Nursing Nurse Practitioner Role: Current and Future Trends

If one is looking for a bare-bones description of today's nurse practitioner, a description presented in quite simple terms, it is convenient to turn to The International Council of Nurses; this organization defines the "nurse practitioner / advanced practice nurse" as an RN who has acquired an "expert knowledge base," who has a Master's degree, and whose expanded practice role is shaped "by the context and/or country in which he/she is credentialed to practice."

Meanwhile, Cheryl Stegbauer, a faculty member and nurse practitioner (NP) at the University of Tennessee for the past thirty years, delves a bit deeper into the NP's role in shaping contemporary healthcare: "Most of the medical profession and patients" may understandably "scratch their heads about how the NP role is defined" (Nelson, 2004), Stegbauer offers. "Because the NP approach is holistic, patients like the increased attention [afforded by NPs] and doctors appreciate the value of a symbiotic relationship that can improve patient care in their practices."

Indeed, NPs "fill a critical gap," Stegbauer continues, since there is a "critical shortage of doctors" in many rural and inner city communities, and doctors in those areas are often stretched too thin to be effective.

That said, it is the purpose of this paper to go well beyond the obvious need for competent nurses, and NPs, the obvious gaps in adequate healthcare services presently being filled by NPs, and the critical, vital skills and talent NPs bring to the table; as Sheila Grossman and Theresa M. Valiga point out through the 223 pages of their book, the new and pivotal issues revolve around nursing leadership. In fact, the Grossman / Valiga book offers 52 separate categories of "leadership" in the book's Index, and many more sidebar leadership points and issues are to be found under additional headings and sub-headings in the Index. The information which provides the seeds for cogent answers to this paper's questions -- "So What?" And "Now What?" And "Who Cares?" And "Who Should Care?" -- are found everywhere in this book. That excellent information, along with the analysis of what a NP must be busy doing in terms of preparation for a preferred future, will constitute the substance and direction of this paper.

Topic Information / Analysis of So What? Now What? Who Cares? Who Should Care?

The Grossman / Valiga book is very patiently presented: there are clearly defined learning objectives at the outset of each of the ten chapters, and there are critical thinking exercises and self-assessment quizzes for a reader's follow-up after digging deeply into each chapter. For example, in Chapter Two ("The New World and New Leadership"), the authors begin to set the stage for the new way to look at healthcare by pointing out that 85% of executives in the nursing field reported in a survey that their institution had "already gone through" or was "in the process" of going through serious redesign. This is a great launching place for the highly germane first question, "so what

And, "so what" if there is serious redesign, "retooling" (in the authors' words) and rethinking currently going into how nurses perform their duties, and how healthcare advances new ideas to better serve the needs of the public? So what if this era today is a "new age of healthcare" (27), and so what if there is a dire need to change the perception that "leadership" and "management" are synonymous? (The two concepts shouldn't be thought of as synonymous -- and this book makes clear and provides guidelines through which to eschew that tired and untrue notion.)

Indeed, so what if "many nurses are not prepared for the role they will need to assume" as healthcare seeks to better serve the ill and injured in our society? So what if the nursing profession is moving from the "Scientific Age" (with focus on planning, patient acuity, "using formulas to provide staff coverage" and "following bureaucratic procedures and policies") into what the authors allude to as the "New Science Age" (which emphasizes "empowerment of all" and teamwork, among other dynamics).

What this book takes pains to express is that those not thinking of "now what?" are stuck in the old system of viewing management staff as the true leaders, and the rest of the healthcare talent as followers. The "now what?" In this book offers a vision for future, "New Science Age" nurse practitioners as individuals who no longer just carry out medical orders, but rather, learn the leadership skills necessary to work within the "chaotic" environment...

"Now what?" also means using "our imaginations and be more in tune with the idea that there is more to our work than assessing, planning, implementing and evaluating," the authors assert on page 33.
The authors make the point again and again that the future of nursing is going to be shaped through the development of leadership at the individual level. That is a notion dramatically apart from "leadership" at the corporate level, or executive level, or even the middle-management level; and the leadership called for, the "now what?" leadership, entails the shrugging off of shackles from old rigid notions about "stability" (doing what you are told), and protecting the "status quo" (35). Now what? Here's what: now, we're either moving ahead into an exciting and more progressive period, where independent, critical thinkers are empowered to give better care to patients -- or, we're going to remain an industry clogged with "sheep," "yes people," and "alienated followers," who are eager to take orders and reticent to engage in teambuilding and strategic learning practices.

'Who cares," meantime, whether or not the concept of a new style of leadership, embraced and practiced in particular by the NP, leads to more efficient health care services? The families of the sick and dying care, that's who. The public cares, those who are injured from auto accidents and from gunshot wounds care. If a vitally important decision needs to be made on the spot, if a patient is critically hurt and his survival must be addressed forthwith, and there is no doctor nearby, the NP certainly "cares" that he or she has solid leadership training and strong independent skills in order to be able to save that life.

Those who believe in and strive to communicate the importance of leadership and followership (the art of learning from leaders, of providing vision and energy to leaders; not simply becoming clones of leaders) are the answer to the question, "who should care?" They should, and do care. The vitality and sense of professional satisfaction leaders and followers derive from happy faces on the families of patients -- who are also in the "who should care?" genre -- lend credence to much of what this book delivers, in terms of laying out the dynamics for change, so desperately needed the healthcare industry.

A description of the "Preferred Future" that I seek in Healthcare

Prior to discussing my preferred future in specifics, there are some points brought out in an article in Nursing and Health Care Perspectives (Ketefian, 2000), that deserve attention. The writer, in critiquing the Grossman / Valiga book, states that while the book is "an effective teaching and learning tool," and is presented in an "accessible manner," there is the question of how the practice of "developing leadership at the individual level" can also "enable the nursing profession as a body to demonstrate more effective leadership in the public arena." That is a very appropriate question to ask; and Ketefian, who is professor and director, Doctoral/Postdoctoral Studies and International Affairs at the University of Michigan's School of Nursing, follows that question up with the observation that, "It is not clear how collective and group leadership follows from the individual level."

At a time when polls and surveys show that the public "holds the highest respect for nursing as a profession," Ketefian (EdD, RN, FAAN) continues, "nursing finds itself without much influence in shaping both institutional and public policy." And just "how," Ketefian asks, "can this be explained

The other contention of Ketefian's -- regarding possible gaps in the book's thoroughness with reference to the "real world" of nursing and the workplace -- is that the Grossman / Valiga book does not address the issue of "developing leaders from among members of underrepresented groups, and what the unique circumstances and challenges may be." Ketefian says "this is a missing component" in the book, and "it is not clear that we do a good job of devoting attention and mentorship to the large number of nurses from minority groups."

As for my own preferred future, I have always prided myself on keeping an open mind and heart towards all things relating to healthcare and the people being served and doing the serving. And I certainly hope to continue to develop a sharp and critical eye towards all laws and regulations affecting my work, and also, an eye towards what independent observers / experts -- and professionals from within my industry -- have to say about the present condition and the future of…