Advanced Practice Nurse: Roles and Issues
January 26, 2015
America is facing health crisis in critical proportions. A large percentage of people don’t have adequate access to basic health care. As health care industry broaden access to health care with three important things in mind, the care provided must be competent, efficiency and readily available at all stages of life. Advanced practice nurses play an important role to promote these goals. These well-trained providers -including nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists—can and do practice across the full range of care settings and patient populations.
History of Advanced Practice Nursing Summary
The Nurse Practitioner role as it was originally developed focused on one-to-one direct primary health care services with ambulatory patients outside of the hospital setting. The NP was designed and educated to increase access to health care services, to educate patients, to more effectively use qualified nursing preparation to meet national health needs and to promote community based continuity of care. The NP provided important access in areas of physician shortages in primary health care (Cukr, 1996). In 1965, Loretta Ford, a nurse, and Henry Silver, a physician, developed the first NP program to improve access to primary health care services. During the next three decades NP certificate and graduate program proliferated in the United States with an expansion in to multiple specializations (Nagelkerk, 2006). The formalization of the advanced practice-nursing role in the United States has focused on four clinical practice domains: nurse–midwife, nurse anesthetist, nurse practitioner (NP), and clinical nurse specialist (CNS) (Sipe, Fullerton, & Schuiling, 2009).
Buppert (2012) describes nurse anesthetist as “narrow range of services (preoperative assessment, administration of anesthesia and management of post anesthesia recovery) to a narrow base of patients (people having anesthesia)”(p.3). Modern nurse anesthesia traces its roots to the last two decades of the 1800s when records indicate that nurses were often asked to administer anesthesia. By 1912 a formal course in anesthesia had been developed in Springfield, Illinois and later nurse anesthetists became well known for their expertise in the administration of anesthesia. CRNAs function as sole anesthesia providers in rural hospitals, enabling these hospitals to stay open by providing surgical, obstetric, and trauma stabilization services (Jansen & Stauffacher, 2010).
Clinical Nurse Specialist
Clinical nurse specialist: Medium range of, services (consultation, research, education, administration, coordination of care, case management, direct care within the definition of a registered nurse) to in a narrow patient base (people under the care of a medical specialist) (Buppert, 2012). CNSs are registered professional nurses with graduate preparation earned at the masters or doctoral level. The CNS is one of four categories of APNs, each with distinctively different Practice characteristics. The clinical nurse specialist role was developed during World War II. The first Masters program in a clinical nursing specialty was developed in 1954.that program launched the CNS role that has been an important player in the nursing profession and healthcare arena ever since, although the role has not been without controversy. Health care restructuring and cost-cutting initiatives in the 1980s and 1990s resulted in a loss of CNS positions in the United States. However, after increasingly frequent reports of diverse events in hospital settings in the 1990s it became apparent that CNS were critical to obtaining quality patient outcomes, with the result that CNSs are again seen us valuable professionals in many US health systems (Jansen &Stauffacher, 2010).