Advanced Practice Nursing Roles: NP, Educator, and Informatics

Historical Development of Advanced Nursing Roles

The starting point of all current-day nursing practice is the registered nurse. The standards and policies governing education and legal regulations for attaining a basic first-level nursing credential were not always fixed — and, for that matter, there were not always professional nurses at all.

Specialist nurses can be considered the primary product of nursing's professional evolution. The foundation of today's advanced nurses was established with the advent of specialist nurses in America. They were recognized in practice from the latter part of the 19th century, and by the 1930s and 1940s the number of specialist nurses in the United States had grown substantially. Clinical nurse specialists (CNSs) have been strongly recognized in the field of nursing since the 1960s. The clinical activities of these nurse specialists were usually considered to fall within conventional nursing practice domains, though their expertise was typically extended beyond those boundaries. As a result, CNSs were not regarded as posing any particular threat to the conventional arrangement of the broader healthcare system. More recently, CNSs have become intimately and commonly linked with advanced nursing concepts, a connection that reflects the significant overall growth of advanced nursing (Development of Advanced Nursing Roles, 2012).

Contrary to the relatively gradual evolution of specialist nurses, research scholars initiated the role and concept of nurse practitioner in tandem with the launch of a new pediatric primary healthcare role in 1965 in the United States. The role was built upon the extensive functional capabilities of specialist nurses, but also incorporated conventional therapeutic and diagnostic skills. Researchers note that the necessity for this change arose from practical issues as well as social concerns of the era, including a shortage of pediatricians. Initially, there may have been some concern about the potential repercussions of transcending former professional limits on nursing practice's scope. This was particularly significant during a period when nurses were achieving greater autonomy and moving away from the long-established dominance of medical authority (Development of Advanced Nursing Roles, 2012).

Many other important professional developments in the 1990s and in the early part of the following decade contributed to the future of advanced nursing. These included the government's establishment of consultant nurse roles and the introduction of legislation for non-medical prescribing. Growth during the 1990s contributed in varied and significant ways to the development of advanced nursing (Development of Advanced Nursing Roles, 2012).

Role of Nurse Practitioners in Advanced Practice

One set of definitions describes the nurse practitioner (NP) as a particular type of registered nurse who performs "advanced practice." Generally speaking, NPs are highly educated, holding at least a bachelor's degree in addition to their registered nurse license. They also possess clinical experience and additional education that varies depending on the particular state where they choose to practice. The functional role of the NP is broadly analogous to that of a physician, and generally includes the ability to prescribe pharmaceuticals and order laboratory tests as needed.

Studies indicate that NPs, along with other healthcare providers, are trained to deliver several primary care functions. They may therefore be capable of facilitating increased access to primary healthcare, especially in underserved localities. The term Advanced Practice Registered Nurse (APRN) denotes nurses who, through graduate-level education, have acquired advanced clinical skills and knowledge enabling them to provide direct medical care to patients. APRNs are trained through graduate and postgraduate courses in pharmacology, advanced health assessment, physiology, and other medical sub-disciplines.

NPs constitute the largest cluster of APRNs and practice across various population-focused areas, including family practice, women's health, geriatrics, and pediatrics. They are the most commonly found non-physician providers of primary health care and offer comprehensive services that include disease prevention, counseling, and health promotion. National licensing boards dictate the full range of services NPs may perform, such as hospital admissions, prescribing medications, and diagnosing patient ailments. Individual hospitals and Medicaid agencies can further expand the activities permitted for NPs. Half of U.S. states allow NPs to practice largely independent of supervising physicians, including diagnosis, treatment, and patient referral; however, in some instances significant limitations are imposed on the scope of services NPs are permitted to provide. Laws governing NP licensure, regulations, and certifications pertaining to practice limits differ widely by state and are often less broad than the full extent of APRN training (Schiff, 2010).