Blended role advanced practice nursing

Advanced practice roles that include blended roles of the CNS and NP, the CNM and the CRNA

Nursing began as a generalized discipline but has become increasingly specialized as the profession has grown more technical in nature. "From these early beginnings -- the nurse midwife (CNM), the nurse anesthetist (CRNA), the clinical nurse specialist (CNS), and the nurse practitioner (NP)" evolved (Hanson & Harnric 2003: 203). This process of evolution was a relatively gradual one, as the specialty developed in specific practice settings; gradually made organized training for specialties available in routine clinical practice; then, finally, with the growth of the specialized knowledge base the pressures mounted "for standardization and graduate educational programs" (Hanson & Harnric 2003: 204). This can be seen in the more recent evolution of the specialty of the nurse pediatrician. For example, at Vanderbilt University's School of Nursing, its "Pediatric Primary Care Nurse Practitioner (PNP) track provides a broad theoretical and research foundation in advanced concepts of parent, child and adolescent nursing. An expert preceptorship provides an immersion experience with a clinical mentor -- combining theory, research and practice in a clinical setting. Direct clinical experience is provided through observation and participation on a health care team in a primary care setting" (PNP, 2013, Vanderbilt).

In the field of medicine, fewer and fewer physicians are embarking upon careers in less lucrative specialties such as primary care and pediatrics. Nurses are beginning to fill this 'gap' and can provide more cost-effective solutions for routine care. Increasingly, nurses may be able to take on many of the roles of doctors in this evolving field. "Like other nurses, pediatric nurses can perform physical examinations, measure vital statistics, take blood and urine samples and order diagnostic tests. Nurses with advanced training can interpret test results to form diagnoses and develop treatment plans" (Pediatric nurse, 2012, Explore Health Careers). Nurses can specialize in this field at universities which offer it as a specialized 'track' where they take relevant electives and focus their training upon this aspect of practice. In the future, it is likely to become a critical specialty given demographic and economic trends in healthcare today.