Nurse Practitioner Role: Current Trends and Preferred Future

For a straightforward description of today's nurse practitioner, one convenient starting point is the International Council of Nurses, which defines the "nurse practitioner / advanced practice nurse" as a registered nurse who has acquired an "expert knowledge base," holds a Master's degree, and whose expanded practice role is shaped "by the context and/or country in which she/he is credentialed to practice."

Cheryl Stegbauer, a faculty member and nurse practitioner (NP) with thirty years of experience, delves deeper into the NP's role in shaping contemporary healthcare. "Most of the medical profession and patients" may understandably "scratch their heads about how the NP role is defined" (Nelson, 2004), Stegbauer observes. "Because the NP approach is holistic, patients like the increased attention afforded by NPs, and doctors appreciate the value of a symbiotic relationship that can improve patient care in their practices."

NPs "fill a critical gap," Stegbauer continues, since there is a "critical shortage of doctors" in many rural and inner-city communities, and physicians in those areas are often stretched too thin to be fully effective.

That said, it is the purpose of this paper to go well beyond the obvious need for competent nurses and NPs, the gaps in adequate healthcare services presently being filled by NPs, and the critical skills and talent NPs bring to the table. As Sheila Grossman and Theresa M. Valiga argue throughout their book, the new and pivotal issues revolve around nursing leadership. Their book offers 52 separate categories of "leadership" in its index, along with many additional sidebar leadership points found under further headings and subheadings. The information that provides the seeds for cogent answers to this paper's guiding questions — "So What?", "Now What?", "Who Cares?", and "Who Should Care?" — is found throughout that text. That information, combined with an analysis of what an NP must do to prepare for a preferred future, constitutes the substance and direction of this paper.

The Grossman/Valiga book is carefully structured: each of the ten chapters opens with clearly defined learning objectives and closes with critical thinking exercises and self-assessment quizzes. In Chapter Two ("The New World and New Leadership"), the authors begin to reframe healthcare by noting that 85 percent of nursing executives surveyed reported that their institution had "already gone through" or was "in the process" of going through serious redesign. This is a productive launching point for the first guiding question: "So what?"

So what if serious redesign, "retooling" (in the authors' words), and rethinking are currently reshaping how nurses perform their duties and how healthcare advances new ideas to better serve the public? So what if this era is a "new age of healthcare" (p. 27), and so what if there is a dire need to change the mistaken perception that "leadership" and "management" are synonymous? The two concepts should not be conflated, and this book provides clear guidelines for moving beyond that tired and inaccurate assumption.

So what if "many nurses are not prepared for the role they will need to assume" as healthcare seeks to better serve the ill and injured? So what if the nursing profession is moving from the "Scientific Age" — with its focus on planning, patient acuity, "using formulas to provide staff coverage," and "following bureaucratic procedures and policies" — into what the authors call the "New Science Age," which emphasizes "empowerment of all" and teamwork, among other dynamics?

What this book takes pains to express is that those not asking "Now what?" remain stuck in an old system that views management staff as the true leaders and everyone else as followers. The "now what?" vision in this book positions future NPs as individuals who no longer merely carry out medical orders but instead develop the leadership skills necessary to work within the "chaotic" environment that exists in healthcare facilities. "Now what?" also means using "our imaginations and being more in tune with the idea that there is more to our work than assessing, planning, implementing, and evaluating," the authors assert on page 33.