Describe how the role of advanced registered nurse transformed over time

By obtaining my Master of Science in Nursing with an emphasis on Nursing Education, I can see myself transitioning into a fearless leader and someone to look up to as I transition into mentoring students in the classroom when I am ready to leave the bedside. According to Barnes (2015), the transition from the RN to the APRN role can be stressful as there is a shift from an experienced RN to an inexperienced APRN. This can result in an alteration in professional identity, loss of confidence, and impaired NP role development (Barnes, 2015). According to Lamb et al., (2018), registered nurses working in advanced practice nursing (APN) roles have completed graduate education, and have an expert level of knowledge, complex decision‐making skills, and clinical competencies for expanded practice specific to the context in which they are credentialed to work. Leadership within this profession is considered role-dependent, for example, APRNs are considered informal leaders while those employed in administrative or management positions are considered formal leaders.  Throughout this course and program, I hope to gain valuable leadership skills and education to be fully prepared to lead the nursing workforce and to educate fellow students on the joys that healthcare can provide, and the complexity of care they may face working at the bedside.

NUR 513 Topic 1 Discussion Question One

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?

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Re: Topic 1 DQ 1

The role of advanced registered nurse has transformed over time in so many ways. We focus on how nursing has rapidly evolved. There was the traditional Registered Nurse than over time it has evolved into many distinct categories of nursing which involved (CRNAs), certified nurse–midwives (CNMs), clinical specialists (CNSs), and nurse practitioners (NPs) then Doctor of nursing practice (DNP) (DeNisco & Barker, 2016).

The shifts of scope and expectations in the 20th and 21st centuries have not change as much as we think. “Clinical nurse specialists (CNSs) have been providing care to patients with complex cases across healthcare settings since the 1960s. The CNS role originated to satisfy the societal need for nurses who could provide advanced care to psychiatric populations.

Following this implementation, the usefulness of the role became apparent, and schools of nursing began to educate nurses across specialties, including oncology, medical-surgical, pediatric, and critical care nursing” (DeNisco & Barker, 2016). “Nurse practitioners have been providing care to vulnerable populations in rural and urban areas since the 1960s. The role was born out of the shortage of primary care physicians able to serve pediatric populations.

Today, nurse practitioners are the largest group of advanced practice nurses. More than 192,000 NPs are licensed and practicing with some level of prescriptive authority in all 50 states. Nurse practitioners work are educated and hold board certification in a variety of specialty areas, including pediatrics, family, adult gerontology, women’s health, and acute care.” (DeNisco & Barker, 2016). Midwives are essential.

“In the 1920’s when the first midwifery school began because of high mortality rates and poverty in Kentucky which led to the demand of Midwives brought about change to these rural communities.” (DeNisco & Barker, 2016). Midwives are needed more than ever in so many areas of nursing especially when pregnant women are not comfortable being in a hospital setting. Nurse anesthetists have a crucial role in nursing because they provide anesthesia during surgery.

“Nurse anesthetists are licensed as independent practitioners, and they provide care autonomously and in collaboration with surgeons, dentists, podiatrists, and anesthesiologists. The shortages of physicians qualified to administer anesthesia during wartimes continued, and nurse anesthetists were the main providers of anesthesia care for U.S. military personnel on the front lines for World War I, World War II, the Korean War, and the Vietnam War; nurse anesthetists also provide care in the current conflicts in the Middle East.” (DeNisco & Barker, 2016).

Advanced registered nurse role and responsibilities will continue to evolve and emerge as the American health care system changes by technology and continued education. Nurse educators are essential for keeping registered nurses informed of all the new policies and procedures we must abide by.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570

Peer Responses

Re: Topic 1 DQ 1

You bring up a great point about the difficulty with being an advanced practice registered nurse (APRN). Even though its been 20 years since the Institute of Medicine released their report “The Future of Nursing: Leading Change, Advancing Health” recommending that nurses work to the full extent of their education and training, some people and regulatory bodies are still hesitant to allow this (Institute of Medicine, 2011).

My mother was a Nurse Practitioner (NP) trained in acute cardiovascular care. I remember how frustrated she would get because the physician she worked under wouldn’t allow her to do certain procedures or tests that she was capable of performing because he would rather her handle the paperwork. I find it sad that it has been such a struggle for nurses to break through these barriers to be able to do what they are capable of. I also think it does the patients a huge disservice.

References

Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209881/

Re: Topic 1 DQ 1

I really enjoyed your post and the inclusion of some of the nontraditional APRN roles. Many of these nonclinical, or nontraditional roles do require knowledge and experience beyond the bachelor’s degree level of education. I was surprised to learn that all Nurse Administrators are not required to have a graduate level degree (DeNisco & Baker, 2016).

Nurse Educators are another vital nontraditional APRN role that is tasked with preparing the nursing workforce in a clinical setting (DeNisco & Baker, 2016). There has been debate about the content that should be taught to future nurse educators; whether its advanced clinical knowledge or teaching techniques.

In my mind both components seem necessary to adequately do the job. I agree that the National Council of State Boards of Nursing (NCSBN) should reassess the current APRN roles. I think you hit the nail on the head when saying that reevaluating the APRN roles would better serve nurses and patients alike with our ever-evolving healthcare system.

Porter-O Grady and Malloch (2018) stated that “an understanding of change and innovation is not an option for nurses but rather it is a professional obligation” (p.52). This professional obligation to transform and innovate extends to the NCSBN and their duty to redefine the APRN role.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett   Learning. ISBN-13: 9781284072570

Porter-O Grady, T. & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones &. Bartlett Learning. ISBN-13: 9781284146530

Re: Topic 1 DQ 1

The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).

These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016).

The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline. This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016).

Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators.

DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.

References

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570

The role of advanced registered nurse (ARN) has progressed over the past years. In 1960s for example the role of Nurse Practioners (NP) emerged to help in primary care due to shortage of physicians at that time. The NPs provided primary care to the less fortunate treating minor illnesses and emergencies that didn’t require critical attention and referral (DENISCO, 2024).

In 20^th and 21^st century this has dramatically evolved and shifted to where now the NPs has become more independent in providing not only primary care but are more involved in advanced specialized care, they now have ability to prescribe, diagnose and managed patient of all kind with minimal physician supervision (DENISCO, 2024). NP was listed by US News world report (2021) as second top occupation.

Today more ARNs in different specialties have emerged as well, such as Nurse educators, leaders, anesthetists and so on. This comes with more responsibilities and dependency which allow them to better assess, diagnose, plan, implement and evaluate care of patients in a timely manner. Technology has also increased in the hospitals and institutions nowadays making it easier to train more ARNs, it has also made healthcare systems manageable to both the patient and healthcare workers.

Looking forward, im eager to see more trained and practicing ARNs as projected by (DENISCO, 2024) that the percentage of ARNs will increase to 52% compared to 10% for physicians by the year 2030.

DENISCO, S. M. (2024). Advanced practice nursing: Essential knowledge for proffession 5th edition. Jones and Bartlett learning.

Re: Topic 1 DQ 1

Advanced registered nurse roles and responsibilities will forever be evolving due to changes in policy such as health care acts, aging populations, and the overall need for advanced registered nurses. Furthermore, the responsibilities of advanced registered nurses have already started to expand. Densico and Barker 2016, shed light on the importance that barriers for advanced practice nurses be identified and resolved.

In some states, nurse practitioners (NPs) do not work in primary care due to some state restrictions; however, the Institute of Medicine (IOM) released a report stating that NPs be allowed to practice independently with full autonomy. There have been many reports validating that NPs provide high-quality care, while also being extremely cost-effective.

Moreover, according to Denisco and Barker, “the Health Resources and Services Administration (HRSA) has projected a large increase in demand for nurses, from approximately 2 million full-time equivalents in 2000 to approximately 2.8 million in 2020” (2016). The demand for nurses in the year 2020 came from the idea that people born in the 1960s (baby boomer generation), would put a strain on the healthcare system due to their size in population and the fact they were an aging generation.

However, no one would fathom that the actual demand for nurses in 2020 would be due to a pandemic. Shifts in scope of practice and expectations have already been seen in the 21^st century. Mainly focusing on expectations, universities have started to phase out nurse practitioner programs and replacing NP programs with doctoral nursing programs (DNP). This is partly because DNP programs provide more resources and opportunities to bring forth better health outcomes for patients. However, NP vs. DNP does not change scope of practice.

References

DeNisco, S., & Barker, A. (2016). Advanced practice nursing: essential knowledge for the profession (Third). Jones & Bartlett Learning. https://doi.org/ISBN978-1-284-07257-0

According to the American Nurses Association, the advanced registered nurses are the primary care givers and play a critical role in provision of preventive care services to the general public. They include nurse specialists, nurse anesthetists, and nurse midwives (ANA, 2022). The notable advancement has been achieved through tremendous transformation in the past century.

For instance, the current role of advanced registered nurses is based on the basics 20th century practices of nurse midwives and nurse anesthetists. Over time, four different advanced practice nursing roles have emerged; the nurse midwife (CNM), the nurse anesthetist (CRNA), the clinical nurse specialist (CNS), and the nurse practitioner (NP) (Hanson & Hamric, 2003).

Over the years, the role of advanced registered nurses has transformed in three distinctive phases. The first phase in evolution of the role was initiated by changing patient needs and treatment opportunities. In this case, the introduction of anesthetic agents offered the foundation for CRNA role (Hanson & Hamric, 2003). Initially, the nurse was supposed to make an evaluation of the patient’s status prior to selecting the appropriate analgesic treatment.

Nursing education and training is the key factor in the second phase of evolution. In the early years of the 20th century, nursing roles involved activities that were not valued by physicians and in instances where physician supply was insufficient. This led to evolution of advanced registered nursing roles through education. For example, the introduction of the nurse practitioner certification project in 1965 helped prepare nursing practitioners offer comprehensive care and provide preventive health services to manage common health problems (Keeling, 2015).

Finally, the need for standardization and the emergence of graduate education has transformed the role of advanced registered nurse. In the past 50 years, the demand for specialized education has greatly expanded these roles. Since the 1990s, three nursing specialties have evolved the expectation of master’s level education. These include CNS, NP, and CRNA (Hanson & Hamric, 2003). As a result, migration from one role to another by practitioners is a common practice.

References

ANA. (2022). Advanced Practice Registered Nurse (APRN). Retrieved september 14, 2022, from American Nurses Association: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Hanson, C. M., & Hamric, A. B. (2003). Reflections on the Continuing Evolution of Advanced Practice Nursing. Nurs Outlook 51, 203-211.

Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing . Online Journal of Issues in Nursing, 20(2).

Advanced practice registered nurses (APRNs) are masters prepared nurses responsible for providing clinical care to patients in different healthcare settings. Traditionally, the role of APRN was commonly associated with clinical roles and specialties that included clinical nurse specialists, nurse practitioners, certified nurse midwives and certified registered nurse anesthetist.

The American Association of Colleges of Nursing (AACN) in 2004 defined the advanced nursing practice as “any kind of nursing intervention which impacts healthcare outcomes for individuals or populations (Brykczynski, 2023). These include direct care of individual patients, management of care for populations and administration of nursing as well as health care organizations. However, the roles of advanced nurses have continued to transform based on the changes and situations in the health sector, especially the need to expand access to healthcare services for populations.

The shortage of physicians in the 1970s led to the federal government funding the establishment of more APRNs through training so that they can bridge the gap, especially in rural areas. The implication is that many APRNs can now diagnose and treat patients for different conditions as some states recognize them as primary care providers (DeNisco, 2019). The transformation in healthcare delivery models in 20th and 21st centuries has also led to a system that focuses on patient based on the concept of patient-centered care. Imperatively, the roles of advanced practice nurses have expanded as evidence shows that they should be allowed to practice to full extent of their training and education. Today, APRNs work collaboratively with other professionals to deliver quality care to individual patients and health populations.

The caring patterns of the advanced registered nurses will continue to shift because of the transforming healthcare system that focuses on value-based care and other innovative care delivery models. Advanced registered nurses will continue to expand their practice as they become specialists to cater to diverse patient needs (Zaccagnini & Pechacek, 2019). Working in teams will expand their roles as patient managers and leaders at the organizational level, especially with attainment of terminal degrees like PhD and DNP.

References

Brykczynski, C. L. M. K. A. (2023). Role development of the advanced practice nurse. Hamric

& Hanson’s Advanced Practice Nursing-E-Book: An Integrative Approach, 98.

DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:

            Essential Knowledge for the Profession. Jones & Bartlett Learning.

Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new

            model for advanced practice nursing. Jones & Bartlett Learning.

Over the past century, the function of the advanced practice nurse has evolved significantly. Beginning in the 1960s, the major function of the nurse practitioner was to offer primary care in underserved communities (DeNisco, 2021). Over the subsequent decades, NPs pushed to shift the political and socioeconomic perspective of society, opening the path for NPs to be viewed as more than just a cost-effective method of providing healthcare to the underprivileged. In the 1980s and 1990s, NP education migrated to the university environment as a master’s-level program.

Realizing that education also leads to credibility, NP education followed the adage “education is power” (DeNisco, 2021). Nonetheless, misunderstanding regarding the APRN’s role continued into the early 2000s. As a result, a consensus model was developed to define the qualifying roles and education of an advanced practice registered nurse (APRN).

As nursing is a profession that requires lifelong learning, it is not surprising that nurses desired to further their education by pursuing PhD degrees. The American Association of Colleges of Nursing (AACN) formally accepted the Doctor of Nursing Practice degree, which is currently recognized as the highest practice degree, in order to reduce misunderstanding regarding the range of available doctoral degrees.

The role of the APRN is presently developing before our eyes. Anesthesia is administered to surgical patients by CRNAs instead of an anesthesiologist. Similarly, ACNPs are replacing internists in intensive care units and emergency departments across the nation. Additionally, nurses are educated to treat patients, not diseases. The cornerstone of nursing enables patients to be active participants in their treatment, hence enhancing patient outcomes and health care compliance.

This holistic approach to patient care, combined with the NP’s extensive education and practical experience, will certainly make the NP the preferred primary care practitioner over the MD. As a personal objective for the nursing profession, I want nurses to have a voice in the political arena. Historically, nursing has been administered and perceived as an employee work group; hence, nurses’ engagement and presence in the political and public sector have been insufficient. (Weberg et al., 2019) I’d love to see the day when the public views APRNs and MDs in the same light, when the nurses’ unique perspective, education, and approach to patient care can be a driving force for our local and national public policy.

References

DeNisco, S. M. (2021). Advanced Practice Nursing: Essential Knowledge for the Profession (4th Ed.). Jones & Bartlett Learning.

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in Nursing Practice: Changing the Landscape of Health Care (3rd ed.). Jones & Bartlett Learning.

NUR 513 Topic 1 DQ 1 

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes? 

Re: Topic 1 DQ 1
 

Historically, when one spoke of advanced practice nursing, they meant one of four roles; certified registered nurse anesthetist (CRNA), certified nurse mid-wife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). In 2004, the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as “Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy” (Denisco & Barker, 2016).

Since this definition came out many other nursing roles, such as nurse administrators and public health nurses have also been thought of as advanced practice nursing roles. Whereas advanced practice nursing used to be mainly reserved for clinical practice, it is now branching out into non-clinical roles. With the ever-expanding role of nurses coupled with the push to expand access to and decrease costs of health care there will likely be many new roles developed for nursing practice. These roles will require advanced degrees even if they are not in clinical areas, therefore, they too should be thought of as advanced practice nursing. 

  Denisco, S.M. and Barker, A.M. (2016). Advanced Practice Nursing: Essential Knowledge for the Profession. Jones and Bartlett Learning. https://www.gcumedia.com/digital-resources/jones-and-bartlett/2016/advanced-practice-nursing_essential-knowledge-for-the-profession_3e.php 

I agree with you that nursing practice is any form of nursing intervention that is meant to influence the care outcomes. The nurse practice has been evolving overtime especially with the transformation of the healthcare systems and healthcare policies. In the current healthcare industry where the focus is on the patient, what is commonly referred to as patient centered approach has ensured that the patient is given autonomy to choose on the best care practice that is appropriate and improves the patient’s health condition (American Association of Nurse Practitioners, 2019).

This has called upon the nurse training institutions to shift and adapt to the new and emerging trends in healthcare. The advanced nursing role has been the significant part that the Affordable Care Act aims to enhance health promotion measures among the aging US population (Woo et al., 2017). The research findings reveal that the advanced nursing role would be one of the professions at a highest demand by the year 2022. 

References 

American Association of Nurse Practitioners. (2019). Scope of Practice for Nurse Practitioners. American Association of Nurse Practitioners; AANP Website. https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners 

Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1). https://doi.org/10.1186/s12960-017-0237-9 

A code of ethics within nursing is imperative to maintain the dignity of the patient and the integrity of the APRN no matter what population or patient one may be providing service to. When an RN decides to seek further education and advance their practice into an APRN practice, they dive into more specialized patients and populations. Although the foundation of the code of ethics for APRN’s may be the same, this divergence into specialties means applying those ethics to each role very differently.

A clinical nurse specialist in a pediatric setting may respond to ethical dilemmas very differently than a Family Nurse Practitioner (FNP) . One such example would be one of non-maleficence, the avoidance of harm to a patient (Haddad & Geiger, 2022). Although practitioners that work in pediatrics in some capacity know they are not only treating the patient but supporting the family as well, a pediatric CNS may see a problem specific to how to it affects just the patient whereas an NP may see the greater picture as to how the health problem affects the whole family unit. The CNS and the FNP may make different choices or suggest different directions of treatment because of their different training and experience.

An FNP may make a treatment suggestion knowing the family unit or because of the knowledge of the barriers or strengths in the community as they are often located in primary care. A CNS may make a treatment suggestion or plan to the healthcare delivery system of all those patients that present with that issue as they often serve as “expert consultants” to nursing staff or work to improved delivery of care within the healthcare system (Explorehealthcarecareers.org, 2022).

One such example could be with controller medications in a pediatric patient with asthma. The FNP may take into consideration the abilities of the parents to adhere to 20 minute nebulizers everyday in a two year old and may suggest a less effective but more complied with treatment plan of metered dose inhalers if the benefit outweighed the cost. A CNS may suggest a change to the system of asthma management and/or advise this family/patient to figure out a way to adhere to best practice of inhaled nebulized mediation. In either case, the primary goal is in respect to Provision 2 of the nursing code of ethics, “the fundamental commitment of nursing to the uniqueness, worth, and dignity of the patient” (American Nurse’s Association, 2015). APRN’s in this situation is to maximize the treatment plan for a child with asthma.

Re: Topic 1 DQ 1 

The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).

These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016). The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline.

This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016). Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators. 

DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.  

References 

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570 

I agree with your statement that the advanced nurse practice numbers have soared high in the 21st century compared by the 20th century. The current Covid-19 pandemic has however, proved that health and wellness is a collective responsibility (Kovac, 2020). In this context both the patient and the nurse are at risk of contracting the disease regardless of age, gender or religious underpinnings hence adequate precautionary measures should be taken. The advanced nursing role has taken up active role in preventive measures of the disease by offering the routine guidelines of hygiene the emerging trends in the spread and severity of the disease.

The concept of preventive care is one of the key pillars in the patient protection and well-being. The advanced nurse role requires the nurses to carry out educational programs, seminars and workshops that are meant to help the public on the need of maintaining our bodies for optimal health and reduced chances of hospitalization. The one situation where the advanced nurses’ practitioners have shown resilience is the tackling of the covid-19 pandemic. Countries that embraced strict, firm and taken early hard precautionary measures have known to be safer with very low reported cases in the country (Trnka et al., 2021) 

 References 

Kovac, M. (2020). The Covid-19 pandemic: collective action and European public policy under stress. Central European Journal of Public Policy, 0(0). https://doi.org/10.2478/cejpp-2020-0005 

Trnka, S., Long, N. J., Aikman, P. J., Appleton, N. S., Davies, S. G., Deckert, A., Fehoko, E., Holroyd, E., Jivraj, N., Laws, M., Martin-Anatias, N., Roguski, M., Simpson, N., Sterling, R., & Tunufa’i, L. (2021). Negotiating risks and responsibilities during lockdown: ethical reasoning and affective experience in Aotearoa New Zealand. Journal of the Royal Society of New Zealand, 1–20. https://doi.org/10.1080/03036758.2020.1865417 

 This week : CAT (150 WORDS) 

This week : We will discuss how the role of advanced registered nurse transformed over time, considering various shifts in scope and expectations in the 20th and 21st centuries. We will also discuss different ways that will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes. Here is a CAT ( classroom assessment technique question for you to get additional participation points). Please respond in addition to your 2 main dbqs dq1 and dq2. 

CAT #1 

Explore the 4 APRN roles 🙂 of your personal interest. 

The APRN roles which are the advanced roles include; certified registered nurse anesthetist (CRNA), certified nurse midwife (CNM), clinical nurse specialist (CNS) and certified nurse practitioner CNP). The advanced nurse roles have been traditionally entailing focus on the clinical procedures, advocating for better patient care, being case managers (Hu & Forgeron, 2018). Additionally, ADP is also expected to work in consultation and collaboration with other healthcare professionals.

The roles entail a wide scope of practice and ideally, the learning is meant for advancement on the already available information. However, in the current situation the healthcare industry is approaching a new era as emphasized in the affordable care act which we still don’t know what will happen. The affordable care act insists on offering medical care that built on patient centeredness and care that is preventive rather than curative (Courtemanche et al., 2018). This is meant to tackle the rising number of the elderly population that is battling serious chronic illnesses that are associated with old age  

References 

Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2018). Effects of the Affordable Care Act on Health Care Access and Self-Assessed Health After 3 Years. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 004695801879636. https://doi.org/10.1177/0046958018796361 

Hu, J., & Forgeron, P. (2018). Thinking, educating, acting: Developing advanced practice nursing. International Journal of Nursing Sciences, 5(2), 99–100. https://doi.org/10.1016/j.ijnss.2018.04.006 

An advanced registered nurse encompasses many different roles, including nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. Primarily focusing on the role of a nurse practitioner (NP), NPs have become more common in the health care setting, with licensure, accreditation, and certification requirements evolving in response to the growing demand of the public (Penn Nursing, n.d). During the 20th century, a major factor that revolutionized the role of an NP was the lack of health services. The ability to specialize in medicine created a shortage of primary care physicians. This shortage affected the rural areas or those who lack access to care in inner cities (Keeling, 2015). Primary care physicians, who did not specialize, decided to recruit registered nurses with clinical expertise and collaborate with them to identify and treat the needs of children and families (Penn Nursing, n.d). In addition, the creation of Medicare and Medicaid allowed low-income children, women, the elderly, and people with disabilities to gain access to health care, thus increasing the need for primary care. This allowed nurses to have more of an expansion in their roles, working parallel with primary care physicians (Penn Nursing, n.d). With the demand for healthcare and more healthcare professionals, the first training program for nurse practitioners was developed in 1965. It was created by Loretta Ford, who partnered with a physician named Henry Silver (Penn Nursing, n.d). This program was used to bridge the gap between physicians and nurses, allowing them to work in a collaborative relationship, and not as a physician substitute.

Early in the 20th century, there was not much regulation as to what nurses did. The Henry Street Settlement (HSS), established in 1893, was a group of 12 nurses who made home visits, providing not only care, but other services including ice, sterilized milk, and meals. The HSS nurses also routinely dispensed physician-prescribed medicines. These medications were obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). This practice was questioned in 1903 with the passage of the state nursing registration act, declaring “Nothing contained in this act shall be considered as conferring any authority to practice medicine or to undertake the treatment of disease” (Keeling, 2015). This act brought up numerous questions as to what nurses were allowed to do. For example, were the nurses able to administer certain medications that were prescribed by physicians? Because the nurses had been routinely doing this during their home visits. Over the years, the HSS grew exponentially. By 1926 these nurses made over 300,000 home visits a year, treating illnesses such as pneumonia, polio, measles, influenza, and tuberculosis (Keeling, 2015). “At the turn of the 20th century, the medical/nursing professional boundaries changed almost daily as new treatments became available and state/federal legislative acts regulated the professions of medicine, pharmacy, and nursing” (Keeling, 2015). Nurse practitioners in the 21st practiced in almost every health care setting, ranging from hospitals, clinics, urgent care, nursing homes, schools, and public health departments. NPs practice autonomously and in coordination with other healthcare physicians, providing healthcare services (Scope of practice for Nurse Practitioners, 2022). NPs are expected to practice with a code of ethics, using best evidence-based practice, and be nationally certified. Their scope of practice includes, “assessment, ordering, performing, supervising, and interpreting diagnostic and laboratory tests; making diagnoses, initiating and managing treatment including prescribing medication and non-pharmacologic treatment” (Scope of practice for Nurse Practitioners, 2022). Over the years, the scope and expectations of a nurse have grown exponentially.

As health care changes, the role of advanced registered nurses will also evolve. With the affordable care of 2010, many demands were placed on health care professionals. The act shifted the focus of healthcare from acute and specialty care to primary care, including care coordination and prevention/wellness (National Academy of Sciences, n.d). This is to help prevent chronic conditions. With the increase in the insured population, there will be more of a demand for nurse practitioners to help close the gap between physicians and physician assistants (National Academy of Sciences, n.d).  In the United States, physicians account for 287,000 of the primary care providers, while NPs account for 83,000, and physician assistants account for 23,000 (National Academy of Sciences, n.d). The education and roles of NPs continue to evolve, allowing nurses to enter the workplace qualified and willing to provide more services than before. NPs work with a team of providers, help to integrate a range of skills, coordinating care from nutrition services, physical therapy, and social work (National Academy of Sciences, n.d). Nurses have come a long way since Florence Nightingale almost 150 years ago and will continue to grow.

References:

Keeling, A. W. (2015, May). Historical perspectives on an expanded role for Nursing. Retrieved August 4, 2022, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Historical-Perspectives-Expanded-Role-Nursing.html

National Academy of Sciences. (n.d.). Transforming practice – the future of Nursing. Retrieved August 4, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK209871/

Penn Nursing. (n.d.). Nurse practitioners: Shaping the future of Health Care. Nursing, History, and Health Care. Retrieved August 4, 2022, from https://www.nursing.upenn.edu/nhhc/nurse-practitioners-shaping-the-future-of-health-care/

Scope of practice for Nurse Practitioners. American Association of Nurse Practitioners. (2022). Retrieved August 4, 2022, from https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners

An advanced registered nurse encompasses many different roles, including nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist. Primarily focusing on the role of a nurse practitioner (NP), NPs have become more common in the health care setting, with licensure, accreditation, and certification requirements evolving in response to the growing demand of the public (Penn Nursing, n.d). During the 20th century, a major factor that revolutionized the role of an NP was the lack of health services. The ability to specialize in medicine created a shortage of primary care physicians. This shortage affected the rural areas or those who lack access to care in inner cities (Keeling, 2015). Primary care physicians, who did not specialize, decided to recruit registered nurses with clinical expertise and collaborate with them to identify and treat the needs of children and families (Penn Nursing, n.d). In addition, the creation of Medicare and Medicaid allowed low-income children, women, the elderly, and people with disabilities to gain access to health care, thus increasing the need for primary care. This allowed nurses to have more of an expansion in their roles, working parallel with primary care physicians (Penn Nursing, n.d). With the demand for healthcare and more healthcare professionals, the first training program for nurse practitioners was developed in 1965. It was created by Loretta Ford, who partnered with a physician named Henry Silver (Penn Nursing, n.d). This program was used to bridge the gap between physicians and nurses, allowing them to work in a collaborative relationship, and not as a physician substitute.

Early in the 20th century, there was not much regulation as to what nurses did. The Henry Street Settlement (HSS), established in 1893, was a group of 12 nurses who made home visits, providing not only care, but other services including ice, sterilized milk, and meals. The HSS nurses also routinely dispensed physician-prescribed medicines. These medications were obtained from local pharmacists and carried in their nursing bags (Keeling, 2015). This practice was questioned in 1903 with the passage of the state nursing registration act, declaring “Nothing contained in this act shall be considered as conferring any authority to practice medicine or to undertake the treatment of disease” (Keeling, 2015). This act brought up numerous questions as to what nurses were allowed to do. For example, were the nurses able to administer certain medications that were prescribed by physicians? Because the nurses had been routinely doing this during their home visits. Over the years, the HSS grew exponentially. By 1926 these nurses made over 300,000 home visits a year, treating illnesses such as pneumonia, polio, measles, influenza, and tuberculosis (Keeling, 2015). “At the turn of the 20th century, the medical/nursing professional boundaries changed almost daily as new treatments became available and state/federal legislative acts regulated the professions of medicine, pharmacy, and nursing” (Keeling, 2015). Nurse practitioners in the 21st practiced in almost every health care setting, ranging from hospitals, clinics, urgent care, nursing homes, schools, and public health departments. NPs practice autonomously and in coordination with other healthcare physicians, providing healthcare services (Scope of practice for Nurse Practitioners, 2022). NPs are expected to practice with a code of ethics, using best evidence-based practice, and be nationally certified. Their scope of practice includes, “assessment, ordering, performing, supervising, and interpreting diagnostic and laboratory tests; making diagnoses, initiating and managing treatment including prescribing medication and non-pharmacologic treatment” (Scope of practice for Nurse Practitioners, 2022). Over the years, the scope and expectations of a nurse have grown exponentially.

As health care changes, the role of advanced registered nurses will also evolve. With the affordable care of 2010, many demands were placed on health care professionals. The act shifted the focus of healthcare from acute and specialty care to primary care, including care coordination and prevention/wellness (National Academy of Sciences, n.d). This is to help prevent chronic conditions. With the increase in the insured population, there will be more of a demand for nurse practitioners to help close the gap between physicians and physician assistants (National Academy of Sciences, n.d).  In the United States, physicians account for 287,000 of the primary care providers, while NPs account for 83,000, and physician assistants account for 23,000 (National Academy of Sciences, n.d). The education and roles of NPs continue to evolve, allowing nurses to enter the workplace qualified and willing to provide more services than before. NPs work with a team of providers, help to integrate a range of skills, coordinating care from nutrition services, physical therapy, and social work (National Academy of Sciences, n.d). Nurses have come a long way since Florence Nightingale almost 150 years ago and will continue to grow.

The role of the Advanced Practice Registered Nurse (APRN) has continually evolved since it began. It seems that the definition of what it means to be as APRN has been changing and gaining clarity over time. The role first came about as a means to provide primary care to the underserved. One of the early examples of this was in the late 1800s at Wald’s Henry Street Settlement House in New York. It wasn’t until 1965 that the official role and title of Nurse Practitioner was formalized. Once formalized, the APRN classification was widely defined as the umbrella term over four roles: Nurse Practitioner, Certified Nurse Midwife, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist. (DeNisco, 2021)

In the latter part of the 20th century and early 21st century, the number of Nurse Practitioners as well as Nurse Practitioner Master’s and Doctorate level education programs have grown dramatically. This has supplied a much-needed infusion of primary care providers, as 87% of Nurse Practitioners are educated in primary care. (DeNisco, 2021)

In addition to the four specialties listed above, Advanced Practice Nursing (APN) has grown to incorporate nursing roles such as nurse educators, nurse leaders, quality and safety specialists, informaticists and others. I believe that the future of our healthcare system will rely heavily on the experience, skills and educations of these advanced roles. One challenge to overcome will be the long-standing issue of inconsistent practice standards as well as licensing rules that exist from state to state. I feel that this lack of clarity diminishes our professional strength and voice that is needed to lead healthcare through current and future challenges. My hope is that we can develop clearly defined guidelines for APRN practice across the country.

The role of advanced registered nurse first grew out of a necessity to provide access for populations in communities lacking access to primary and preventative health during the 1960’s.  However, it quickly grew during the 1970’s to begin educating nurses to diagnose, treat and refer patients for chronic and common illnesses (DeNisco, 2021).

As advanced practice nursing education expanded, so too did variability in scope and authority at the state level despite national standards and a board certification exam. The American Association of Nurse Practitioners distinguishes three separate working domains for advanced registered nurse practitioners which includes full, reduced and restricted authority (American Association of Nurse Practitioners, 2023).  States with full practice authority allow practitioners to function at the greatest potential within their scope of practice including but not limited to assessing, diagnosing, treating and prescribing (Kleinpell, et al., 2023).

At the height of the CoVid-19 pandemic, several states across the US enacted temporary emergency waiver of restrictions in authority for advanced practice registered nurses, allowing them to provide care in a crisis.  For example, Arkansas now permits these providers to perform duties as primary care providers, and be reimbursed by Medicaid (Kleinpell, et al., 2023).  Additionally, the advantages for compact licensure among advanced practice registered nurses has become a topic of discussion. Multistate licensure may allow for these providers to respond more quickly during emergencies and provide telehealth opportunities (Kleinpell, et al., 2023).  As the American health care system evolves, so too does the need to serve the population in dynamic ways allowing advanced practice registered nurses the opportunity to expand their role.

References

DeNisco, S. M. (Ed.). (2024). Advanced practice nursing: Essential knowledge for the profession (5th ed.). Jones & Bartlett Learning.

Kleinpell, R., Myer C. R., & Schorn, M. N. (2023). Addressing barrier to APRN practice: Policy and regulatory implications during COVID-19. Journal of Nursing Regulation, 14(1), 13-20. https://doi.org/10.1016/S2155-8256(23)00064-9

American Association of Nurse Practitioners. (November, 2023). Issues at a Glance: Full Practice Authority. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

 

I chose the Affordable Health Care Act Policy as this is well-known and has been a big part of the legislation. The Affordable Care Act (ACA) makes affordable health insurance available to more people. The law provides consumers with subsidies and tax credits that lower costs for households with incomes between 100% and 400% of the federal poverty level (Affordable Care Act, 2020). Politics plays heavily into policy making and evaluation. A video from Walden University (2018) featuring Joel Teitelbaum shares, “It is clear that politics is playing a vital role in the design of the outset and now the implementation and evaluation of the ACA.” A program could not be successful after many years if it were not being evaluated and adjusted.           

  

            There have been several ways the ACA has been evaluated over time. After evaluation, the ACA has changed from 2011-2022. The policy will always change as the population grows, presidents change, and the cost rises or falls over time. One of the first ways the policy has been evaluated is by the number of individuals enrolled from 2010 to 2022. The government calls this administrative data and has looked at how many people have enrolled through new health insurance marketplaces or the number of people who have enrolled in Medicaid. As numbers have increased over time, policymakers have assumed success. So, if fewer Americans lack health insurance, it will be a crucial indicator of how well the ACA is working. 

  

            Administrative data can be limited, so A lot of the policies evaluation has come from surveys over time. In 2014 before federal surveys were allowed, they launched, the Health Reform Survey, this is a quarterly survey of the nonelderly designed to provide timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes (Long,2014).  This looked at data, affordability, participation, and healthcare access. It helped give a good visual of implementation success. After that rolled out so did other surveys that had been given to private entities, which ask about health insurance by type of coverage and track changes over time. Another survey that is often a source of health coverage evaluation is the Annual Social and Economic Supplement (ASEC) to the Current Population Survey, which provides socioeconomic and demographic information, including health coverage status, for the non-institutionalized U.S. population (Montero,2022). The surveys look at insurance utilization and insurance status. The survey data received from the U.S. Department of Human Services and Medicare has been used for the evaluation and success of the policy.   

  

Social determinants weigh heavily in the health world, especially regarding the ACA. The World Health Organization defines social determinants of health as the conditions in which people are born, grow, live, work, and age (Abrams,2017). Racism, poverty, unsafe neighborhoods, and lack of education are some of the many social determinants that create health inequity in our country (Leong & Roberts,2013). Not everyone had access to healthcare in 2010 due to the high costs of plans. Poverty greatly affected this over time as money was required to deliver efficient care safely. The Affordable Care Act expansion did lessen the consequences of socioeconomic status and healthcare access by assisting disadvantaged persons in receiving health services. The ACA has been a tremendous help to those falling at or under the poverty level. 

References 

  

Abrams, M. (2017). Chapter 7 – Social Determinants of Health. Alliance for Health Policy. Retrieved October 19, 2022, from https://www.allhealthpolicy.org/sourcebook/social-determinants-of-health/ 

Centers for Medicare & Medicaid Services. (2020). Affordable Care Act (ACA). Federal Poverty Level (FPL) – Glossary | HealthCare.gov. Retrieved October 19, 2022, from https://www.healthcare.gov/glossary/federal-poverty-level-fpl/  

Leong, D., & Roberts, E. (2013). Social determinants of health and the Affordable Care 

 Act. Rhode Island medical journal (2013), 96(7), 20–22. 

Long , S. (2014). What do we know about ACA implementation? introducing the Health Reform Monitoring Survey. Introducing the Health Reform Monitoring Survey. Retrieved October 20, 2022, from https://www.urban.org/urban-wire/what-do-we-know-about-aca-implementation-introducing-health-reform-monitoring-survey  

Montero,A. (2022). Measuring Changes in Insurance Coverage Under the Affordable Care Act.  

KFF. Retrieved October 19, 2022, from https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/ 

Walden University, LLC. (Producer). (2018). Introduction to Health Policy and Law with Joel 

Teitelbaum [Video file]. Baltimore, MD: Author.