Family Nurse Practitioners: Improving Quality of Care

Introduction and Background

A study published in 1976 helped to establish the meaningful difference between family nurse practitioners and traditional healthcare providers such as doctors and nurses. Patients reported higher satisfaction with family nurse practitioners than with traditional providers, revealing the need to integrate family nurse practitioners into the repertoire of care (Linn, 1976). Because of research like this, the value of the nurse practitioner — and the family nurse practitioner in particular — has been highlighted in the scholarly literature as well as in anecdotal practice.

Part of the reason for the increased awareness of the role the family nurse practitioner fulfills is the improvement in overall quality of nursing care and delivery of services. The nursing profession has become fully distinct from the medical profession in ways that are well articulated. As McDowell (1984) notes, "The values of nursing must not get lost in the dominant medical culture. If they do, you justly risk the epithet of junior doctor. Patients do not need junior doctors. They need the knowledge and skills of both medicine and nursing."

I am embarking enthusiastically on a career as a family nurse practitioner because I believe in the profession and what it can do to improve quality of care. I also understand that the family nurse practitioner serves a unique role in the medical care system — as an individual who develops long-term relationships with patients and who views patient success within the greater context of family and community. Family nurse practitioners develop cultural awareness and sensitivity in addition to providing optimal delivery of care.

Personal Reasons for Pursuing Family Nurse Practice

My grandmother was a nurse, and my aunt is a nurse practitioner. Although neither was officially a family nurse practitioner, both of my role models illustrated the ways nurses take family issues into account when delivering care. My grandmother worked as a nurse in the army, providing care under stressful conditions and frequently interacting with people from various cultural backgrounds who spoke different languages. Treating soldiers outside of their family context proved challenging, but my grandmother made every effort to communicate with patients about their lives outside of combat. When patients were able to provide family context, it became easier and more effective to deliver care that was meaningful to each individual. My grandmother practiced nursing in this way long before she had ever heard terms like "cultural competence."

My aunt came from a different generation, one in which nursing was becoming more established from a scholarly standpoint. She has become familiar with phrases like "cultural competence" throughout her work and continually reflects on the role of the nurse in the community. As a Registered Nurse, my aunt has worked in a hospital that serves a high proportion of economically disenfranchised people. She has gone beyond the parameters of the profession to become involved in community organizations that provide outreach services for people experiencing addiction and homelessness. In this way, my aunt taught me about the need to understand context in healthcare. Whereas doctors often see only the broken leg or the cancerous lung, the nurse sees the whole person — taking into account family background, history of abuse, and other issues that might impact the patient's current situation and future ability to stay healthy. The concept of the nurse as health promoter is the primary idea I have internalized through my personal relationships with these two remarkable nurses.

Of all the different types of nursing and areas of specialization, why would I choose to become a family nurse practitioner? The nursing profession is diverse, with several different potential areas of professional application, and there are several compelling reasons why the family nurse practitioner role is the one I want to fulfill.

First, I strongly believe in reducing or eliminating disparity related to gender, race, and socioeconomic class. As Gibson (2013) points out, nurse practitioners have "a greater responsibility in decreasing health disparities among minority patients." It is this sense of responsibility that draws me to this aspect of nursing. By taking into account family issues pertaining to socioeconomic class and social status, nurses can raise awareness of the ways these issues influence health status among individuals and whole communities. Family nurse practitioners are also in a unique position to understand the impact of gender on health issues, access to care, and overall health status. Furthermore, I want to work with underprivileged populations, as my aunt does. "Nurse practitioners have been utilized to deliver primary care, traditionally in underserved areas or to vulnerable populations" (Gibson, 2013). Knowing that I can contribute to underprivileged communities, I intend to devote my energy to the populations most in need.

Why Family Nurse Practitioner?

Second, I strongly believe that patients cannot be treated without taking their family backgrounds and current family situations into account. Nyirati, Denham, Raffle, and Ware (2012) note that most, if not all, family nurse practitioner programs "frame family as the context of care for the individual." I cannot imagine treating a patient as if he or she were not part of a family system. Family systems influence lifestyle choices, which in turn impact health. Both mental and physical health depend on the family system.

Third, I possess a strong degree of emotional intelligence and cultural sensitivity that can best be applied within the family nurse practitioner setting. The family nurse practitioner is trained in cultural competence and sensitivity as a matter of course. Family nurse practitioners need to include family members in the decision-making process, enabling collaborative healthcare decisions that are more effective for patients in the long run. I believe it is impossible to treat patients fully without understanding their lives outside of medical care — lives that include ties to community, employment, language, and a host of other factors related to care.

Finally, the family nurse practitioner plays an active role in holistic caring. The family nurse practitioner does not hold a fragmented view of healthcare but a comprehensive one. As noted in the scholarly literature, "In addition to conventional practice in an office, clinic, or ambulatory care center, the FNP may follow families in a variety of settings, such as school, home, work place, or hospital." A holistic vision of healthcare is made possible through the family practitioner approach.

As a systems theorist, I view individuals as parts of a community rather than isolated entities. This theoretical viewpoint will influence my approach to healthcare and ensure that I can deliver the best quality of care for patients. By learning about a patient's family background, I can make individualized recommendations for health promotion. Generalizing about the patient population is a faulty practice, especially in a diverse society. It is far more productive to acknowledge diversity and prepare for the future of medical care in a global community.

Conclusion

Family nursing requires a great degree of patience and cultural sensitivity that cannot be taught in a classroom. I believe that I already possess the emotional, psychological, and theoretical foundations that will make me an effective family nurse practitioner. Because of my personal and theoretical backgrounds, I can apply myself fully to a profession that has the potential to improve the lives of others. In a diverse society, the role of family nurse practitioners is becoming increasingly important. Language, culture, and gender are all issues that must be taken into account when developing optimal care plans for patients and communities.