The Concept of Advanced Nursing Practice - Literature review Example

Heading: Advanced Nursing Practice Your name: Course name: Professors’ name: Date Introduction Clearly, there is an evolving society and health needs, today. Consequently, healthcare in Australia experiences several challenges, which including professional shortages, high costs, aging population, new technology, and inaccessibility to healthcare. The need for innovative and collaborative clinical practitioners to serve as leaders in healthcare system is growing stronger as compared to the past. Advanced nursing practice nurses are well placed to handle development of healthcare. Specifically, advanced nursing practice plays a vital role in the satisfaction of the Australians’ health needs through the development of the nursing profession, advancement of nursing knowledge, contribution to an effective and sustainable healthcare plan. This paper intends to explore the concept of advanced nursing practice, and its cost-effective and holistic nature. It also aims at exploring the concept’s ability to enhance the patients’ continuity of life. International APN roles’ context In the past decade, several countries experienced an increase in the types and numbers of new APN roles including advanced practice case managers, acute care nurse practitioners, and clinical nurse specialists, or nurse practitioners. Latest APN roles have taken place mostly in acute care environments. There are high expectations for further increase in the need for APN in the 21st century, with the extension of the roles in community and ambulatory environments. In spite of the demand for the higher nursing level, there are several issues affecting the effective execution of APN roles. Prelude outcomes of a global survey of the roles demonstrate variability in regulatory and legislative approaches, titling, prescriptive, role autonomy, educational preparation, role functions, and degree to which the assessment of the roles happened. Therefore, it is inexplicit which roles really mirror advanced practice (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). APN roles may be designed to handle dynamic and complex system demands and needs for flexible delivery of services. Whereas inconsistency among APN duties is desirable and expected, constancy in integral features is instrumental for the occurrence for advanced nursing practice. Nevertheless, in the nursing profession, there is uncertainty on term used in describing APN roles. The terms advanced practice nursing, and advanced nursing practice are applied interchangeably. This difference amid the two terms is essential in the definition and development the full possibility of the roles (McGee, 2009). Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004) assert that advanced nursing practice entails what nurses undertake in their roles. The concept does not have one definition, but there is consent extending to conventional boundary of nursing, which involves highly independent practice that fully utilizes the nursing knowledge, and adds to the profession’s development. An intrinsic advanced nursing practice function is the change agent, which engages consultation and collaboration with healthcare decision makers and providers. Advanced practice is seen as another concept that refers to the advance nursing practice, and is different from advanced clinical practice, which entails the provision of clinical care to clients. According to McGee (2009), several models agree that clinical practice concerns the basic emphasis of advanced nursing practice. Advanced nursing practice involves other role areas widely associated with research, education, organizational leadership, and professional development. The definitions of these role domains differ among the models of advance nursing practice. There are four incorporated sub-roles associated with indirect and direct expert education, practice, consultation, and research for consultant nurse and advanced practitioner. Skills and knowledge relating to collaboration, transformational leadership, as well as organizational development were necessary in the implementation of the sub-roles. To start with, the Synergy model recognizes eight areas of the clinical nurse specialists’ practice. These domains include clinical inquiry, clinical judgment, collaboration, learning and teaching, moral agency and advocacy, systems thinking, caring practices, and reaction to diversity effect on three specialties of effect, including nursing, family, patient, and health systems. Secondly, the Strong Model explains five areas or acute care nurse practitioner roles, which include systems support, education, direct complete care, research, professional leadership, and publication. Particular features of role areas reflect practitioners, patient, academic, and systems demands distinct to practice environments (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). Role focus on physician support or replacement The initiation of APN roles is featured by a focus on physician support or replacement instead of health-focused, patient-centered, holistic course to practice, which is complementary to current care delivery models. A nursing course to practice is also vital for the development of confidence in the nursing knowledge and skills. When the basic APN roles focus is not described with respect of health needs, as explained in advanced nursing practice models, the nursing aspects of the duties can get less visible and valued. Study evaluating APN roles As Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004) says, evaluation researches that the value-added element of APN roles expands past the medical functions transfer. In the case of primary care, meta-analyses show that physicians and nurse practitioners offer equivalent care in relation to the diagnostic accuracy and assessment, and attain the same health results. Nonetheless, care by nurse practitioner was related to enhanced patient fulfillment, as well as care quality associated with patient communication, education, and documentation. Regarding the acute care, there are many studies have assessed the effect of Transition Model, whereby advanced practice nurses offer continuous care between hospital and home. High-risk neonatal, obstetrics, older patients randomized to APN care had minimized hospital time of stay, lowered healthcare costs, lower re-admission rates, enhanced behaviors of health promotions, and higher satisfaction with care as compared to those achieving standard care. In oncology, Bryant-Lukosius, DiCenso, Browne, & Pinelli (2004) says that women who recently had breast cancer randomized to advanced practice nursing care enhanced life quality as compared to those attaining standard care. Patients obtaining APN care for managing breathlessness associated with advanced lung cancer attained independently tailored, multidimensional, and holistic strategies to enhance physical function, endure reduced lung capacity, and adjust to psychological and disability distress. In comparison with patients randomized to conventionalized supportive care, the APN group patients indicated physical signs, improved performance status, and decreased breathlessness. These studies recommend that the value-added APN roles’ element entails a nursing course to practice featured by holistic, integrated, coordinated, and patent-oriented care meant to exploit life quality, health, and functional ability. notably, opportunities for enhanced healthcare and patient care systems, and innovation results happen when the initiation of APN roles symbolize a complementary contribution to the care model, instead of role functions transfer between healthcare providers (Fitzpatrick & Wallace, 2006). Advance Nursing Practice According to Delamaire and Lafortune (2010), advanced nursing practice (APN) entails an umbrella word that describes a higher clinical nursing practice stage, which capitalizes the application of graduate nursing expertise and knowledge in satisfying the health needs of families, individuals, groups, populations, and communities. This also concerns the analysis and synthesis of understanding, knowledge, interpretation, and application of nursing research, development, and theory, that is the development and advancement of nursing knowledge, as well as the profession at large. As Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004) assert, APN symbolizes the future edge for professional development and nursing practice. It is an approach of looking at the world, which allows questioning of present practices, enhanced delivery of health and nursing care services, as well as development of modern nursing knowledge. Thus, continued advancement of APN is of prime importance of for the professional nursing and society. In terms of the advancement concept, three features differentiate APN from the primary nursing practice. These include provision or specialization of care for particular populations of patients with unpredictable, complex, and exhaustive health needs, acquisition, and expansion of modern skills and knowledge, and role independence expanding beyond conventional limits of nursing practice, and development that includes expansion and specialization (Fitzpatrick & Wallace, 2006). Advancement refers incorporation of research-based, theoretical, and practical knowledge, which happens as a graduate nursing education component. Some of its implicit features include orientation to practice, innovation, and synthesis of skills and knowledge. Innovation entails professional activity, which boosts development of modern nursing knowledge, or enhances nursing care. Professional activities involve improving the nursing role in modern models of delivery of care, assessing nursing interventions, facilitating reform in the healthcare practices and policies. Advancement or innovation of nursing practice cannot happen without dedication to the essential professional values. These values include a nursing orientation to practice, which is health-focused, patient-centered, and holistic (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). Advancement entails purposeful actions to enhance patient health via incorporation of skills and knowledge associated with clinical practice, research, education, professional growth, and organization leadership. The incorporation of role areas refers to mixture of competencies. The capacity to synthesize and use this breadth and depth of knowledge recommends that advancement entail more than skill, which is grown by experience, and needs high degrees of critical thinking and scrutiny (McGee, 2009). Additionally, advancement also takes place when APN role areas work synergistically in order to give a whole, which is superior to the total of its components (Hamric, 2000). Thus, advanced clinical practice cannot happen in isolation from other role areas. Notably, the attainment of specialty or extended clinical skills and knowledge does not indicate advanced practice except when clinical practice guides and directed by activities and knowledge of other role areas in order to enhance patient care. Thus, roles expanding past conventional scopes of nursing practice, but designed only to promote clinical care, signify extended but not APN (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). According to Styles and Lewis (2000), APN field is a pyramid. They further say that at the base, the field has environmental variables, which support purpose or apex of the APN roles. Here, APN comprises of more than APN, as it involves a wide range of APN roles, environmental variables influencing nature and practice of the APN roles, settings in which APN roles interact and exist, structures and resources facilitating the occurrence of APN. In some countries where regulatory mechanisms, legislation, and safeguarded title for nurse midwives, nurse specialists, nurse practitioners, and nurse anesthetists exist, it is easy to distinguish APN roles. Nevertheless, most countries lack protected title, and no global consent on the application of the titles in distinguishing APN roles. Role confusion happens when a similar title, such as, nurse specialists is used to various roles with distinct functions, educational training, and limits of practice. Role competencies entailing areas of APN associated with clinical practice, research, education, professional development, and organizational leadership are good signs of APN roles as compared to role titles only. There is a rising consent that a combination of graduate education and practice experience is needed for APN roles (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). It is worth noting that several environmental influence the growth, execution, and assessment of APN roles, which include culture, local conditions, healthcare system, nursing profession, government, and APN community (Styles & Lewis, 2000). Here, local conditions entail work environment, employer’s culture, structures, and domestic health care system. Organizational structures include policies, contracts, procedures, and policies that support and define role autonomy, role accountabilities and responsibilities, support role independence, and workload and schedules, give compensation strategies, file support and resources provision, and ease collaboration, transfer and discussion with medical care providers (Delamaire & Lafortune, 2010). The acceptability, development, and need for APN roles are motivated by societal expectations, values, nursing needs, and healthcare services. The roles of nurse practitioner have grown in reaction to health needs in rural, under-serviced, and remote populations. The healthcare system affects APN roles via fluctuations in the demand and supply of healthcare providers, latest practice trends, as well as economic pressures influencing the healthcare services delivery. Additionally, competition among care providers for limited healthcare resources influences the initiation and compensation of APN roles (Jansen, 2010). Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004) argue that government priorities on healthcare affect the growth of Latest APN roles of via allotment of policies and funds that need reforms in the delivery of healthcare. The nursing profession is in charge for explaining APN roles, determining standards for education and practice, and controlling and monitoring APN to ensure effectiveness, safety, and quality of practice. The APN legitimacy is established by the profession’s aid of prerequisite for advanced practice, such as, graduate education, certification, and licensure for specialty-based practice and is reliant on research to rationalize the need, file the effectiveness, and enhance the growth of APN roles. The definition and clarification of APN roles in and outside to the profession is significant for role constancy and advancing the efficient application of APN roles. Role development also relies on the nursing profession’s power in lobbying for regulations and laws that sustain APN. The APN community entails educational institutions, advanced practice nurses, social networks, and specialty organizations, which influence the development of APN role (Styles & Lewis, 2000). Characteristics of APN Delamaire and Lafortune (2010) say that APN nurses develop their expertise in an area of expertise, incorporating and continually showing the following characteristics and features. To start with, provision efficient and effective care, delivered with a high level of independence, to a recognized population. It also demonstrates leadership and introduction of change to enhance client system and organization results. Moreover, it involves intentional, purposeful, and incorporated application of in-depth research, knowledge, and clinical expertise, and incorporation of knowledge other domains. Additionally, APN entails breadth and depth of knowledge that involves a broad range of approaches to satisfy the clients’ needs and to enhance the accessibility to and care quality. Furthermore, NSW Government (2012) indicates that it has the capacity to describe and use the empirical, theoretical, experiential, and ethical nursing practice foundations. It also concerns the development, understanding, and distribution of evidence-based knowledge about nursing. In addition, APN focuses on the potential to introduce or take part in the planning, coordination, implementation, and evaluation of programs to satisfy patients’ needs and aid nursing practice. Notably, APN entails the utilization of knowledge-transfer methods to apply research-based information. What is more, APN involves the indication of advanced decision-making and judgment skills, as well as critical examination of, and effect on the health policy. Competencies Competencies involve are particular skills, knowledge, personal, and judgment attributes essentially registered nurse to conduct their roles ethically and safely in a designated setting and role. For APN, core competencies are founded on suitable breadth, depth, and variety of nursing knowledge research and theory, and improved by clinical practice. They encompass specialty lines exhibited by entire APNs. This structure differentiates competencies into four classes including clinical, leadership, research, collaboration, and consultation. Nevertheless, it is the successful and concurrent interaction, execution and blending of skills, knowledge, personal attributes, and judgment in a broad range of practice settings that features advanced nursing practice (Jansen & Zwygart-Stauffacher, 2010) In clinical competencies, the foundation of APN is proficiency in nursing specialized area. By integrated and holistic approach, the nurse works in collaboration with the patient and other medical team members to provide inclusive care. An APN incorporates extensive clinical practice with research, theory, and in-depth nursing and interconnected knowledge to establish multiple advanced intervention and assessment approaches in a patient-centered structure for individual patients, populations. APNs should also posses the ability to employ quantitative and qualitative data from several sources, often in complex and ambiguous situations, when formulating clinical decisions, introducing, and managing change. These nurses should also be able to examine the multifaceted interaction with psychological, physiological, sociological processes, health determinants, and patients’ life experience. Moreover, Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004) say that APNs must explain and anticipate the broad variety of client reactions to the real or possible health issues, and suggest actions. Such nurses ought to guide decision-making in multifaceted clinical situations. Additionally, they should also involve clients and other members of the team in settling matters at the organizational, individual, and levels of healthcare systems. They also recognize and evaluate patterns or trends that have health effects for families, individuals, communities, and groups. Besides, they undertake planning, initiating, coordinating, and conducting educational plans founded on the priorities, needs, and firm resources. What is more, APNs can generate and incorporate latest nursing knowledge, and set new care standards, policies, and programs. They also manage various patients’ reactions to real and prospective issues (Fitzpatrick & Wallace, 2006). With respect to research competencies, APN generate, synthesize, and use research findings. Here, nurses can recognize and implement research-based innovations for enhancing client care, systems, and organizations. They also assess present practice at system and individuals levels in relation research evidence. They also gather data and evaluate results to enhance their profession, and the health system. Regarding the leadership competencies, APNs act as change agents who continually effective latest ways to practice, in order to enhance healthcare delivery, shape their firms, and advantage the public to impact health policy. They advocate for families, individuals, communities, and groups. What is more, collaboration and consultation competencies enable APNs to collaborate and consult with colleagues workmates across other sectors and at the provincial, organizational, national, global level. They can initiate appropriate and timely referrals, consultation, collaborations with other healthcare practitioners (Jansen & Zwygart-Stauffacher, 2010). Categorizing advanced nurse roles in enhancing quality of life Nurse practitioners (NPs) According to Bryant-Lukosius, DiCenso, Browne, and Pinelli (2004), these entail registered nurses possessing graduate level preparation of nursing as a nurse practitioners at the doctoral or master’s level. These nurses accomplish complete assessments and enhance health as well as the hindrance of injury and illness. Moreover, these advanced practice NPs are responsible for the diagnosing; development of differential diagnoses; ordering, conducting, supervising, and interpreting laboratory and diagnostic tests; prescribing pharmacologic and non-pharmacologic therapies in expressly managing chronic and acute disease and illness. Additionally, the NPs offer medical and health care in acute, primary, lasting care settings. They can also specialize in various fields including geriatric, family, acute, or primary care. They also practice independently and in cooperation with other medical professionals in the effective treatment and management of clients’ health programs, as well as serving in different environments as consultants, researchers, and patient advocates for families, individuals, communities, and groups (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). NPs have conventionally been termed as primary care givers. Nevertheless, NPs are currently functioning in numerous setting, which include tertiary care, and in turn, specific examinations, and competencies have been put in place for NPs providing severe care. Notably, the NP movement started at the University of Colorado where Professors Loretta Ford and Henry Silver cooperated to initiate a post-baccalaureate program for preparation of nurses in extended roles in providing care for families and their children. These professors realized that nurses are capable of examining children’s health status, as well as defining the suitable nursing actions (Delamaire & Lafortune, 2010). The reason for the initial NP demonstration project was to execute modern roles to enhance efficacy, safety, and quality of care for families and children. Even though the project’s first spotlight was on families and children, the professors were confident that NPs could be trained to satisfy the health needs of community-dwelling people throughout their life span. The nurses in Colorado project obtained 4 months of rigorous informative training in which examination skills, growth, and development were stressed. They then finished a 20-month pre-empted clinical rotation in a community-based environment (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). Over these years, NPs have shown that they are capable of providing high-quality health care, and their role has extended into various modern practice fields. Even though the founding professors’ aim was to prepare NPs in master’s programs, the demand for nurses in the society caused an increase of post-baccalaureate instead of graduate education. Imperatively, federal funding also facilitated the NP programs; hence, the increased introduction of several graduate NP and post-baccalaureate programs. The duration of the programs differed between few weeks and two years, with numerous certificate programs ranging between 9 and 12 months (NSW Government, 2012). Changes in compensation regulations, laws, and policies that facilitate direct NPs reimbursement, the fast increase in managed care as an approach to regulate healthcare costs, and the emerging appreciation of vital NPs contributions to positive patients’ results have led to fast increase in the NPs programs, especially the DPN programs. Despite the short duration existence of NPs in health care sector, it is clear that they have achieved the respect of several medical practitioners and of their clients. Lately, lay publications and televisions have shown NPs and their crucial contributions they make in order to promote quality health. Modern fields of settings and practice for nurse practitioners still arise. In several instances, NPs have been effective in providing care for people in rural areas, cities, and other susceptible groups. NPs have recognized themselves as a fundamental component of the healthcare organization (MacDonald & Schreiber, 2005). Nurse-Midwives These advanced nurses are unique among APNs, as they are trained in two varied professions. Midwifery entails a profession on its own, as nursing is not a precondition to midwifery in certain parts of the globe. Certified nurse-midwives are persons trained in the two fields including midwifery and nursing, and have confirmation of certification. It is midwifery practice entails the autonomous women’s healthcare management, emphasizing specifically on usual primary care matters, gynecologic and family planning needs of women, childbirth, pregnancy, postpartum time, and the newborn care. The CNMs, as well as certified midwife practice in a health system providing collaborative management, consultation, or referral as shown by the client’s health status. CNMs and certified midwives practice in compliance with the midwifery standards (RCNA, 2010). Even though the emphasis on midwifery care has traditionally involved prenatal care and the management of labor and births, nurse-midwives are also caregiver for fundamentally healthy women. Nurse-midwives robustly believe in sustaining natural life processes and not using medical interventions, except when there is an explicit need (Fitzpatrick & Wallace, 2006). This belief and others assert that each individual person are entitled to equitable, accessible, ethical, quality healthcare that uphold health and healing; healthcare, which respects individuality, human dignity, and group diversity. It also asserts that accurate and complete information to make informed health decisions; active participation and self-determination in healthcare decisions; and participation of a woman’s elected family members, to the degree desired, in all healthcare experiences (NSW Government, 2012). According to McGee (2009), midwives believe in watchful waiting and non-intervention in usual processes, and suitable use of technology and interventions for present or possible health issues. They are collaboration, consultation, and referral with other healthcare team members necessary in order to offer optimal healthcare system. Midwifery is an old profession, which is declined between 18th and 19th centuries, and obstetrics established as a medical specialization. Nurse midwifery education started with certificate programs, but it has developed to graduate education. Notably, some scholars have shown lower rates of caesarean section and results similar to a personal obstetrics practice in nurse-midwifery practice who provide care for underserved women and fewer medical interventions, a lower rates of caesarean section for nurse-midwifery patients as compared to similar low-risk women for whom family obstetricians and physicians care. Clinical Nurse Specialists (CNSs) According to the Jansen and Zwygart-Stauffacher (2010), a clinical nurse specialist refers to a clinical professional that gives express patient care services, which include diagnosis, health assessment, health promotion, health problems management, and preventive interventions in specialized field of nursing practice. Clinical nurse specialists boost the enhancement of nursing care via education, research, consultation, and in role change agent within healthcare system. CNSs entail registered professional nurses who possess graduate preparation attained at the doctoral or master’s level. Besides, they could be trained in postmaster’s program that prepares graduates to practice in certain specialty fields. McGee (2009) says that in 2000, 183 schools provided CNS master’s courses, an increase in from the 1997’s 147 courses. Additionally, CNSs have conventionally worked in hospitals, but they currently practice in several settings, including nursing schools, homes, hospice, and home care. The CNS has four classes of APNs, each with uniquely various practice features. The CNS has developed for long in United States. The role of the CNS was established after the World War II. Before then, nurse specialization was in the practical fields of education and administration. Identifying demand for highly trained nurses expressly involved in the clients’ care, the CNCs concept emerged. The establishment and utilization of multifaceted healthcare technology in the patients’ management in hospitals, as well as elaborate surgical procedures has led to increased acuteness and intricacy in the delivery of patient care. Therefore, it is imperative that nurses with advanced expertise and knowledge are essentially involved in collaborating with staff in the assessment, planning, implementing, and evaluating care for the patients. Several hospitals have applied CNSs as care case managers and coordinators in which they organize the patients’ care with chronic or acute disease during their stay in hospitals, as well as organize them for release to other care facilities or their homes. CNSs have been utilized as discharge planners that collaborate with staff to arrange post-hospital patient care who have intricate health issues. Their significance in care coordination on the care scale is currently lauded, and causes decline in the readmissions of old cardiac clients (McGee, 2009). As Jansen and Zwygart-Stauffacher (2010) maintains, since its commencement, the CNS role has experienced role ambiguity. Even though the first vision was for these advanced practice nurses to be fundamentally engaged in patient care for certain patient population, they have presumed several other roles, including patient and staff educator, supervisor, consultant, project director, and lately, case manager. Notably, it is hard for CNSs to explain their roles to other people accurately, as their roles are constantly changing to satisfy healthcare needs of a dynamic population of patients in an ever-dynamic healthcare system. Role ambiguity makes it hard to assess the effect of CNSs on patient results. Therefore, when budgetary adversities have happened in hospitals, CNSs have regularly had to campaign for maintenance of their positions, as outcome information to aid the positive effect of their practice has been readily accessible or just inexistent. Furthermore, some of specialties and subspecialists of CNS include, but not limited to adult health, mental or psychiatric health nursing, gerontology, pediatrics, oncology, neuroscience, cardiovascular, pulmonary, rehabilitation, diabetes, renal, and palliative care (RCNA, 2010). Certified Registered Nurse Anesthetists (CRNA) These refer to registered nurses who educationally prepared to give anesthesia and anesthesia-related service in conjunction with other healthcare professionals, such as, dentists, surgeons, anesthesiologists, and podiatrists. The nurse anesthesia’s practice is a specialization in the nursing profession and CRNAs are indentified by regulatory or state licensing agencies, nursing boards. The CRNA limit of practice involves comprehensive patient care, which include performance and documentation of a pre-anesthetic patient assessment, which include diagnostic and consultation studies, choosing, attaining, ordering, and administration of pre-anesthetic fluids and medications, as well as attaining informed decision for the procedure (Jansen & Zwygart-Stauffacher, 2010). They also involved in the development and implementation of anesthetic plan, and introducing the anesthetic method, which includes local, regional, and sedation. They also concerned with the selection, application, and insertion of suitable invasive and non-invasive monitoring modalities for consistent assessment of patient’s physical condition. Moreover, CRNA involves selection, obtaining, and administration of the anesthetics, accessory and adjuvant fluids, and drugs essential for management of anesthetic. CRNA also entails the management of patients’ pulmonary and airway status using present practice modalities (Jansen & Zwygart-Stauffacher, 2010). Additionally, CRNA facilitates appearance and recovery from anesthesia through the selection, attainment, ordering, and administration of fluids, medications, and ventilatory support. They also discharge the patients from post-anesthesia care location and offer post-anesthesia follow-up assessment and care. In addition, CRNA deal with the implementation modalities of managing chronic and acute pain. They also respond to emergencies through the provision of airway management, administration fluids and drugs, and advanced and basic cardiac life support methods (McGee, 2009). Effect of APN on patient care and costs McGee (2009) demonstrates that the application of advanced practice nurses improves patients’ accessibility to healthcare services, and reduces waiting periods or the set of services provided. Other studies demonstrate that advanced practice nurses can deliver similar quality of care as medical practitioners for various services referred to them, as long as they have attained appropriate training and education. Most of the studies also realize that a high patient fulfillment rate with services offered by advanced practice nurses and in several instances a higher satisfaction instead of same services offered by doctors. This seems to be caused by the fact that advanced practice nurses seem to take time with every patient, offering them more counseling and education. Fewer researches have attempted to assess the effect of APN activities on health results, yet those that have attempted to do so have failed to identify any negative effect on patient results due to the movement of various roles from doctors to nurses(Fitzpatrick & Wallace, 2006). Other studies also have attempted to approximate the effect of APN on cost. Most of them excluded some items anticipated to have an effect on cost, such as, training and education expenditure for advanced practice nurses, the output gap amid doctors and advanced practice nurses; and any lasting cost effect associated with avoiding complications of hospitalizations and conditions, which could result from actions. The outcomes of studies demonstrate that one of the major factors that will influence the effect on cost is if the APN roles are meant to alternate activities that were previously performed by doctors, or if they are extra activities. When the APN role entails majorly task substitution, most studies have found that effect is either cost neutral, or cost reducing. Other studies indicate that the nurse salary savings are balanced wholly or partly by other variables including long consultation periods, more test ordering, and higher patient transfers to other medical doctors or rates of recall (McGee, 2009). In case APN role entails supplementary activities, some studies show that the effect is cost increasing. Nevertheless, a frequent restricted of these assessments is that they do not consider potential lasting saving that may result from high quality care and preventing complications. Research also indicates that there might be certain unintended effects associated with the utilization of advanced practice nurses in basic primary care, associated in specific to care harmonization (Jansen & Zwygart-Stauffacher, 2010). Conclusion Clearly, ANP is holistic, cost-effective, and enhances quality of life. It has contributed to healthcare quality, specifically for susceptible populations. The enhanced healthcare quality is facilitated by distinct categories of advanced practice nurses including CNRA, CNSs, NPs, and CNMs. It is holistic because it involves the incorporation of the humankind totality in body, emotion, mind, and spirit. In order to achieve cost-effective, holistic, and enhanced healthcare quality, it is imperative to embrace and further develop advanced nursing practice in every society. References Bryant-Lukosius, D., DiCenso, A., Browne, G., & Pinelli, J. (2004). Nursing and Health Care Management and Policy Advanced Practice Nursing Roles: Development, Implementation, and Evaluation. Journal of Advanced Nursing, 48(5), 519–529 http://w3.uniroma1.it/nursing/js/PDF/Advanced_practice.pdf Delamaire, M., & Lafortune, G. (2010). Nurses in Advanced Roles: A Description and Evaluation of Experiences in 12 Developed Countries, OECD Health Working Paper No. 54. Pp. 1-107. http://www.oecdilibrary.org/docserver/download/fulltext/5kmbrcfms5g7.pdf?expires=13 49839160&id=id&accname=guest&checksum=FA71CD0CBC4695E0FB6EA45A1488F 4CC DeNisco, S.M. (2012). Advanced practice nursing: evolving roles for the transformation of the profession. Burlington, MA: Jones & Bartlett Learning. Pp. 50-70 Hamric, A. (2000). A definition of advanced nursing practice. In Advanced Nursing Practice: An Integrative Approach (Hamric A.B., Spross J.A & Hanson C.M., eds), W.B. Saunders, Philadelphia, pp. 53–73. Jansen, M.P., & Zwygart-Stauffacher, M. (2010). Advanced Practice Nursing Core Concepts for Professional Role Development, Fourth Edition. New York, NY: Springer Publishing Company, LLC. Pp. 1-50. http://www.springerpub.com/samples/9780826105158_chapter.pdf McGee, P. (2009). Advanced practice in nursing and the allied health professions. Chichester, U.K. Ames, Iowa: Wiley-Blackwell. Pp. 1-20. NSW Government (2012). Nurse Practitioners in NSW - Guideline for Implementation of Nurse Practitioner Roles - NSW Health. Nurse Practitioners in NSW Guideline. Pp. 3-67. http://www.health.nsw.gov.au/policies/gl/2012/pdf/GL2012_004.pdf RCNA (2010). Position Statement Advanced Practice Nursing. Pp. 1-2. http://www.rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and% 20link/policy/documentation/position/advanced_practice_nursing.pdf Styles, M. & Lewis, C. (2000). Conceptualizations of advanced nursing practice. In Advanced Nursing Practice: An Integrative Approach (Hamric A.B., Spross J.A. & Hanson C.M., eds), W.B. Saunders, Philadelphia, pp. 33–51. Fitzpatrick, J.J. & Wallace, M. (2006). Encyclopedia of nursing research. New York: Springer Pub. Pp. 13-20. Read More