NUR 513 Topic 1 Discussion Question One
Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?
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Re: Topic 1 DQ 1
The role of advanced registered nurse has transformed over time in so many ways. We focus on how nursing has rapidly evolved. There was the traditional Registered Nurse than over time it has evolved into many distinct categories of nursing which involved (CRNAs), certified nurse–midwives (CNMs), clinical specialists (CNSs), and nurse practitioners (NPs) then Doctor of nursing practice (DNP) (DeNisco & Barker, 2016). The shifts of scope and expectations in the 20th and 21st centuries have not change as much as we think. “Clinical nurse specialists (CNSs) have been providing care to patients with complex cases across healthcare settings since the 1960s. The CNS role originated to satisfy the societal need for nurses who could provide advanced care to psychiatric populations. Following this implementation, the usefulness of the role became apparent, and schools of nursing began to educate nurses across specialties, including oncology, medical-surgical, pediatric, and critical care nursing” (DeNisco & Barker, 2016). “Nurse practitioners have been providing care to vulnerable populations in rural and urban areas since the 1960s. The role was born out of the shortage of primary care physicians able to serve pediatric populations. Today, nurse practitioners are the largest group of advanced practice nurses. More than 192,000 NPs are licensed and practicing with some level of prescriptive authority in all 50 states. Nurse practitioners work are educated and hold board certification in a variety of specialty areas, including pediatrics, family, adult gerontology, women’s health, and acute care.” (DeNisco & Barker, 2016). Midwives are essential. “In the 1920’s when the first midwifery school began because of high mortality rates and poverty in Kentucky which led to the demand of Midwives brought about change to these rural communities.” (DeNisco & Barker, 2016). Midwives are needed more than ever in so many areas of nursing especially when pregnant women are not comfortable being in a hospital setting. Nurse anesthetists have a crucial role in nursing because they provide anesthesia during surgery. “Nurse anesthetists are licensed as independent practitioners, and they provide care autonomously and in collaboration with surgeons, dentists, podiatrists, and anesthesiologists. The shortages of physicians qualified to administer anesthesia during wartimes continued, and nurse anesthetists were the main providers of anesthesia care for U.S. military personnel on the front lines for World War I, World War II, the Korean War, and the Vietnam War; nurse anesthetists also provide care in the current conflicts in the Middle East.” (DeNisco & Barker, 2016). Describe how the role of advanced registered nurse transformed over time
Advanced registered nurse role and responsibilities will continue to evolve and emerge as the American health care system changes by technology and continued education. Nurse educators are essential for keeping registered nurses informed of all the new policies and procedures we must abide by.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Peer Responses
Re: Topic 1 DQ 1
Hi E,
You bring up a great point about the difficulty with being an advanced practice registered nurse (APRN). Even though its been 20 years since the Institute of Medicine released their report “The Future of Nursing: Leading Change, Advancing Health” recommending that nurses work to the full extent of their education and training, some people and regulatory bodies are still hesitant to allow this (Institute of Medicine, 2011). Describe how the role of advanced registered nurse transformed over time
My mother was a Nurse Practitioner (NP) trained in acute cardiovascular care. I remember how frustrated she would get because the physician she worked under wouldn’t allow her to do certain procedures or tests that she was capable of performing because he would rather her handle the paperwork. I find it sad that it has been such a struggle for nurses to break through these barriers to be able to do what they are capable of. I also think it does the patients a huge disservice.
References
Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209881/
Re: Topic 1 DQ 1
Hi M,
I really enjoyed your post and the inclusion of some of the nontraditional APRN roles. Many of these nonclinical, or nontraditional roles do require knowledge and experience beyond the bachelor’s degree level of education. I was surprised to learn that all Nurse Administrators are not required to have a graduate level degree (DeNisco & Baker, 2016). Nurse Educators are another vital nontraditional APRN role that is tasked with preparing the nursing workforce in a clinical setting (DeNisco & Baker, 2016). There has been debate about the content that should be taught to future nurse educators; whether its advanced clinical knowledge or teaching techniques. In my mind both components seem necessary to adequately do the job. I agree that the National Council of State Boards of Nursing (NCSBN) should reassess the current APRN roles. I think you hit the nail on the head when saying that reevaluating the APRN roles would better serve nurses and patients alike with our ever-evolving healthcare system. Porter-O Grady and Malloch (2018) stated that “an understanding of change and innovation is not an option for nurses but rather it is a professional obligation” (p.52). This professional obligation to transform and innovate extends to the NCSBN and their duty to redefine the APRN role.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Porter-O Grady, T. & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones &. Bartlett Learning. ISBN-13: 9781284146530
Re: Topic 1 DQ 1
The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016). These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016). The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline. This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016). Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators.
DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Re: Topic 1 DQ 1
Advanced registered nurse roles and responsibilities will forever be evolving due to changes in policy such as health care acts, aging populations, and the overall need for advanced registered nurses. Furthermore, the responsibilities of advanced registered nurses have already started to expand. Densico and Barker 2016, shed light on the importance that barriers for advanced practice nurses be identified and resolved. In some states, nurse practitioners (NPs) do not work in primary care due to some state restrictions; however, the Institute of Medicine (IOM) released a report stating that NPs be allowed to practice independently with full autonomy. There have been many reports validating that NPs provide high-quality care, while also being extremely cost-effective. Moreover, according to Denisco and Barker, “the Health Resources and Services Administration (HRSA) has projected a large increase in demand for nurses, from approximately 2 million full-time equivalents in 2000 to approximately 2.8 million in 2020” (2016). The demand for nurses in the year 2020 came from the idea that people born in the 1960s (baby boomer generation), would put a strain on the healthcare system due to their size in population and the fact they were an aging generation. However, no one would fathom that the actual demand for nurses in 2020 would be due to a pandemic. Shifts in scope of practice and expectations have already been seen in the 21st century. Mainly focusing on expectations, universities have started to phase out nurse practitioner programs and replacing NP programs with doctoral nursing programs (DNP). This is partly because DNP programs provide more resources and opportunities to bring forth better health outcomes for patients. However, NP vs. DNP does not change scope of practice.
References
DeNisco, S., & Barker, A. (2016). Advanced practice nursing: essential knowledge for the profession (Third). Jones & Bartlett Learning. https://doi.org/ISBN978-1-284-07257-0