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...

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…