The nurse practitioner role: theoretical foundations and historical development

NP "role" definition

A nurse practitioner is any independent certified nursing care provider who offers primary, specialty, or both primary and specialty, nursing services in long-term, ambulatory and acute care settings. NPs are engaged in the chronic or acute episodic ailment assessment, diagnosis, treatment, and management. They are specialists in the areas of illness prevention and health promotion, and perform the tasks of ordering, performing, overseeing and interpreting lab and diagnostic tests, prescribing non-pharmacologic treatment and pharmacological mediators, and educating and advising their patients (American Association of Nurse Practitioners, 2015).

History of the Nurse Practitioner Role, in General

The demand for individuals providing primary care in the nation grew with the launch of the Medicaid and Medicare initiatives, developed after the enactment of the 1965 Social Security Amendments. The two initiatives ensured low-income kids, women, aged persons, and disabled individuals could now access healthcare. Thus, with the enhanced need for healthcare providers in primary care settings, nurses obviously assumed the responsibility of educating families with regard to illness prevention and health promotion.

All through the nation, nursing care leaders reached a consensus that nursing professionals were cognizant of, and experienced in tackling, kids' and families' healthcare requirements. The consensus resulted in a growth of their responsibilities and roles to match those of primary care doctors. In the year 1965, Loretta Ford, a nursing leader, developed the nation's earliest NP training program in collaboration with Dr. Henry Silver. The program, which was available at the University of Colorado, concentrated on the areas of family health, health promotion and disease prevention (History of nurse practitioners in the United States, 2014).

Family Nurse Practitioner

A specialty under the NP profession is the FNP or family nurse practitioner. An FNP is an APRN (advanced practice registered nurse) who operates independently or collaborates with other health care providers for delivering family-directed therapy (Family Nurse Practitioner, 2016). PRIMEX, one among the foremost family nurse practitioner initiatives, was introduced into the University of Washington; ever since, FNPs have been engaging patients/clients in care, aiding them in comprehending their ailment, and educating them on practical measures to adopt for improving health (Britt, 2012).

History of the FNP role

Healthcare's mounting complexity and the decrease in primary care doctor supply has led a number of patients to approach FNPs to take care of primary care issues. FNPs assist their clients in chronic and acute ailment management. They carry out physical tests, diagnostic procedures and tests. They engage in patient diagnosis and treatment right from the patient's childhood into adulthood.

Significance of the FNP Role to Promote and Preserve Healthy Communities

FNPs are enjoying a more prominent role in the sense that they make up nearly 50% of the overall NP workforce. Their role offers flexibility, as FNPs are able to take care of patients from diverse age groups. From the point-of-view of FNPs, the patient is the overall family. Thus, FNPs treat patients within the familial context (Britt, 2012). Licensure vs. Certification
Licensure

The term 'licensure' denotes a process whereby a person is authorized by any local, state, or federal government agency to offer his/her services in some specific vocation, subject to the governmental authority's rules. Such an individual may tag the label of "licensed" to his/her professional role, indicating legal authority to practice that role (Licensure vs. Certification, n.d.).

Certification

On the other hand, the term 'certification' is employed to denote a process whereby private institutions recognize people who meet particular conditions specified by that institution. The person will be recognized for superior skills and knowledge. It represents a kind of voluntary self-regulation, as it isn't mandatory before one can practice. Furthermore, certifications are not overseen by the government (Licensure vs. Certification, n.d).

Differences between Licensure and Certification

It is compulsory to acquire a license prior to commencing practice of any profession. State regulations might even have provisions of administrative or criminal fines for an individual who is caught practicing without license. Fines for licensure law violations are different for different states. Meanwhile, professionals normally pursue certifications for self-promotion, as well as with an aim at distinguishing between different practitioners. Certification is not compulsory, and if an individual loses his/her certification recognition, or fails to obtain one altogether, he/she will not be liable to governmental fines. This constitutes one difference between certification and licensure (Licensure vs. Certification, n.d).

A second difference existing between licensure and certification in case of a number of healthcare professions deals with the organization administering the qualification. Generally, licenses for healthcare professionals are provided by federal or state governments. But certificates are normally accorded by private organizations (non-profit organizations, nursing associations, etc.) having authority in any given field, rather than public ones (Wandrei, 2016).

Examples of both Concepts

Following the certification of a nurse practitioner by a certification institution, the individual needs to apply for a state-accorded Advanced Practice Registered Nurse license. An NP is not authorized to practice using only a certificate. Whenever available, individual state licenses are mandatory to obtain (Hittle, 2010).

A license is normally needed, but certificate acquisition is typically voluntary. For instance, a majority of American states do not allow NPs to practice if they have not obtained the necessary license. Meanwhile, certificates simply intend to let the public or prospective clients know that one has attained an advanced qualification. For instance, the Registry of Emergency Medical Technicians provides a certificate which doesn't suffice for practicing as an emergency medical technician (Wandrei, 2016). FNP Practice
Scope of Practice

NP practice's independent nature necessitates responsibility towards the public, to deliver superior quality healthcare. This accountability is in line with NPs' conduct codes and ethics codes, national certification, clinical outcome assessment, routine peer review, and proof of ongoing professional growth. The client-focused character of nurse practitioners' duties necessitates long-term commitment towards meeting society's changing needs, as well as healthcare science advancements. NPs are accountable to citizens and need to be flexible to healthcare changes. They assume responsibility for ongoing professional growth, participate in professional institutions, and engage in local, state, countrywide and global health policy undertakings. The above facts hold true for FNPs as well (American Association of Nurse Practitioners, 2015).

Standards of Care

NPs employ national care standards and scientific processes as the foundation to manage patient care. The process (NP and FNP patient care) entails health status assessment, disease diagnosis, treatment plan creation, implementation, and follow-up. The last step of patient care management involves patient status evaluation (American Association of Nurse Practitioners, 2013).

Relevance of State Practice Acts regulating FNP practice

State Practice Acts that regulate FNP practice specify restricted and reduced practices. State licensure and practice regulations are able to limit NP participation in one or more FNP areas. The former term deals with the state law's requirement of an external health discipline's oversight, team-management or delegation for FNP provision of patient care. On the other hand, the latter term deals with state law's requirement of a regulated joint agreement with some external health discipline, for FNP provision of patient care (American Association of Nurse Practitioners, 2016).

Credentialing and Privileging

The process of FNP credentialing in hospitals entails authorization of a healthcare professional to deliver patient care within clinical settings. The governing body of the healthcare organization is in charge of reviewing the education, certifications, licensure, training, and skills of its NPs. The credentialing activity comes under the Joint Commission's supervision. Following effective completion of necessary paperwork, the governing body of the organization will credential the individual, verifying its faith in that individual's qualifications, to deliver healthcare at the organization.

Another process whereby a healthcare organization's governing body (which credentials its FNPs) permits FNPs to deliver distinct patient care elements is termed as 'privileging'. Privileges accorded to FNPs include patient admission, treatment prescription, and procedure performance. In some cases, individual states' Nursing Practice Acts may credential, train, and license their NPs to deliver, as part of their practice scope, specific care; however, their scope might be restricted by hospital privileging (Hittle, 2010).

One Issue or Challenge Related to Role Delineation/Implementation

In FNP practice, one of the challenges linked to role implementation or definition is turnover. This occurrence hampers consistent guideline implementation. Some practice directors state that, at times, nurses who are provided training with respect to guidelines quit, and others cannot effectively step into their roles since they lack the necessary training. Practice physicians, in such cases, are increasingly tasked with carrying out the majority of these guideline-linked tasks, besides their daily clinical decision-making (Chimeddamba et al. 2016). Healthcare Policy and Legislation
Difference between legislative and regulatory processes

Legislation denotes a governmental, or governing body, dictation on an industry, community or citizens of a given nation that has to be adhered to if one wishes to stay within the industry's, community's or nation's legal boundaries. Meanwhile regulations denote definite requirements which may assume numerous forms -- broad or industry-specific ones. Regulations essentially describe how regulators enforce legislation and support its requirements (Kivumbi, 2011).

Legislative or Regulatory Issue for the FNP

Full practice is one regulatory problem encountered by FNPs: State licensure law and practice provide for FNPs to assess patients, carry out diagnoses, direct patients to diagnostic tests and interpret them, and commence and manage treatment of patient issues (including medication prescription) under the state nursing board's exclusive licensing authority (American Association of Nurse Practitioners, 2016). Conclusion
Nurse Practitioners have grown into the prominent health partner chosen by many American citizens. We simply cannot underrate their value, as they are engaged in active assessment, diagnosis, treatment, and management of chronic and acute episodic ailments. Hence, one really needs to grasp NPs' history, current role, certification, and licensure. Finally, it is imperative that one recognizes their practice setting, largely governed by regulatory and legislative framework.

References

American Association of Nurse Practitioners. (2013). Standards of Practice for Nurse Practitioners. Retrieved September 21, 2016, from https://www.aanp.org/images/documents/publications/standardsofpractice.pdf

American Association of Nurse Practitioners. (2015). Scope of Practice for Nurse Practitioners. Retrieved September 21, 2016, from https://www.aanp.org/images/documents/publications/scopeofpractice.pdf

American Association of Nurse Practitioners. (2016). State Practice Environment. Retrieved September 21, 2016, from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment

Britt, D. (2012). Family nurse practitioner's role in primary care. Retrieved September 21, 2016, from http://source.southuniversity.edu/family-nurse-practitioners-role-in-primary-care-110820.aspx

Chimeddamba, O., Ayton, D., Bazarragchaa, N., Dorjsuren, B., Peeters, A., & Joyce, C. (2016). The Adoption of Roles by Primary Care Providers during Implementation of the New Chronic Disease Guidelines in Urban Mongolia: A Qualitative Study. International journal of environmental research and public health, 13(4), 407.

Family Nurse Practitioner. (2016). Retrieved September 21, 2016, from http://www.graduatenursingedu.org/family-nurse-practitioner/

History of nurse practitioners in the United States. (2014). Retrieved September 21, 2016, from https://onlinenursing.simmons.edu/nursing-blog/history-nurse-practitioners/

Hittle, K. (2010). Understanding certification, licensure, and credentialing: A guide for the new nurse practitioner. Journal of Pediatric Health Care, 24(3), 203-206.

Kivumbi (2011). Difference Between Legislation and Regulation. retrieved September 21, 2016, from http://www.differencebetween.net/miscellaneous/difference-between-legislation-and-regulation/

Licensure vs. Certification (n.d.). Retrieved September 21, 2016, from https://www.fsmtb.org/media/1128/member-boards-agencies-member-services-government-relations-resources-licensure-v-certification.pdf

Wandrei, K. (2016). The difference between the certification & licensing of a health care professional. Retrieved September 21, 2016, from http://oureverydaylife.com/difference-between-certification-licensing-health-care-professional-35642.html