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NSG6006 Study Guide Policies & Practice Standards State Nurse Practice Act (Roles 2022/2023
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NSG6006 Study Guide Policies & PracticeStandards State Nurse Practice Act (Roles
2022/2023
• _History and Developmental Aspects of Advanced Practice Nursing
• Definition of advanced practice nurse (APN) - A nurse who has completed an
accredited graduate-level education program preparing her or him for the role of
certified nurse practitioner, certified registered nurse anesthetist, certified nurse-
midwife, or clinical nurse specialist; has passed a national certification examination
that measures the APRN role and population-focused competencies; maintains
continued competence as evidenced by recertification; and is licensed to practice as an
APRN
involves advanced nursing knowledge and skills; it is not a medical practice, although APNs
perform expanded medical therapeutics in many roles
• History of APN movement
History and evolution of nursing science
Knowledge development
APN Roles
CNSs have a strong and tumultuous history. Over the past 20 years, the
departure from direct patient care as being a main focus to working predominantly in
the nursing education and systems improvement domains has created confusion within
nursing and the public because non- CNSs (e.g., nurse educators, quality improvement
managers) function in the same capacity.
However, CNSs are uniquely educated to provide advanced practice and specialist
expertise when working directly with complex and vulnerable patients, educating and
supporting interdisciplinary staff, and facilitating change and innovation in health care
systems that those in other roles in health care cannot. As health care reform continues
to gain momentum to improve the health care system, there will be many new
opportunities for CNSs. As masters of flexibility and creativity, CNSs can develop new
roles to meet the needs of patients and health care systems. For example, in nurse-
managed clinics, perhaps NPs could deliver the primary care to patients in the
management of hypertension. Once first- or second-line therapies or interventions are
found to be ineffective, a referral could be placed to the cardiovascular CNS for
specialized pharmacologic and nonpharmacological treatment. Also, the cardiovascular
CNS could integrate the latest evidence to create educational materials for patients and
other health care professionals. Perhaps a CNM who is caring for a pregnant woman
NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
, NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
who develops gestational diabetes, preeclampsia, and is in breech position could ask
the perinatal CNS to commonage the patient by following the patient and fetus or
neonate in the prenatal setting through hospital discharge into the postpartum phase.
The perinatal CNS could establish interagency processes to facilitate care delivery
across practice settings to provide seamless transitions of care. The possibilities are
endless if CNSs understand their role, improve understanding of the importance of this
role in advanced practice nursing, and maximize the driving forces and minimize the
restraining forces in the health care system.
Primary care is the foundation of the evolving U.S. health care system. If access
to primary care for all is the goal, while containing costs and focusing on quality
outcomes, then NPs will be crucial to achieving these aims. In our current system, there
just aren't enough PCPs to meet the need and, with an additional estimated 32 million
more people who will be covered and need access to full primary care, based on the
PPACA, we will need additional providers more than ever.
Physicians are not choosing primary care practice for complex reasons. On the other
hand, most NPs choose primary care practice roles (e.g., family, adult, and pediatric
NPs) because they enter these programs specifically to provide primary care. Two areas
in particular must be addressed before NPs will be able to contribute fully to primary
care delivery nationwide:
1. There must be changes in the outdated state scope of practice laws and
regulations of nurse practitioners. This is because the variation in state regulations on
scope of practice and prescribing authority has been a major barrier to using NPs fully
and providing increased access to quality, cost-efficient primary care.
2. There must be substantive changes in health professional education to
foster true collaboration and teamwork among physicians, NPs, and other health care
disciplines in general to obtain the full benefit of diverse competencies inherent in a
team.
If both of these are addressed, meeting U.S. primary care needs could be
significantly affected in a positive way. Today's NP students and graduates must accept
the professional responsibility for being active in the governance of delivery systems
and informing and changing policy. There is too much at stake to leave this to a few, or
to someone else. The health of the United States population depends on new models of
care, on all health care providers practicing to the fullest extent of their education and
training, and on strong teams who respect each other and partner with patients. NPs
NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
, NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
must support their efforts as they take an active role in developing stable health care
policy and care delivery systems that allow for patient access to primary care services
provided by NPs.
The ACNP role provides an opportunity for NPs to have a significant impact on patient
outcomes at a dynamic time in the history of health care delivery. As their role
continues to evolve, and as health care systems respond to market forces and economic
change, opportunities to develop the ACNP role further will arise. Future development of
the ACNP role should be based onthe evaluation of the need for the role, understanding
the scope of the role, assessment of the practice or organization, and the service needs
of the patient population. Ensuring that ACNPs practice to the full scope of
their education and training is in alignment with the recommendations of the
Institute of Medicine
(2011). Because the ACNP role continues to evolve, participation in national
organizations to refine consensus regarding role components, program curriculum,
marketing, and role evaluation is necessary. ACNP educators and clinicians must work
together to ensure that the preparation and practice of ACNPs is safe, effective, and
fully represented as the movement of doctoral APN education evolves. ACNPs must be
strong activists in efforts to gain full recognition of their role within their proper scope
of practice across acute care settings. In this evolving health care arena, ACNP practice
is rapidly expanding and holds unlimited potential. Ongoing challenges include ensuring
expansion of the ACNP with a focus on advanced practice nursing, rather than as a
physician replacement model of care.
Nurse-midwifery practice encompasses a full range of primary health care
services for women, from adolescence beyond menopause. These services include the
independent provision of primary care, gynecologic and family planning services,
preconception care, pregnancy care, childbirth and the postpartum period, care of the
normal newborn during the first 28 days of life, and treatment of male partners for
sexually transmitted infections. CNMs provide initial and ongoing comprehensive
assessment, diagnosis, and treatment. They conduct physical examinations, prescribe
medications, including controlled substances and contraceptive methods, admit,
manage, and discharge patients from birth centers or hospitals, order and interpret
laboratory and diagnostic tests, and order the use of medical devices. CNMs' care also
includes health promotion, disease prevention, and individualized wellness education
and counseling. CNMs must demonstrate that they meet the core competencies for
basic midwifery practice of the ACNM (ACNM, 2008b) and must practice in accordance
with the ACNM standards for the practice of midwifery (ACNM, 2011d). With constant
NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
, NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
changes in health care, CNMs may need to expand their knowledge and skills beyond
that of basic CNM practice. Advanced CNM skills, such as level 1 ultrasound or acting as
first assistant in surgery, may be incorporated into a CNM's practice as long as the CNM
follows the recommendations for acquiring these skills by obtaining formal didactic and
clinical training to ensure that the advanced skill is acquired and monitored to ensure
patient safety.
There have been many recent positive advances in nurse-midwifery and between nurse-
midwifery and the broader health care system. The ACNM has been reaching out to
professional nursing, midwifery, medical, policy, and public health colleagues nationally
and internationally. There has been international recognition of the need for more
midwives to reduce maternal and neonatal mortality. In the United States, the IOM
report, the Future of Nursing, and passage of the PPACA has placed CNMs and other
APRNs in a partnership role in redesigning the health care system for the future.
From a midwifery perspective, we hope that this system will honor women and offer them
support in realizing the power that comes with the choice of a woman-centered health care
system.
Nurse anesthesia, the earliest nursing specialty, was also the first nursing
specialty to have standardized educational programs, a certification process, mandatory
continuing education, and recertification. Nurse anesthetists have been involved in the
development of anesthetic techniques along with physicians and engineers. CRNAs
have been nursing leaders in obtaining third-party reimbursement for professional
services and in coping with challenges such as the prospective payment system,
managed care, and physician supervision. Nurse anesthetists provide surgical and
nonsurgical anesthesia services in a variety of settings in the United States and other
parts of the world. CRNAs work collaboratively with physicians, as do other APNs, and
are capable of providing the full spectrum of anesthesia services. Activism at the state
and federal legislative and regulatory levels is a recognized CRNA activity. Increasing
coalition building among nurse anesthetists, other APNs, and nursing educators is
congruent with a shared nursing vision. This vision values health care for all Americans,
provided in a safe and cost-effective manner by APNs collaborating with other health
care professionals. John F. Garde was a distinguished health care leader who served as
AANA Executive Director from 1983 to 2001, and again on an interim basis from
February 2009 until his untimely death in July 2009. A statement of his holds true today
(Garde, 1998, p. 15): The profession has an optimistic future. I point out with pride the
NSG6006 Study Guide Policies & Practice
Standards State Nurse Practice Act (Roles
2022/2023
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