There continues to be a shortage of nurses in the U.S. and worldwide, and in some areas there is a shortage of physicians. One particular field of healthcare could provide support where there are shortages and that is the advanced practice RN, a nurse that has gone for a Master's degree in order to get the skills needed to step in and perform healthcare functions in lieu of doctors. Moreover, the advance practice nurse is trained as a leader, a manager, a researcher, and a talent that can solve medical problems.
Advanced Practice Nurse
The RN that wishes to go deeper into the field and point towards a career as an advanced practice nurse (APRN) must first have the aptitude and motivation, and more importantly he or she must also have the knowledge of the educational requirements and professional components that are part of achieving the APRN license. The educational requirements and professional components involved in becoming an APRN will be presented in this paper, along with the emerging roles of the Advanced Practice Nurse, the theoretical perspectives of advanced practice nursing, and a global perspective of the field of advanced nursing.
Emerging Roles of the Advance Practice Nurse
Essayist Michaelene Jansen explains that many APRNs have difficulties simply working from the standard model for nursing; part of their frustration lies in the fact that they have been "…forced to launch their practice within the medical model…due to medical diagnoses used for billing and coding" (Jansen, 2010, 33). The advanced practice nurses today are involved in the identification and validation of "nursing diagnoses" -- and the revisions of existing diagnoses -- in order to follow through with nine "functional patters": exchanging, communicating, relating, valuing, choosing, moving, perceiving, knowing, and feeling" (Jansen, 35). Another role of the APRN is to "…develop skills to capitalize on the chaos in the healthcare system" and also to "create opportunities for the advantage of the profession rather than fear the future" (DeNisco, et al., 2012, 254). Moreover, the APRN must be able to help shape public policy -- by working with and leading other nurses -- and he or she must understand how to navigate the regulatory process (DeNisco, 254).
Professional Components in California & Florida
In Florida and in California, there are many pages (single-spaced) identifying the requirements for being licensed as an APRN (too many to list here). Some of the key requirements include: having a Master's degree in advanced nursing; paying up to $100 for the licensing process; passing state, and regional (or national) examination; have fingerprints recorded and accept a background check; applicants that fail the exam three times in a row (no matter which state they are in or where the examination was taken) are required to complete "a board-approved remedial course" prior to applying for another exam.
In both states, prior convictions must be reported. Even a misdemeanor that has been "…dismissed, or expunged" or otherwise wiped from the official records, must be reported to the licensing board (along with copies of the arrest paperwork); also, in both states any previous discipline / sanction that a nurse received in any context within the field must be reported. Failure to report either an arrest or a disciplinary action will result in disqualification as an APRN (Board of Registered Nursing).
Educational Requirements
The American Association of Colleges of Nursing (AACN) published a report consisting of all the educational requirements that an RN must successfully complete in order to qualify to obtain a license to practice as an advanced practice nurse. Called "The Essentials of Master's Education for Advanced Practice Nursing," the document is in effect a series of national standards that covers the general and specific courses in nursing schools across the country, including the required courses in California and Florida.
The schools provide courses that offer "…essential content to provide direct patient/client services at an advanced level" for advanced practice nursing core (AACN). ONE: Research: The practitioner must be able to gain "new knowledge" constantly through research so this is an important learning moment for future APRNs. The student must learn how to use the appropriate software and "…understand statistics and research methods" along with being able to utilize systems that retrieve and store data (and understand databases). Moreover, the APRN student must "write and communicate effectively" so she or he can "critically analyze the problem" and come up with a strategy for a solution.
TWO: Policy, Organization, and Financing of Health Care: a) the student must be fully aware of government (the legislative and regulatory processes) and private industry vis-a-vis the "shape and direction of healthcare systems"; b) course work provide graduates with the understanding as to exactly how the healthcare delivery systems are supposed to work; c) how the healthcare system is financed, fiscal management, and budget accountability are also important to the student; also when to use the services of a lawyer is part of the learning.
THREE: Ethics: This portion of the learning experience for the RN wanting to be an APRN is important because: a) ethical dilemmas and how they impact patient care must be part of the curriculum; b) decision-making with ethics as a driver for decisions must be learned; c) in what instances do personal conflict of interest arise? FOUR: Professional Role Development: the knowledge and skills to be effective are taught: a) learn collaboration with other healthcare professionals; b) an APRN must be an advocate, a teacher, a researcher, a consultant, a clinician, and a manager; c) changes must be monitored so learning to monitor changes is important; d) graduates must have learned how to recruit potential new students into the field. FIVE: Human Diversity and Social Issues: An APRN must not only be open-minded and comfortable with patients and nurses from other cultures, the APRN must: a) assess his or her community using "appropriate epidemiological principles"; b) understand the cultural norms and specific health practices of myriad cultural and ethnic groups, in order to make care appropriate to any culture; c) be prepared to practice within a "multicultural workforce"; SIX: Health Promotion and Disease Prevention: the course work for this topic should give graduates sufficient skills to: a) use "epidemiological, social, and environmental data to draw inferences" with reference to the health of clients, families, communities and groups; b) monitor holistic and comprehensive strategies that point towards preventing disease; and c) incorporate theories and research that lead to counseling and teaching strategies (AACN).
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