Advanced Practice Nurse Roles in High-Quality Care

Introduction: The APN as Researcher and Collaborator

A Master's-prepared nurse or Advanced Practice Nurse (APN) continuously increases and expands knowledge to support her own practice and to contribute to the broader body of knowledge in her field (CNHS, 2011; Cooke et al., 2008). She applies appropriate communication technologies to transfer her ongoing learning to others in related fields. She also initiates the exploration of new knowledge by identifying researchable issues or problems, collaborates with other health professionals in the development and implementation of practice, determines the rights of research participants, and evaluates the findings of her own research for applicability in practice. She then transmits and shares these research findings with others (CNHS, 2011; Cooke et al., 2008). The Advanced Practice Nurse is distinctively a researcher because she needs and uses research evidence to address specific patient conditions. The research-theory-practice link is precisely the driving force in clinical practice among APNs.

As a collaborator, an APN determines and interprets her professional strengths and the scope of her role to her peers, clients, and their families (CNHS, 2011; Cooke et al., 2008). She takes an active part in coordinated care as a leader or team member in activities that pursue high-quality, cost-effective, and consistent services and nursing case management. She contributes to the peer review and performance evaluation of other healthcare providers. She also participates in the group's problem-solving efforts, in setting realistic work goals, and in formulating strategies for programs and other activities. She forges strategic partnerships aimed at improving healthcare system operations and accountability from an economic, social, political, and legal standpoint, and promotes the use of healthcare resources in every way that will benefit the patient (CNHS, 2011; Cooke et al., 2008).

The APN as Clinician and Consumer Advocate

As a clinician, the APN diagnoses and manages acute and chronic diseases while addressing the overall illness experience of all clients, drawing on the expert knowledge and technical competence she continuously develops (CNHS, 2011; Cooke et al., 2008). She imparts healthy behaviors and practices to patients, their families, and communities. She provides advanced guidance on probable health issues where there may be a shortage of information or ethical knowledge. She extends culturally competent care to increasingly diverse populations, addressing their need for information on health status and care in accordance with their cultural beliefs and values, and with genuine appreciation for those beliefs and values. In doing so, she strives to serve as a role model in providing culturally competent healthcare. Under all circumstances, she promotes health and wellness and the prevention of disease by emphasizing primary and secondary preventive strategies (CNHS, 2011; Cooke et al., 2008).

As a consumer advocate, an APN establishes and maintains a caring attitude toward clients and their families (CNHS, 2011; Cooke et al., 2008). She notes their individual and collective strengths, helps them meet their healthcare needs whenever possible, and extends comfort while protecting their dignity in times of crisis. She assists them in making sound decisions about their healthcare. Her advocacy role often begins simply by listening to clients discuss an issue or problem, then consulting with colleagues to determine how best to advocate in clients' interests. While all nurses must perform advocacy work to some degree, an APN is particularly suited to it because of the depth and breadth of her knowledge and her ability to articulate issues clearly (Donnelly, 2006). Advocacy thus extends beyond the individual patient and into the systems of care, made possible by carefully observing care practices and structures (Donnelly, 2006).

Manager of Systems, Consultant, and Change Agent

As a manager of systems, the APN interacts with medical staff and serves as a role model (Donnelly, 2006). She participates in interviewing applicants for medical staff positions and ensures appropriate personnel allocation. She uses all available resources effectively to facilitate practice, including supplies, equipment, budget, and personnel. She formulates appropriate policies for nursing practice, evaluates and analyzes the suitability and effectiveness of nursing practice models, and assesses the clinical performance of both medical and non-medical staff under her supervision. She sets realistic goals and timetables for subordinates and plans, organizes, directs, controls, and evaluates operations and inputs in order to create an environment conducive to professional nursing practice (Donnelly, 2006).

As a consultant, the APN first appraises the need for consultation (CNHS, 2011; Cooke et al., 2008). Where a need exists, she draws on the expertise of other disciplines — such as psychology, social work, physical therapy, and medicine — to design a suitable and comprehensive intervention. She initiates and enters into a contractual agreement, gathers and interprets relevant information, and prescribes an appropriate plan of action. She then designs and provides the support necessary to implement the agreed plan and, upon completion of the contractual agreement, formally terminates it (CNHS, 2011; Cooke et al., 2008).

As a change agent, the APN is simultaneously a teacher and a learner of new knowledge, and she promotes an environment that facilitates learning (CNHS, 2011; Cooke et al., 2008). In her practice, she routinely assesses patients' health behaviors and learning needs, internalizes key assumptions from theories of teaching and learning, and identifies factors that affect learning. She provides anticipatory guidance based on the patient's age or developmental level and helps clients integrate what their illness and recovery mean for healthy lifestyle development. She helps clients set proper goals for health promotion and maintenance, formulates plans and protocols for client education, and interprets a client's condition while explaining necessary procedures. She evaluates her staff's readiness to learn, establishes teaching-learning objectives, and selects appropriate strategies or theories to facilitate educational activities. She instructs clients on the actions and side effects of medications and develops educational programs tailored to the learner's age, level of functioning, emotional needs, and personal characteristics. Overall, she possesses the knowledge expertise, the ability to fit evidence-based educational interventions to the needs of individual patients and their families, and the skill to apply appropriate adult teaching principles (CNHS, 2011; Cooke et al., 2008).