recommendations APNs have a comprehensible theoretical foundation for their practice as discussed in literature and must therefore keep on describing this scope of practice to organizations, managers, nurses and other healthcare experts and clients. The basic role of APNs involves managing the care of the versatile and susceptible populace of patients and families through expert direct care, coordination of care and collaboration. The APNs have faced numerous efforts in their efforts to provide quality care which includes lack of role clarity, few research designs to help in understanding the role of APN and the impact of APN practice on patient outcomes and costs of care, lack of understanding of the role of APN by other nurses, healthcare professionals, administrators and consumers, lack reimbursement for indirect patient care and increased role diversity. Despite these challenges, the APNs have succeeded in providing evidence-based care to patients (LoBiondo-Wood and Haber 2006). The clinical resource nurses should consider developing a standardized approach to patient care from interdisciplinary perspective. Research studies have shown that an interdisciplinary approach can lead to delivery of quality patient care. Clinical resource nurses need to use their leadership skills to create resourceful, goal-oriented alliances across a array of disciplines. To do this the clinical resource nurse need to practice connective leadership. This is leadership that connects persons resourcefully to their duties and missions, to each other, to the group and the community. The clinical resource nurse should ensure effective communication and conflict resolution to enhance a cohesive interdisciplinary team. Recommendations are hereby made for further research in APN clinical practice focusing mainly on explicating the elements of the direct expert practice role of the APN. For example, such studies must tell us how the direct expert care given by APN differs from that given by registered nurses who have not done a master’s degree. It is also important to find out how the APN combine the different “substantive areas” as discussed above in their daily work. APNs must also use rigorous research designed studies to validate they have shifted from expert direct care to indirect care features of the APN responsibility such as staff training and change agency. For example, APNs should be able to tell us whether educational strategies for staff lead to improved outcomes for patients and families (Burns and Grove 2005). Reference Burns N. and Grove S. (2005). The practice of nursing research: conduct, critique and utilization. Elsevier Sanders, St. Louis. Caldwell K. et al. (2006). Getting ready for practice: how well are advanced practice nurses ready for collaboration? British Journal of Nursing, 15(22): 1250-1254 Carberry M. and Fleming B. (2009). Developing an advanced practice essential care role to help the interdisciplinary team. University of the West of Scotland, Hamilton. Dawes M. (2005) Evidence-Based Practice: An introduction to Health Care Professionals. 2nd ed. Edinburgh: Churchill Livingstone. Department of Health (2008). The National Education and Competence Strategy for Advanced Medical Care Practitioners. London: DH. Dicenso A. et al. (2005) Evidence-Based treatment: A Guide to medical Practice. Elsevier Sanders, St. Louis. Furlong E. and Smith R., (2005). Advanced nursing practice: guidelines, learning and role improvement. Journal of clinical nursing, 14(9), 1059. Hamric A. et al (2005). Advanced practice treatment: An incorporated strategy (3rd ed). St Louis: Elsevier Saunders. ICN (2005) The Scope of practice, standards and competencies of the advanced practice nurse. Reviewing papers and the peer review process. Nurse Education in Practice, 2; 71-72. Jones M. (2005) Role improvement and effectual practice in specialist and advanced practice roles in severe hospitals settings: A logical review and meta-synthesis. Journal of Advanced Nursing, 49(2): 191-209. Latter S. (2007). Evaluating Competencies and Standards in Advanced Medical Practitioner. Journal of research in Health care 12: 70-26. Levin R. and Feldman H.R. (2006) Training Evidence-Based Practice in Nursing: A Manual for educational and Clinical Settings. New York; Springer Publishing. LoBiondo-Wood G. and Haber J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis, Missouri: Mosby Elsevier. Malloch K. and Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and healthcare. Boston, MA. Jones & Bartlett. Malloch K. and Porter-O’Grady, T. (2006). Standards for Evidence-based Practice for Nursing and Health Care. Boston: Jones & Bartlett Malloch K. and Porter-O’Grady, T. (2005) A premier to Evidence-Based Practice in Nursing and Health Care. Jones and Bartlett. Mantzoukas S. and Watkinson S. (2006). Evaluation of advanced nursing practice: the global literature and developing the generic features. Journal of Clinical Setting, 16: 28-37. Maria P. (2009). Evidence-based nursing: An introduction. Journal of Inter-professional care, 23(3): 314. Mirr Jansen M. and Zwygart-Stauffacher M. (2006) Advanced practice Nursing: Core Concepts for professional Role Development (3rd ed). New York; Springer Publishing Company. Pearson A. et al. (2007) Evidence-based Clinical Practice in Nursing and Healthcare: Assimilating Research, Experience and Expertise. Blackwell, Oxford. Running A. (2006). Prescriptive Patterns of medical Practitioner. Journal for the American Academy for Medical Practitioners.  Schober M and Affare F. (2006). International Council of Nurses: Advanced Nursing Practice. Oxford: Blackwell Publishing. Thomson S. (2007). Nurse-physician collaboration: A comparison of the attitudes of nurses and physicians. Med-Surg Nursing, 16(2), 87-93. Weaver CA. et al. (2005). Bedside, classroom and bench: Collaborative strategies to generate evidence-based knowledge for nursing practice. Journal of Medical Information, 7(3):2126–2137. Wilson K. et al (2005). Nurse Practitioners’ knowledge of working Cooperatively with General Practitioners and related Health Professionals in New South Wales, Australia. Australian Journal of Advanced Nursing, 23(2): 22-27. Read More