How nursing practitioners evolve

Abstract
A practitioner in the nursing profession is someone who is intelligent enough to offer comprehensive health services for the people of Alberta at all times whereas an NP (Nurse Practitioner) is a registered professional with high level education at graduate level. An NP's role involves the provision of a wide range of health services and the role played by an NP is different from that played by a registered nurse due to the fact that an NP has to have superior knowledge and advanced skills in decision making which need to be acquired through extended clinical practice, experience and education. This makes it possible for the NP to manage more duties that are beyond the scope of what a registered can do. The NP’s accountability, responsibilities and professional role entails consultation, referral, collaboration, leadership, research and most of all clinical practice (College and Association of Registered Nurses of Alberta, 2017). The SNAP (Saskatchewan Nursing Advanced Practice) model is a good base to understand the role of NPs across the board.
The SNAP (Saskatchewan Nursing Advanced Practice) model happens to be a framework of education entailing the program and curricular design of CNPP (Collaborative Nurse Practitioner Program). CNPP was borrowed rom from “Strong Model of Advanced Practice Nursing”. This model has been widely accepted as a reliable and valid way of portraying the role of advanced practice dimensions in the context of international modern health service (Saskatchewan Registered Nurses’ Association, 2016).
Introduction
The origin of the NP model wasps the basis for the SNAP model and later formed the strategy adopted for the enhanced primary care access. This strategy was used as a response to the decline of physicians providing primary care. The Colorado University was the place where the first NPs program was successfully prepared in the year 1965. The program was co-directed by Loretta Ford, a nurse, and Henry Silver, a physician and it entailed the preparation of pediatric NPs whose focus was the wellness and health of patients. The collaboration between NPs who have no degree but have an advanced level of education, and skilled physicians made it possible to recognize the diagnosis, symptoms and eventual management of children’s health problems (Sherwood et al, 1997). This is especially the strategy used across Canada from a very early stage.
The delivery of healthcare as a whole has rapidly evolved in Canada. This radical evolution is credited to aspects such as innovations in technology, new care models, increasing practice scopes for non-physicians, changing expectations from patients, and new requirements and regulations in healthcare. A fundamental change for the physicians involves the expansion of NP roles in many jurisdictions from Canada including Alberta under the foundation of the SNAP model. The NPs in Alberta province are health professionals who are under regulation but function independently. They are licensed to operate by CARNA (College & Association of Registered Nurses of Alberta) and the NPs can operate in autonomy while also being able to work alongside other providers of healthcare (Alberta Medical Association, 2015).
NPs from Alberta are poised to work in many settings including clinics, public health facilities, outpatient and inpatient hospitals, public health centers, urgent care facilities, and community health units. NPs will also play a role in inter-professional groups in the family care hospitals and primary care systems. Due to the fact that NPs are independent and regulated health professionals they have the authority to operate independently within the scope of their legislation and the limitations of the experience and the training that they have. Any NP functioning beyond the stipulated practice scope is only allowed to do that under appropriate supervision and medical directive. HPA or Heath Professions Act alongside the regulations for professional nurses details the NP’s legal authority in their practice scope. Over and above this the practice scope from CARNA details the practice scope under which registered nurses operate. At the moment Albertan NPs are mandated to execute several clinical duties like placing an order for prescription medication, diagnostic tests, monitoring the outcome of clients, management of chronic disease, provision of continuing care, consultations for patients and referrals to physicians, alongside other providers of healthcare (Alberta Medical Association, 2015).
Competence
In recent times graduate nurse practitioners in Alberta have become proficient in the details of the NP practice as time goes by. Continuous support and education from other NPs, employers, physicians as well as fellow group members has played the part (CNA, 2010). NPs need to individually evaluate their competence levels and sustain their competence levels continuously. NPs are mandated to involve themselves in CCP (Continuing Competence Program) for CARNA (Alberta Medical Association, 2015) as well understand their roles as outlined in the SNAP model.
The NP and APNs competencies are detailed in SNAP model as precise personal attributes, skills and knowledge necessary for ethical and safe practice. Competencies in nursing practice are fundamental for the development and education of NP concerning their work roles and nurse practitioners at entry point need support and time from their mentors, healthcare groups and employers in order to cement their judgment, abilities, knowledge, skills, expand their professional network as well as advance their personal care delivery approach. As the NPs become more confident in NP clinical responsibilities they deepen and develop their expertise andd competencies in leadership, mentoring skills and research skills which are fundamental components of any NP role (Saskatchewan Registered Nurses’ Association, 2016).
Competencies at entry level are categorized into 4 categories of competency: Quality research and improvement, client care, education and leadership. The competencies at entry level are relevant in the first 12 months of NP practice. The SRNA standards for NP are influenced by CCRNR analysis and thrive from the foundational competencies of NP at entry level. The competencies at entry level for the existing SRNA NP are utilized alongside the practitioner standards for SRNA NP (Saskatchewan Registered Nurses’ Association, 2016). The first area of competence i.e. client care will have 6 other sub-categories of competency. These subcategories elaborate the significance of NP clinical dimension of their professional responsibilities. The six subcategories as competently and legally recognized include building of relationships with clients, communication, management and treatment, assessment diagnosis, consultation, health and referral promotion (Saskatchewan Registered Nurses’ Association, 2016).
Legislation
The practice of NPs is in compliance with the scope that is legally recognized and must be within the entirety of relevant regulation. Even though NPs may be authorized and competent to operate under HPA, some federal and provincial legislations have not recognized NPs as being authorized health providers with authority to execute some responsibilities. This is so due to the fact that the HPA regulations require all members under regulation to complete a contemplative review of their practice annually through a form submitted to the competence committee of the college. The regulation also requires the members to include some personal assessment for their own nursing practice in compliance with the college standards. The NP ought to have an implementation and development of written plan for learning followed by the assessment alongside some written evaluation of learning results. Finally, an NP is required to provide some feedback regarding the nursing practice of the member under legal regulations of the model as they exist and change across time (College and Association of Registered Nurses of Alberta, 2017). They are also required to adapt to all regulations for renewals as well.
NPs are required to comply with the renewal requirements stipulated within the past five years of membership after completing 1125 RN practice hours and also offer satisfactory evidence to register that they have completed 600 NP practice hours in the space of the past 2 years of membership. It is the responsibility of the NP to understand the impact that the auxiliary legislation has on their practice scope and comply with the legislation during their practice. The legislation includes federal regulation on drugs and food, CDSA (federal Controlled Drugs and Substances Act), hospital act dealing with discharging, treatment, and admission of clients, organization act from the government concerning the supervision of persons that are not regulated, and the act that protects persons under care for the purpose of promoting deterrence of abuse for adults receiving support services or care that is funded by the government (Health Professions Regulatory Advisory council, 2007). This can be seen in thhe foundation principles of SRNA as applied in Saskatchewan.
The SRNA, being a profession that is self-regulating, develops the standards of the NP profession in Saskatchewan. The standards of practice are developed with the assistance of NPs and offer employers, government, educators, the public and other providers of healthcare information about what a Saskatchewan NP is expected to do. The standards of practice for NPs are revisited after a five years period in order to integrate new NP practice developments. Staff depends on SRNA, NPs, RNs, key stakeholder, and employers’ feedback as a way of ensuring that the documents are reflective of modern practice (Health Professions Regulatory Advisory council, 2007). These can regulations and models can therefore be used to recommend furture models for NPs.
Recommendations
The implementation and development of a funding model for NP that is sustainable is executed for the purpose of supporting collaboration among healthcare groups while at the same time enhancing the autonomy of NP care. The united front from the governance of professional nursing practice, employers and funders of healthcare is formulated to support and market NP’s practice scope in Alberta. The provincial committee put in place is designed for the purpose of identifying the organization that will indirectly or directly interact with NPs. This committee also champions the revisiting of procedures and policies adopted in the organization in order to reflect practice scope for NPs. Governance structures are elected for the purpose of prevention of marginalization and monitoring the scope of NP practice (Tapper & Trevoy, 2014) as well as its growth, evolution and application in the short and long run.
Conclusion
The NP role has continually evolved in compliance to the changing healthcare and societal needs even as healthcare consumers in all categories continue to seek more services. Through the evolution NPs have the chance to become significant players in delivery of healthcare. In the efforts to clarify the NPs primary healthcare leadership responsibilities, the NPs working in the academic field offer support to the university’s missions just as other faculties do (Sherwood et al, 1997).
As a result of this, NPs become essential contributors to the new pool of knowledge, in the application of that knowledge in clinical practice, incorporation of concepts of nursing and other concepts from disciplines that are related. NP profession members have a duty to advance their NP role and ensure professional standards are sustained and maintained. The outcome of NP research will make it possible for them to impact on the public policy as they participate in the activities related to the health policy and the professional organization at international, national, state and local levels using the aforementioned foundational models like SRNA, CDSA, HPA and SNAP. Although the nursing practice scope is evolving NPs have remained to be an integral force in the shaping and expansion of primary healthcare services both in Canada and the U.S. The NP model is poised for global expansion (Sherwood et al, 1997).
References
Alberta Medical Association. (2015, March 26). Physicians and nurse practitioners. Working collaboratively for better patient care. Retrieved October 3, 2018, from https://www.albertadoctors.org/5301.aspx
College and Association of Registered Nurses of Alberta. (2017). Scope of Practice for Nurse Practitioners. Retrieved October 3, 2018, from http://www.nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Standards/NP_ScopeofPractice_2017.pdf
Health Professions Regulatory Advisory council. (2007). Scope of Practice for Registered Nurses in the Extended Class (Nurse Practitioners). A Jurisdictional Review. Retrieved October 3, 2018, from https://www.hprac.org/en/projects/resources/hprac-nursing.jurisdictionalreview.november2007.final.pdf.
Saskatchewan Registered Nurses’ Association. (2016). Registered Nurse (Nurse Practitioner) Entry-Level Competencies. The Saskatchewan Gazette. Retrieved October 3, 2018, from http://www.publications.gov.sk.ca/freelaw/documents/Bylaws/SRNA/September22,2017.pdf
Sherwood, G. D., Brown, M., Fay, V., & Wardell, D. (1997). Defining nurse practitioner scope of practice: expanding primary care services. The internet journal of advanced nursing practice, 1(2), 1-12.
Tapper, L., & Trevoy, J. (2014). Key Issues Impacting Nurse Practitioner Practice and Integration in Alberta. Nurse Practitioner Association of Alberta, 9-10. Retrieved October 3, 2018, from https://albertanps.com/wp-content/uploads/2015/03/Key-Issues-for-Nurse-Practitioners-of-Alberta.pdf.