What is an Advanced Practice Nurse?
Advanced practice nurses are registered nurses that receive additional training and education to play a more advanced role in the healthcare system. They may have a master’s degree, post-master’s certificate, or practice-focused doctor of nursing practice degree. With their advanced training, they have the expert knowledge, clinical expertise, and complex decision-making ability necessary for expanded practice. Advanced practice nurses can take on more complex casework and can handle those cases with greater autonomy and discretion, and in some areas, are able to practice independently, without the supervision of a physician. As a result, advanced practice nurses are increasingly relied upon to meet the demand in primary care especially in rural and underserved areas.
Nurses filling advanced patient care roles is not new, harkening back to the frontier days when the shortage of doctors called for nurses responsible for delivering care to rural and outpost communities. The formal development of the nurse practitioner role was a response to an increased demand for qualified primary care practitioners in the 1960s with the first nurse practitioner training programs starting in Colorado in 1965.
With a worldwide physician shortage and a rapidly aging population, the demand for advanced practice nurse is very likely to increase. Understanding this need and recognizing the quality of care that advanced practice nurses provide is impelling government officials and administrators to utilize the unique services these roles offer.
What does an advanced practice nurse do?
The advanced practice nurse plays varying roles in the healthcare system. From physical exams and diagnosing to prescribing and administering medications, advanced practice nurses have more freedom to make decisions and suggest treatments. They also may serve as consultants to other nurses, giving treatment advice and directive in their specialty.
Many studies have shown that advanced practice nurses can provide better outcomes than physician care alone. One study on a cardiac unit found that patients who received care from an advanced practice nurse had lower rates of readmission and had on average fewer days in the hospital. A systematic review found that in primary care, Nurse Practitioners had high patient satisfaction, spent more time with each patient, and ordered more investigations than a GP, all with no difference in patient outcome or differences in prescriptions. These studies, along with many others, have shown that advanced practice nurses provide excellent care to meet an expanding gap in service in the healthcare system worldwide.
There are four main types of advanced practice nurses, with a continuous expansion into many different specialties. The most common types today the Nurse Practitioner, Clinical Nurse Specialist, Nurse Anesthetist, and Nurse Midwife.
The nurse practitioner is the most common type of advanced practice nurse and can work in many different areas. Some nurse practitioners work in acute care while others work as primary care practitioners, running their own small clinics or working alongside doctors in their medical clinics.
Nurse practitioners can diagnose, prescribe certain medications, and are instrumental in educating patients on their conditions. They can do many procedures and may even conduct research. Depending on the local legislation many nurse practitioners work entirely independently, completing the entire circle of care on their own; starting from patient check-in and diagnosis to creating a treatment plan and prescribing of treatments and medications.
There are six main areas that nurse practitioners may specialize in:
- Family/Primary Health Care
- Women’s health
- Psychiatric/Mental Health Care
Other specific specialty fields may be pursued by a nurse practitioner such as Emergency or Orthopedics, but they are confined within the selected focus population but enhance the care within that focus (i.e., Nurse Practitioner that focuses on Pediatrics and further specialized in Pediatric Orthopedic care).
Nurse practitioners must complete a Master’s Degree and then a specialized Nurse Practitioner diploma program. They must then complete a licensing exam before applying for a license to practice in their area.
Clinical Nurse Specialist
The clinical nurse specialist is a nurse that works in a specialized area providing education, guidance and developing institutional policies. The specialization can be defined by the following parameters:
- Disease (Diabetes, Cardiac)
- Population (Pediatrics, Geriatrics or women’s health)
- Setting (Critical Care, Emergency, ICU Nurse)
- Type of Care (Rehabilitation, mental health)
- Type of Problem (Pain, Nutrition)
Clinical nurse specialists work within their area focus and are often involved in advisory or management roles. They are sometimes used as educator, supervisors, or managers. They can serve as patient facilitators or educators, helping patients and their families navigate a new and complex disease.
Clinical Nurse Specialists must complete a Master’s program to practice, and roles and responsibilities are determined by the local licensing authority. The scope of practice for Clinical Nurse Specialists vary, with some areas allowing independent prescribing authority.
The nurse anesthetist works in the operating room and provides anesthesia to a wide variety of patients who are undergoing surgical procedures. They may also perform pre- and post-anesthesia care. They conduct physical assessments, pre-operative screening and manage medications used for pain management and anesthesia. They carefully monitor patients during and after anesthesia both in the operating room and in recovery.
Providing anesthesia is incredibly complicated, and nurse anesthetists receive some of the most advanced education and have had the most challenging time with legislation and utilization. The shortage of anesthetists has left underserviced areas with the choice between using nurse anesthetists or canceling surgeries, so as a result many rural regions solely rely on these practitioners for both simple and emergency services.
To become a nurse anesthetist, you must complete a graduate degree program and pass a licensing exam before applying for a license.
Nurse midwives provide both gynecological and midwifery care. The nurse midwife can care for women and infants throughout their pregnancy and beyond, including assisting in deliveries at people’s homes or in the hospital.
Also, the Nurse-Midwife may also provide the following care:
- Regular gynecological care including annual exams
- Basic Nutrition Counselling
- Family planning and birth control
- Pregnancy, childbirth, and postpartum care
- Parenting education to parents and soon to be parents
- Healthy Newborn care for the first 28 days of life
- Treatment of male partners for sexually transmitted diseases.
Nurse-midwives must complete a graduate program and pass a certified licensing examination.
Advanced practice nurses are well-educated health professionals that are essential to meet current and future healthcare needs. The future demand for these health professionals is ever expanding, providing a bright future for nurses and nursing students who enjoy an extra challenge in their career.
- See Also: What is Forsenic Nursing?
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