Nurse practitioners: roles, responsibilities, and job satisfaction

Advanced Practice Roles in Nursing

What is Advanced Practice Nursing? Advanced Practice Nursing offer new ways of practicing and delivering cost-effective health care as well as augmenting access to qualified practitioners for numerous patients and their families. Advanced Practice Nurses frequently offer their services to under-served populations. They must be ground in research and theory as the guides of their clinical practice.

They work in reciprocal capacities with physicians. They also prepare to diagnose, treat and assist patients with chronic and acute diseases as well as prescribe medications. These job duties require smart and perceptive, caring and compassionate nursing professionals. NPs often develop differential diagnoses and prescribe medication. Nis participate in research studies. NEs or Nursing Educators provide the basis for family/patient counseling and education. NAs or Nursing Administrators maintain patient records and arrange patient referrals/consultations.

Nurse practitioner or NPs supply much of an individual's health care needs. They are also widely regarded as a critical component of any modern health care system. For over half a century, NPs provided a vast amount of various services in chronic, acute, and community settings. They make their presence an essential one in any healthcare setting. In the future, NPs will become an even more crucial part of health care delivery. This is because Americans will gain increased access to broader services through new and upcoming health care reform efforts.

What are Nurse Practitioners? NPs or APRNs (Advanced Practice Registered Nurses), are one of four roles that encompass a kind of advanced practice nursing. These four are nurse mid-wife, nurse practitioner, clinical nurse specialist, and nurse anesthetist. Each role requires a graduate degree to qualify as a practitioner. In most places in the United States, NPs must also be registered nurses, have graduated from accredited graduate programs, as well as hold certification reflective of the specialized nature of the specific graduate program.

Furthermore, because states have their own requirements for becoming an NP, NPs must adhere to a particular state's criteria. It is often hard for NPs to feel as though they are not being pulled in a million direction from the process of becoming an NP to having to do various job functions. However, because NPs provide so much for the health care community, they do have some say in relation to improving job satisfaction. "There were significant differences in job satisfaction based on intent to leave current positions, and higher job satisfaction scores were significantly related to intent not to leave current positions. There was a significant negative relationship between job satisfaction and anticipated turnover." (De Milt, Fitzpatrick & McNulty, 2011, p. 42).

As the Nurse Practitioner Movement evolves, it becomes part of the constant change of how the public elects who has the authority to grant healthcare. Traditionally physicians were the ones that guided most patient outcomes. However, as access to physicians declined, patients relied more on NPs. They have become the new primary care providers. When looking at their role and the roles of others in their field like nurse educators, nurse informaticist, and nurse administrator, they are the ones that provide a supportive role in healthcare vs. NPs that act as the primary method of health care delivery besides physicians.

They may direct a protocol for patients to follow in terms of making proper lifestyle choices in a clinical setting. They may take blood pressure readings, perform blood screenings and even diagnose and prescribe medication. They are often the ones that do most of the delivery of care for patients in relation to diagnosing and treating illness (Hamric, Hanson, Tracy & O'Grady, 2013, p. 71).

To begin, Nursing Informatics is the practice and science of integrating nursing, its knowledge and information, with proper management of communication technologies and information in order to promote the health of families, communities, and people internationally. Nursing Informatics empowers all healthcare practitioners in achieving quality patient centered care. Specifically, Nurse informaticians works as a sort of developer of information technologies, and communications. Similar to nurse educators, Nis are researchers, educators, implementation consultants, policy developers, and business owners to advance healthcare. They carry and perform many roles much like NPs and do many information-based job duties like Nurse Educators.

NIs provide definition of healthcare policy and address inter-professional workflow requirements over all care venues. They are the go between for information and communication similarly to the NP who is the go between for physician and patient. The contrasting part of being an NI is they are the ones that are focused on information and knowledge, versus educators and practitioners that focus on theory, practice, and direct implementation.

They may participate in research studies and provide policy reform within a clinical setting. To some extent, much like NAs, they may obtain health histories as well as provide documents and other records for other health care employees to utilize for delivery of care. They do not perform any function outside of information and communication.

Nurse educators are important players in the assurance of quality education experiences, which prepare the future nursing workforce for a varied, ever-changing health care environment. Nurse educators are leaders, documenting outcomes of education nursing programs. They guide students through theory and the overall learning process. Like the other two roles, they are an important part of health care because they train future practitioners.

Nursing educators are also practitioners, either retired or still working. They instruct in a variety of fields and help students learn what needs to be done during practice as well as help them decide on the discipline and develop core values and beliefs while in practice. As education evolves, Nurse Educators and nursing program wish to provide interprofessional learning environments to better educate students and enable them to make better decisions for their future. "The faculty developed an interprofessional education program for students in nursing, physical therapy, nutrition, and respiratory care, which focused on sharing knowledge about each discipline, developing respect and value for each other's disciplines, and emphasizing techniques to improve communication and teamwork" (Cranford & Bates, 2015, p. 16).

The main difference with educators in relation to the other two roles is that Nurse Educators teach theory and are or were practitioners. They earned their experience and then taught about what they learned as well as the updated information that comes from the ever-changing education setting. They are the ones that prepare the nurses for clinical practice and assist students in electing their specialty.

When looking at a clinical setting, NEs may provide education and counseling for patients and their families. They may offer consultation for other NPs and guide NPs in proper care of patients. They are often the head nurse and supervise the actions of the other nurses, as they themselves are practitioners. They instruct new practitioners and make sure they do not make mistakes when practicing on a patient. They may even have new NPs observe what they do so they can learn.

Similar to Nis, NAs or Nurse Administrators help develop policies. They are the ones that create work schedules as well as give performance reviews. They have to be a registered nurse in order to qualify for the position. Much like NPs that have to pass a licensing exam as well as pursue continuing education. Some other functions they perform are to attend administrative personal meetings, develop new employee training and have little to no direct contact with patients.

Little to no contact with patients is a big difference between NA and NEs and NPs. Although Nis also do not have much contact with patients as well. So here, some similarities can also be found. In fact, most of the job duties performed by NAs are in the office, not on the care floor. They may work in nursing homes, hospitals, private doctor's offices, urgent care facilities, or home health care organizations.

NAs within a clinical setting are often the ones to assist nurses with ethical decisions.

Nurse administrators are in a position to encounter ethical dilemmas when evaluating philanthropic proposals. Nurses may have little formal training in ethics, or they may be most experienced with ethical frameworks that apply primarily to clinical patient encounters. Gifts of goods, services, education, or other benefits to nurses may create ethical dilemmas. Philanthropic ethics and potential dilemmas are discussed in nonnursing professions such as medicine and nonprofit administration but rarely explored in the nursing administration context. Nurse administrators in a position to evaluate generous offers of philanthropy should identify key components to fully assess the ethics of their receipt (Klein, 2014, p. 319).

As it relates to clinical practice, help arrange patient consultations and referrals. They also assist in evaluating or even modifying a patient's response to plan of care. They help train staff properly and deal with any problems related to patient dissatisfaction and patient complaints. Although they have little to no contact with patient, they can and will speak with patients, if patients are not happy with the level of care the health care facility provide them. They have the ability to grant patients and nurses a level of authoritative reference and guidance in ethical matters.

Selected Advanced Practice Role

For the state of New York, the regulatory and legal requirements to be a Nurse Educator are as follows. Article 139 of nursing states in section 6902, a registered professional nurse teaches health as well as provide other services. Furthermore, corrective measures within any specialty zone of practice, in partnership with a licensed physician who is qualified to collaborate. Nurse Educators are sometimes or were NPs and at times may require to be licensed. Those that are practitioners are able to diagnose illness, perform corrective and therapeutic measures, and provide education for patients, students, or other groups. Section 6905 discusses the requirements for a license within the state of NY as a registered professional nurse. These include education, experience, examination, citizenship, and fees.

The professional organizations available for membership for Nurse Educator are PNEG or Professional Nurse Educators Group and ANA, American Nurses Association. PNEG is a virtual network for those wishing to be or are Nursing Educators, covering all of the United States. All educators in the field have access to this network and they hold conferences annually. ANA offers a section just for Nurse Educators that include tools like desk copies, course adoption program, classroom tools, and nursing standards adopted by ANA. There are even instructor modules.

The required competencies, including certification requirements for Nurse Educator are varied. Certification for Nurse Educators include two options. Either they can accrue fifty-renewal credit during the recertification cycle or they can take the CNE exam. They must fill out forms, pay fees and if the pass the Certified Nurse Educator exam they will have their certificate. The required competencies first should match needs of the institution the Nurse Educator works for. Nurse Educators must show competence in clinical practice as an advance generalist or specialist. There are several roles for a Nurse Educator but the baseline requirement is a Bachelor though Masters in Science is encouraged in Nursing Education. They must have significant clinical experience and expertise as well as a nursing license. NEs fill several roles. The teacher's role involves use of technology in teaching, a broad repertoire of instructional approaches among other things. They also provide clinical supervision for learners and maintain appropriate academic records. In the scholar role they assist learns to apply and interpret research in nursing practice as well as recognize chances for conducting research in nursing. As a collaborator role they demonstration educational and professional values, explain the nursing curriculum, and consult with other in and outside of their discipline.

I plan to work in a hospital. The setting would be urban New York like one of the five boroughs of New York City. Much of what was mentioned in the prior section consists of assisting people in underserviced areas. Here is where I would like to concentrate my efforts. The population will be mixed, of various ethnicities and races. Most of the population will be middle aged or elderly because of the chronic health problems that increase with age. I plan to work with Nurse Practitioners, physicians, administration, among others. As a Nurse Educator one may come to interact all areas of the hospital to teach and instruct, especially with new practitioners and patients.

Health Policy and Advanced Practice Role

The current policy for childhood obesity splits into 26 recommended policies. Three of which show the most promise in reducing childhood obesity rates. "…that afterschool physical activity programs would reduce obesity the most among children aged 6 -- 12 years (1.8 percentage points) and the advertising ban would reduce obesity the least (0.9 percentage points). The SSB excise tax would reduce obesity the most among adolescents aged 13 -- 18 years (2.4 percentage points)" (Kristensen et al., 2014, p. 604). These three policies are easy to implement and seem more effective than creating so many policies for one issue. If federal policy were altered, it would be modified to only include policies that work like the three shown in the article.

Much like evidence-based practice transforms health care policies; the same approach must be taken on childhood obesity. In order to make the change, researchers must gather enough evidence to support or reject current policies. RWJF's goal was to support and stimulate research in order to identify possible environmental factors as well as policies that may influence physical activity for families and children. "…to inform effective childhood obesity prevention strategies, with an emphasis on the lower-income and racial/ethnic communities with highest childhood obesity prevalence" (Sallis et al., 2014, p. 195). The federal government is a key player as well as businesses and other sources for funding in order to gain enough grant money to obtain enough evidence.

Numerous countries began adopting policies that assist in the prevention of childhood obesity including support for more linked initiatives. "Communicating information about these practices will help researchers, public health professionals, and policy makers around the world to take action to fight the growing epidemic of obesity and other nutrition-related diseases" (Zhang, Liu, Liu, Xue & Wang, 2014, p. 171). By gathering information from foreign policy on childhood obesity and demonstrating the evidence of what works for them, policies in the United States may be reformed faster without additional studies. Research is key in modifying policy.

If childhood obesity policy changes occur in the future and promote reduction in childhood obesity, there will be healthier children with less health problems. These children will then take their healthy and active lifestyles into adulthood and instill positive values concerning health in their children. Chronic disease will decrease lessening health care expenses. "Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system" (Bauer, Briss, Goodman & Bowman, 2014, p. 45). The community and the environment benefit from healthier people.