The Future of Advanced Practice Nursing

Role Development for the Nurse with Advanced Education in Nursing

Today, advanced practice nurses specialize in a number of fields, including midwifery, anesthetist, and family nurse practitioner. Moreover, these health care professionals earn far more than the national average are they are in consistently high demand across the country. The purpose of this paper is to explore the role development of a family nurse practitioner with advanced nursing education. To this end, the paper reviews the literature related to the historical, educational, and professional development of family nurse practitioners as well as an examination concerning the current practice environment and related legal and professional considerations. In addition, the results of a telephonic interview with a family nurse practitioner are followed by a critique of the personal skills and characteristics within the context of family nurse practitioners. Finally, an educational and professional practice plan for a family nurse practitioner are followed by a summary of the research and important findings about this advanced practice nursing role in the paper’s conclusion.

Review and Discussion

General role information

One of the defining characteristics of the family nurse practitioner role is its growing ubiquity. Indeed, more than two-thirds of the advanced practice nurses in the United States today hold family nurse practitioner credentials. For instance, according to nursing educators at Carson-Newman University, “Family nurse practitioners (FNP) earn high salaries working in a variety of settings [and] the occupation is among the most popular specialized nursing roles with about 67% of nurse practitioners across the nation [holding] the FNP credential” (Family nurse practitioner overview, 2020, para. 3).

The historical development of the nurse practitioner role dates back a half century when, in 1965, an expansion of the Medicaid and Medicare programs to disabled people and the elderly as well as women and children by the U.S. government resulted in heavy demand for health care services that existing resources were unable to meet. In response, nurse practitioner programs were introduced across the country in order to address this growing demand, especially in rural areas of the country (Family nurse practitioner overview, 2020).

The current regulations for education, certification, credentialing, and competencies for advanced practice nurses vary by jurisdiction, but the provisions of the Balanced Budget Act of 1997 authorized nurse practitioners to receive direct reimbursement and the profession was legally allowed in all 50 states. Today, obtaining an advanced nursing practice degree generally require a master’s degree and a certain amount of clinical experience. In general, advanced practice nurses must provide the following information and documents to receive credentialing and privileging from a health care provider:

· A curriculum vitae or resume that specifies the applicant’s education, work experience, license(s), board certification(s), special certification(s), and references.

· A diploma or certificate and an official transcript from the applicant’s nurse practitioner program. These are used in part to indicate the necessary education and training to function in a particular role (Some agencies may also require a letter or skills checklist from the applicant’s program director indicating which specific skills were obtained during the course of studies. Certain agencies may want to examine case reports, history and physicals, acute care notes, and other supporting materials as evidence of competency in a specific role.) Any clinical logs kept during the applicant’s studies will also help to establish areas of competency.

· Completion of a delineation form that indicates which activities the applicant feels he or she is competent to provide. This assists the agency’s credentialing/executive committee to determine which privileges should be granted (McMullen & Howie, 2020, p. 93).

Some of the professional organizations that support the role of advanced practice nurse include the American Nurses Association (ANA) which established the Council of Primary Care Nurse Practitioners in 1974, an action which provided significant credibility to the new profession (Family nurse practitioner overview, 2020). In addition, the American Association of Nurse Practitioners was established in 1985 and also currently represents the interests of advanced practice nurses across the country (Family practitioner overview, 2020).

Some of the current practice settings for the nearly 300,000 nurse practitioners in the U.S. include family health, medical/surgical units and research. In addition, family nurse practitioners also work in physicians’ offices, hospitals, schools and health care clinics (Advanced practice nurse fact sheet, 2020). Moreover, a growing number of advanced practice nurses enjoy excellent relationships with their other health care team members and professional nursing organizations continue to press for full practice authority for these nursing professionals (Family practitioner overview, 2020). In addition, other authorities are calling for the implementation of nursing residency programs and the elimination of scope-of-practice barriers for advanced practice nurses (Skiba, 2015).

Interview

The interviewee, “Lindsey W.” (her real name) is an advanced practice nurse specializing in family nursing in Oklahoma City, Oklahoma at a major tertiary health care center that is part of a regional network of medical facilities. At present, Lindsey assumes the alternates role of general family nurse practitioner and breast feeding specialist. In her capacity as a general family nurse practitioner, Lindsey’s responsibilities include the provision of preventive health and other health education services to patients of all ages as well as performing diagnoses, disease management and treatment for certain conditions. Conversely, in her capacity as a breastfeeding specialist, Lindsey instructs expecting and new mothers concerning the numerous benefits of breastfeeding, how to maintain adequate milk supplies and proper placement for feeding newborns.

Not surprisingly, Lindsey has experienced significant barriers to implementing her respective roles as family nurse practitioner and breast feeding specialist due to the ongoing Covid-19 global pandemic. In fact, the interviewee advises that her health care network was forced to close one of their hospitals in Oklahoma City, except for the emergency department, for several months following the onset of the pandemic in early 2020 due to a decline in demand for elective surgeries and care. This closure, however, was temporary and the hospital in question resumed normal operations in June 2020 but it underscored the severity of the ongoing pandemic.

With respect to her role as a family nurse practitioner, Lindsey reports that her responsibilities have been severely curtailed in recent months due to a decreased demand for patient care, but the cases she does see have been more acute than normal. In addition, Lindsey reports having received an inordinate number of telephonic requests for emergency medication refills from her patients and family members that have typically maintained a regular visitation schedule in the past.

In her capacity as a breastfeeding specialist, though, Lindsey notes that her caseload has increased significantly over the past 2 months. Although she was unable to pinpoint any specific cause for the increase in demand, she did indicate that several new mothers expressed their discomfort with shopping for formula and exposing themselves to potential infection by the Covid-19 virus, preferring to remain in their homes and feeding their infants naturally. In addition, Lindsey indicated that it was noteworthy that many of these same new mothers were either already aware of or were less interested in the numerous health benefits that accrue to breastfeeding, but she was gratified that more women were electing to breastfeed for whatever reasons. In this regard, Lindsey added that the majority of her patients were from low-income families and many new mothers elected to breastfeed for the pragmatic reason that it was far less expensive than costly commercial baby formula.

Irrespective of their cited reason for wanting to learn to breastfeed properly, Lindsey emphasizes that she tries to take these opportunities to motivate her patients to make other healthy changes in their lifestyles such as smoking cessation or weight reduction as well. This professional philosophy is congruent with the guidance provided by Johnson (2012) who advises, “"When a new baby is born, it is a motivating time for a lot of people to start making changes that are healthy, and starting with breastfeeding is an incredible way to start a healthy habit that will last a lifetime” (p. 20).

With respect to the resources she has available to help her In her dual roles as family nurse practitioner and breastfeeding specialist, Lindsey laments the loss of the “before-times” (her work environment prior to the onset of the Covid-19 pandemic). Current hospital policy mandates the use of telemedicine by advanced practice nurses whenever possible, and Lindsey emphasizes that many of her patients are not native English speakers and this communication medium is suboptimal for her patients’ needs.

Furthermore, Lindsey also reports that a number of family medicine clinics operated by her health care network have closed temporarily, and the alternatives that have been made available are far less effective. Further, Lindsey points out that all advanced practice nurses in this network have been notified that they may be subject to furlough if demand for elective services remains low. In addition, Lindsey also notes that all nurses have been advised that they may be transferred to emergency care temporarily during the pendency of the pandemic if demand exceeds available resources. In sum, this situation has created a profound sense of unease among Lindsey and her advanced practice nursing peers that have adversely affected their morale and productivity.

Personal development

An appropriate theoretical model that can help guide Lindsey future personal development is the aptly named career development theory (Nevill, 1997). The career development theory provides “additional perspectives from which to improve and elaborate on the way practitioners and researchers comprehend and intervene in occupational choice and career development” (Savickas, 1997, p. 248). Some of the personal characteristics and traits that make me an appropriate candidate for the family nurse practitioner role include empathy, compassion, caring and a strong sense of self-efficacy.