Advanced practice nursing roles and scope of practice

Nursing

Advanced Practice Role 5901

The Different Advanced Practice Roles

The Different Advanced Practice Roles

Advanced practice roles

The role of nurses has grown quite complex over years. It is no more simply about cleaning the wounds. The advanced practicing nurses have high education- often post-graduation and acquire skills and knowledge to work in complex healthcare situations. Different nurses have different role since advance nursing is organized into levels. Each nurse has knowledge of assessment, diagnostics, planning, and case evaluation. The advance nursing roles are supported by stand level of skill, knowledge, and experience that is applied within the nurse-patient/client relationship to achieve optimal outcomes through critical analysis, problem solving and evidence-based decision making (Advanced Practice Nurses, 2013). The advance practice nurses are categorized into levels of nurse practitioners, nurse anesthetists, clinical nurse specialists, or nurse midwives. All of them offer primary care to the patients and offer services of disease prevention as well as control.

Growth in Nursing and Advance practice

With the rise in technology industry, more people are choosing IT professions and the number of people joining primary care is decreasing. The individuals seek professions that pay highly and do not require a lot of effort (Schwartz, 2013). The primary health care on the other hand is a profession that involves round the clock service and concern for the clients i.e. patients. The job is even tougher during emergencies. The decrease in number of physicians is sheer than the decrease in number of nurses therefore, since there are relatively more nurse practitioners, the demand of health care for practitioner is rising. Currently there are about 1.5 million people covered by medicad services offered in North Carolina but increasing the capacity and adding new practitioners, there can be additional service offered to about 650,000 patients.

Scope of practice

The nurses are registered and educated in order to equip them with standard skills and capabilities to perform their jobs. Yet, the scope of practice of nurses varies from state to state due to laws that differ in different regions (Poghosyan, Lucero, Rauch, Berkowitz, 2012). The scope of practice, as defined by different institutes and legal bodies, define the roles and responsibilities of nurse practitioners. The scope of practice or SoP sets standards about the autonomy of the nurse practitioner. Thus, the nurses are, in some states fully dependent on the decision of the physicians and on the other hand in some states, they can offer the health care service to the patient independently. There is a requirement of direct supervision of the nurse by a physician in some states. While, some regions require that the nurse as well as the physician should be involved in patient care even if the physician is not formally writing the prescriptions. The regulatory environment also sets the stage for scope of practice of the nurse practitioner. Independent nurse practice is legal in some states and illegal in other states.

Compare and contrast of nursing roles

A nurse may generally appear as s single profession to many but it is actually a combination of further distributed roles of individuals. A nurse can be practitioner, educator, informacist or administrator. Each role is defined below separately to understand how do these resemble as well as how do these vary from each other.

Nurse Practitioner

A nurse practitioner is a qualified person who is tasked to handle the patients with critical and chronic condition. Such a nurse starts the treatment from taking history of the patient. The nurse also conducts primary tests and exams on the patient. Depending on the scope of the nurse, a nurse can run a session of diagnosis. Thus a nurse can function as primary service provider and can, independently or under supervision of a physician, prescribe medicine as well. The advanced education of nurses also enables them to specialize in major medical fields like cardiology, oncology, dermatology, and orthopedics. The nurse practitioner can proceed to doctoral programs and conduct research on specific nursing/medical area. The role of nurse practitioner can be summarized as disease assessment, diagnosis, and therapy, offering primary and secondary health care services, maintaining health care and educating patients.

Nurse Educator

The nurse in the role of nurse educator is a professional who educates and teaches the practical and registered nurses. These nurses can teach the nurses as well as patients about the health care and basic services. He teaches graduates as well as post graduate students. Thus nursing staff education is also the job of nurse educator. The education of nurse educator varies on the basis of nurse practice act and the educational requirements of the state or institution. In USA, minimum of graduation level education is required by the nurse educator. The nurse educator may teach general nursing courses or the special medical courses.

Nurse Informaticist

The role of a nursing informatics is to find out ways in which information management can be improved and communication can be enhanced. The nursing informatics seeks to improve efficiency of the primary health care and cut the costs without compromising the quality of health care. The nursing informatics is formally defined as integrating nursing as well as computer science, and information to carry out nursing practice while communicating nursing data (Nursing Informatics, 2007). It offers data integration, information processing and patient support. The information structures, processes, and technology are vital parts of nursing Informaticist. The role is highly dependent on documentation which is used in communication process. The data in documents improve communication as well as speed of the healthcare service provision. Thus taking notes from the patients about their history as well as the reporting of data to the physicians is enhanced. It is the job of nursing informatics to find out ways that make the documentation process simple as well as easy to understand. The documentation and recording systems may include recent technology for data gathering and voice recognition too.

Nurse Administrator

The role of nurse administrator is to understand and respond to various different health care environments. The nurse administrator is not only responsible for self but also to manage the nurses that have to work under them. The team of nurses can work permanently under a nurse administrator or for particular work shifts (Responsibilities of a Nurse Administrator, 2011). The nurse administrator assigns jobs to the nurses working under her and to check if they are performing their jobs well or not. The responsibilities of a nurse administrator involve understanding nursing task, dividing it into subtasks, making and maintaining documents and procedure for nurses, setting nursing goals, developing nursing team and maintaining the budgets of the nursing staff (Ball, 2005). The nurse administrator also schedules the nursing tasks.

Professional organizations

Nurses, like other professionals (doctors, engineers, business leaders), have professional organizations that offer membership for the purpose of professional knowledge up gradation and skill management. There are many such organizations in America as well as the State of New Jersey. One such organization is New Jersey State Nursing Association. The members benefit from services like education continuity, adoption of standards, guidance etc. (National League for Nursing, 2013). The Academy of Medical-Surgical Nurses is considered a dedicated institute that works on medical-surgical nursing. It focuses on achieving excellence by offering patient care and growing nurses both personally and professionally. Membership of Academy of Neonatal Nursing offers benefits like research in the field of nursing. A member can take advantage of peer-reviewed publications, conferences, and interaction with other professionals in industry. The American Academy of Nursing offers services like nursing education, research, leadership and training.

Certification Requirements

The nurses require some capabilities and competencies to get a nursing job in a registered institute. The nurses require having different certifications to prove their knowledge, skills and capabilities. These certifications are requirements of state as well as the country. Some of these certifications include following:

Associate of Applied Science

Acute Care Nurse Practitioner-Board Certified

Adult Nurse Practitioner-Board Certified

Advanced Public Health Nurse-Board Certified

Bachelor of Nursing

Certified Nurse Midwife

Graduate Nurse

Holistic Nurse, Certified

Orthopaedic Nurse Certified

There are different requirements of each state. Some require specialty and some require general credentials. However, all the states require at least graduation in nursing to be able to work in a hospital.

Targeted Nursing Organization

While graduating, every student targets some organizations and dreams to work with at least one of them. Being a nurse student getting education and planning to settle in the state of New Jersey, I target The Robert Wood Johnson Foundation. The organization is considered largest philanthropic organization that offers nursing and health care facilities. The foundation pursues the objectives of maintaining health of all the Americans. Since mu objectives match those of the Robert Wood Johnson Foundation, I would like to work with the foundation. The population of the organization is about 300 employees. The organization's operations involve millions of dollars and have a vast scope.

Leadership attributes of the Advanced Practice Role

Like any other professional in the contemporary world, the nurses are also required to have leadership traits. The nurses are required to show dedication and vision. The nurse educators and the nurse administrators specially need to serve population. There is a specific set of nursing knowledge and skills. The nurse practitioner should be able to make independent decisions (Willard, 2007). Such a decision is backed by the responsibility and sense of accountability.

Leadership style

While every leader is required to offer direction to the followers, each leader differs from the other in is style. I have a participative leadership style. This style is characterized by democratic attitude where the leader interacts with the team members and asks them for their opinion before coming to the final conclusion. In such a style, the leader normally decides on the basis of popular vote. The participative leadership style balances the authority and delegation of authority. Thus, neither the leader decides on all the health care issues herself nor does she leave it all on the team members. Rather the main role of the leading nurse here is to offer and create an environment that promotes cooperation among the nurses in the team.

Leadership attributes

The leaders in nursing industry need to be very quick in decision making and understanding the situation. A nurse is required to have attributes of stability, emotional intelligence, communication skills, empathy, vision and coordination. While I feel myself to have all the other attributes, I often get emotionally stressed and cannot respond correctly to emotionally tough situations. The emotional intelligence is something that allows a nurse to make better decisions and select wise options in emergency situations (Hamric, Spross, and Hanson, 2008). Emotional intelligence can be achieved by understanding personal and professional weaknesses. I work to achieve the emotional intelligence by closely observing situation and my response. Every time I am in a new situation, I try to hold my response until the right time and not to hurry because quick emotional responses might not be correct. However, once I am emotionally intelligent at my profession, I will be making better decisions even fast.

Attaining and evaluating emotional Intelligence

Emotional intelligence can be gained by a number of methods. A person should be first aware of self. This self-awareness helps find our lacking points. The person after recognizing emotions can try to make them positive. Then I can work of self-management. This means to control reactive responses and not to lose patience. A person needs to take positive initiatives to control emotions. I must also learn to be socially-aware since it is not enough only to know self. Knowing the dynamics of society is also important. I would finally learn social management so that my responses are in best interest of the environment.

Health Policy and the Advanced Practice Role

The health policy at The Robert Wood Johnson Foundation is made to maintain a nursing environment that offers quality services backed by research and experience. The policies of the foundation claim to achieve health of the population particularly women and children. These policies offer guidance to the society at large and ask the nurse practitioners, educators and administrators to work on the aspects of nursing knowledge, awareness and education. The policy of the foundation also focuses to develop healthy behaviors not only in the nursing staff and members but also in the patients. Foundation believes that the activity of the children is directly affected by a healthy neighborhood. Thus the policy guides streets as well schools on how to become healthier. Policy makers ensure that the quality of food sold in neighborhood is good and that physical activity of children is increased in the educational institutes. The women in home are also advised to adopt active lifestyles. The nurses are guided in this perspective to help the women and school staff. The policy guides to dedicate proper time and budget to maintainice of health.

What needs to change?

The policy of the foundation puts all the emphasis on the health of women and children. The elders' age is also of great importance. The elders are often least active thus they not only put extra and unhealthy amount of weight but often get other health issues like diabetes and blood pressure issues. This segment of population should also be a prime focus of the foundation's policies. Then the working class that is normally in service industry that does not actively move around should also be the target of awareness programs so that they may involve in healthy activities to maintain their health. It is suggested that the foundation conducts survey on the population and ask them what they expect from the organization. In this way, the foundation will be able to make a more responsive and effective policy.

Justify conclusions

The focus of foundation should be on the working class because if this class does not focus on its health, the overall productivity of the economy will go down. The working class is normally young and adults. Their majority of time is spent sitting on a desk working on files or computers and they can hardly fid time to maintain health and meet doctors. This class works to maximize wealth but not the health. Therefore, changes in the policy to address the health issues of this class will make the organization more effective.

Change Suggested

Healthcare policy making is a process that involves veterans from various different sectors of life. These are doctors, nurses, organizational administrators, financers, educators, legal authorities, patient care foundations and many more. These all work together to ensure that the policy is effective, humanistic, economically well planned and visionary. Therefore, the foundation can involve people from these professional areas to collaborate and offer suggestions on what to make the part of the policy. It is possible to have a better policy than the existing one if the foundation seeks feedback from different professionals. It will offer insight to different problems that are currently not dealt with like the health of working adult class.

Process of Change

The process of change management is critical yet important. There are always many hurdles in the way of change yet facing and overcoming them is important as well as urgent. The health care system and polices require changes that can start from evaluation of the existing processes. The process is discussed and outlined below:

Finding gaps: The foundation can survey on the gaps in the policy and processes. This can be done by involving nurses, doctors, patients, administrators, advisors, legal bodies and organizations.

Suggesting changes: On the basis of the recommendations from specialists, the foundation can suggest changes to the management. These changes should be practical and implementable as well as effective.

Introducing change: The employees should be brief what are gaps in system and how they will be filled. Taking employees on the board will reduce the resistance that is faced otherwise.

Implementing Changes: With the help of management and nurse administrators, the changes can be introduced in the system. The new policy should be implemented replacing the old immediately since both the policies cannot work together.

Evaluation: The foundation should evaluate if new policy is working or not. If the new policy is effective, it should be followed throughout with higher speed. Else it can be changed or withdrawn.

Leading Change in Policy

Leading change requires much more motivation that leading in routine situations. The leader in the health care setting where policy is changed to become more effective should be far more dynamic and be able to communicate the advantages of the change in policy. The employees and members should not be shocked with the changes but told about it in time. Their confidence should be won by involving them in the process of change.

Effect on health care quality

The health care sector in New Jersey is expected to become far more dynamic by including new policy regarding focus on health of working class. The policy will motivate organizations having a certain number of employees to conduct health checkups. Also it would require organizations to offer them time indoor or outdoor time for workouts. This can be done by having exercise facilities in organizations.

Conclusion

The healthcare industry is ever dynamic and its challenges are increasing as well. These challenges require nurses to be more educated, certified, skilled and experienced. Demands of nurses vary based on their jobs but all the nurses require having some level of leadership skills. These nurses should be able to work in challenging environment and make effective decisions.

The policy in health care setting should be supportive so that the society benefits at large.