Thursday, February 28, 2008

Advanced Practice Nursing

Introduction
With so many pathways to becoming an advanced practice nurse (APN), it is understandable why articulating this healthcare provider role is challenging when compared to other professionals in the field. Delving into this topic in more detail, questions pertaining to advanced practice nursing will be answered more easily.
[Photo Credit: Multidisciplinary Team (Huntsman Cancer Institute, 2007)]



What is the difference between a nurse practitioner (NP), physician (MD), and physician assistant (PA)?
By definition, an NP is a registered nurse (RN) that fulfilled requirements toward higher education (usually a 2-year master’s program) and received
instruction in diagnosing common medical conditions (Women’s Health
Channel, 2001). An NP greatly focuses on patient education, emphasizing health promotion and disease prevention (American Nurses’ Association, 1987).


Pediatric NP Treating & Preventing (University of Iowa, 2002)

With a physician’s 4-year medical school education and 3-year residency training, an MD manages more complex issues, differing from an NP’s more holistic approach to healthcare. On the other hand, a physician assistant, after undergoing a 2-year accredited PA education program, is a mid-level medical practitioner, providing services regarding diagnosis, therapy, and prevention (UC Berkeley Career Center, 2007). Both NPs and PAs can function as a patient’s primary care provider; but, unlike an NP, a PA must operate under the supervision of a surgeon or physician and cannot work an independent practice (Madison, 2007). It is imperative to understand the differences between NPs and PAs, especially for one considering further education beyond a bachelor’s in nursing.

What is the difference between a nurse practitioner (NP) and a clinical nurse specialist (CNS)?
A CNS is an RN who serves as a health care educator, consultant, researcher, administrator, provider or case manager (The North Carolina Center for Nursing, 2004), often functioning in more than one of these responsibilities. While the goal of an NP is specifically “to provide patient care,” a CNS works “to improve patient care” (Hamric & Spross, 1989, p. 162), setting the standards in patient care. Even though both careers take a holistic attitude towards the patient, CNSs narrow their work to specific populations, identifying problems using specialized skills. Although both occupations have a special area of expertise and focus, in order to work successfully, both NPs and CNSs must have the same degree of clinical knowledge while accepting their respective roles in the professional setting (Hamric & Spross, 1989). Both are specialists with a great deal of professional autonomy, but also work proficiently as part of an interdisciplinary team. Because both are advanced practice nurses, it is important to distinguish an NP and a CNS while observing their collaborative disposition. [Photo Credit: Nurse Practitioners in the Emergency Room (Nursing Jobs, 2007)]


Scope of Practice (Lippincott Williams & Wilkins, 2003)

What is the doctor of nursing practice (DNP)?
The DNP, a new concept, is a 3-year clinical degree that is becoming more available at numerous colleges nationwide. Historically, an advanced practice nurse (APN) receives a master’s degree in order to practice as an NP. However, a DNP program prepares an individual for APN roles, including NPs and CNSs, progressing toward greater specialization in the sphere of advanced practice nursing (American Association of Colleges of Nursing, 2006), still greatly emphasizing patient education. The education received through the DNP program prepares one to practice proficiently with dependability and comprehension (American Association of Colleges of Nursing, 2006). Through this program, nurses receive another opportunity to further their education and expand upon their credibility.

In addition to the DNP, the traditional routes to graduate education are also available. A registered nurse can advance to receive a Master of Science in Nursing (M.S.N.) or a Doctor of Philosophy (PhD) which then allows one to proceed to other areas outside of the clinical setting such as advanced nursing practice, research, and health care policy. With the many options for further education, nurses can continue to develop their knowledge, creating greater flexibility with their career.


Wide Variety in the Field of Nursing (Texas Organization for Associate Degree Nursing, 2007)

Conclusion
Stressing the utilization of collaborations and networks, advanced practice nurses are not seen as the “physician extender” any longer, but instead as essential parts to the multidisciplinary team. Understanding that advanced practice nurses possess important roles as healthcare providers, nursing students looking at the greater picture of the future can further extend their horizons.

For more information on other nursing roles, click here!





References
American Association of Colleges of Nursing. (2006, October 30). Doctor of Nursing Practice Essentials of Doctoral Education for Advanced Nursing Practice. Retrieved November 30, 2007, from http://www.aacn.nche.edu/DNP/index.htm

American Nurses’ Association. (1987). Standards of Practice for the Primary Health Care Nurse Practitioner [Brochure]. Kansas City, Missouri: Author.

Hamric, A. B., & Spross, J. A. (Eds.). (1989). The Clinical Nurse Specialist in Theory and Practice (2nd ed.). Philadelphia, PA: W.B. Saunders Company.

Madison, N. (2007). What is the Difference Between a PA, NP, and RN? Retrieved November 26, 2007, from http://www.wisegeek.com/what-is-the-difference-between-a-pa-np-and-rn.htm

North Carolina Center for Nursing. (2004, May 21). Clinical Nurse Specialist. Retrieved November 30, 2007, from http://www.ga.unc.edu/NCCN/recruitmentandretention/youth/roles/cns.htm

University of California, Berkeley – Career Center. (2007, February 9). Nurse Practitioner and Physician Assistant - What's the Difference? Retrieved November 23, 2007, from http://career.berkeley.edu/Article/070209a-jv.stm

Women’s Health Channel. (2001, June 11). What is a Nurse Practitioner? Retrieved November 23, 2007, from http://www.womenshealthchannel.com/nursepractitioner.shtml

Photo/Artistic Credits
Multidisciplinary Team (Huntsman Cancer Institute, 2007)
http://www.huntsmancancer.org/publicweb/content/thoracic/images/HCI.jpg

Nurse Practitioners in the Emergency Room (Nursing Jobs, 2007)
http://www.nursingjobs.org/blog/wp-content/uploads/2007/07/nper.jpg

Pediatric NP Treating & Preventing (University of Iowa, 2002)
http://www.uiowa.edu/~fyi/issues/issues2002_v40/09052002/PHOTOS/FYI%20400/Nd-08-02-2779-TS-13.jpg

Scope of Practice (Lippincott Williams & Wilkins, 2003)
http://www.medscape.com/content/2003/00/45/59/455980/art-cns455980.fig2.gif

Wide Variety in the Field of Nursing (Texas Organization for Associate Degree Nursing, 2007)
http://www.toadn.org/nurses.jpg