This paper is a reflective assignment on the role of the APN in the modern healthcare system. The role of the APN is changing rapidly, as APNs are assuming more and more of the duties traditionally delegated to physicians alone. There is also conflict between APNs and nurses on many wards, where APNs are being asked to assume leadership positions once relegated to physicians and managers.
APNs
Competency
Course competencies: APNs
The role and scope of practice of the advanced practice nurse (APN) in every field and sphere of healthcare has expanded in recent decades. There is "growing recognition that educational preparation must be adequate to meet the expectations that will be placed on the practitioner, coupled with increased regulatory oversight by state boards of nursing…Mandated education at the master's level is now the expected norm for advanced practice nursing" (Hanson & Harnric 2003: 203). With the increased professionalization of the role there has also been increased specialization, "specialties such as psychiatry and oncology leading the development of a cadre of master's-prepared APNs who moved the specialty forward. Current calls for master's level preparation in the specialty of wound/ostomy/continence nursing indicate that this specialty is moving into the third phase" (Hanson & Harnric 2003: 204). Other specialties once subsumed in the APN role have branched off into their own disciplines such as nutritional science. Regardless, the APN clearly plays a vital role in modern healthcare and has considerably expanded the types of duties thought suitable for nurses and the depth as well as the breadth of expertise expected of nurses. APNs can be found in almost every practice setting, from primary care to specialist's offices to anesthesiology to midwifery to critical care.
Yet the expanded role of APNs as independent caregivers has become a topic of frequent debate within the healthcare profession, including amongst APNs themselves who call for more vigorous policing of the definition of the profession. Rising healthcare costs have made using APNs more and more important given the comprehensive nature of APN's capabilities in diagnosis, treatment, and offering specialty care in a manner comparable with that of a physician. But there has been conflict within the profession due to this expanded role, not simply because of friction between APNs and the physicians of whose roles they are subsuming but also between nurses who function within different sub-specialties themselves. "Addressing this issue requires an agreement both within and without the profession that a developing APN specialty constitutes an advanced nursing role" (Hanson & Harnric 2003: 205). For example, nurses who function in a managerial role as APN case managers may often use business skills more than nursing skills in their daily practice. Some nurses believe that "the title 'advanced practice' will have meaning only if it is used consistently to refer to advanced clinical practice, rather than being inclusive of other advanced roles in the profession, such as in research, education, and administration" although "all roles, whether specialty or advanced practice, are valuable and vital to the profession's continued development" (Hanson & Harnric 2003: 205). Others demand a more inclusive vision and stress the need for a multi-layered approach to gaining full respect for APNs.
Delineating such clear roles for APNs can be challenging when the expanded role of APNs is linked to a number of problems within the healthcare system with a wider scope beyond nursing, such as a lack of primary care for many families and a shortage of primary care physicians. Still, the evidence is clear that APNs can provide high-quality care and is bridging that gap. "Sixty-nine studies published between 1990 and 2008 were analyzed and 28 outcomes were summarized for nurses practicing in APRN roles. The results indicated that APRNs provide safe, effective, quality care and play a significant role in promoting health and health care" (Patient Protection and Affordable Care Act; Program Integrity, 2013, ANA). Using APNs for roles once fulfilled by physicians promote patient wellness. APNs can provide accessible, personalized, and high-quality service.
However, because of the ambiguity of their roles, APNs may be called upon to perform multiple functions in a diverse healthcare environment. APNs often must "use their technical knowledge and skills to provide support and teaching, particularly to nurses and junior doctors when they first started on the wards and were unfamiliar with the organization" (Williamson 2012). APNs act as teachers and mentors; facilitators and delegators as well as offer care to patients. Regardless of whether the profession was intended to assume an educational and directive role, it has in many contexts for both specialists and generalists.
It has also been observed that having an APN on a ward often results in a transfer of responsibility to the APN, particularly if doctors are not available, which can result in an shift in responsibility and power in favor of the APN away from those of less credentialed nurses in a process known as 'deskilling.' Combined with the blurred roles for APNs, one study noted that frequently "APNs perceived that they were part of neither the medical nor the nursing team, yet had to meet competing demands and, in some cases, overcome the antagonism of colleagues" (Williamson 2012). There may also be antagonism between APNs in various specialties and clinical nurse practitioners who have areas of personal expertise but lack advanced degrees.
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