Future Scope, Role and Professional Obligations

Introduction

An advanced practice nurse (APN) is a nurse who has fulfilled the minimum requirement of post-graduate education in nursing (America Nurses Association (ANA), 2019). The APN has advanced and didactic clinical skills, knowledge, education, and scope of practice in nursing. ANA (2019) explains that APNs have a level of nursing practice that uses expanded and extended skills, knowledge, and experience in assessment, planning, diagnosis, and evaluating required care. Generally, APNs provide healthcare services to patients of all ages in long-term, acute, ambulatory, or primary settings. According to Halstead (2017), APNs practice on their scope based on their educational background, as well as, the guidelines and the standards set by their national certifying body. 

The Scope of APNs

The scope and roles of an API has dramatically changed in the past two decades. Presently, in the United States, the focus of healthcare services has changed to the delivery of cost-effective and quality care that is accessible to all patients. One way to attain these strategies was through the introduction of cost-effective and evidence-based practice that identifies specific ways to deliver care, which has led the APNs to identify ways to provide best independent care for patients in the U.S. The APNs focuses on health promotion, disease prevention, treatment, disease management, and patient education. This has been exemplified through certified specialty nurses (ANA, 2019). 

The specialty areas for advanced practice nurse include Certified Registered Nurse Anesthetist, Certified Nurse practitioner, Certified Nurse Midwife, and Certified Clinical Nurse Specialist (ANA, 2019). Andrew Scanlon (2014) explains that the role of Certified Registered Nurse Anesthetist is mainly pain management and anesthesia services. The Clinical Nurse Specialist, on the other hand, diagnoses, treats and manages diseases, as well as, the application of best practices and evidence-based care that ensures the delivery of quality care. The Certified Nurse-Midwives are responsible for the provision of reproductive, gynecological, and primary health care. Lastly, Nurse Practitioners provides specialty, acute, and primary healthcare across the lifespan by assessing, diagnosing, and treating injuries and illnesses. 

Importantly, APNs practice varies from state to state where in some states, they practice independently while in others they are required to collaboratively operate with physicians. Some of the functions and services performed by APNs include promoting health maintenance, maintaining hospital privileges, receiving third-party reimbursements, developing treatment plans, developing educational plans, formulating a differential diagnosis, performing physical examinations, obtaining required or relevant medical and health history, and assessing the health status of patients. 

The nursing practice and clinical nurses acquire advanced clinical skills and knowledge, which prepares them to provide indirect and direct care. In contrast, according to Emergency Nurse Association (ENA) (2015), an APN builds on the competencies of CNs and NP where he/she demonstrates a greater breadth and depth of knowledge, greater role autonomy, increased complexity of skills and interventions, and a greater synthesis of data. Other roles explained by ENA (2015) for APN include leadership, research, quality improvement, consulting, advocacy, and education. In addition, regulatory practice provisions, as well as, varying roles of advanced practice in a particular region shape APNs scope. The APNs adheres to the Code of Ethics for Nurses, Nursing Scope and Standards of Practice, and the American Nurses Association’s Nursing Social Policy Statement. Regardless of practice settings and specialty, the scope of practice and core values of APN is stipulated by the National Organization of Nurse Practitioner Faculties, American College of Nurse Practitioners, and American Academy of Nurse Practitioners. 

Professional Nursing Organizations for APNs

There are several professional nursing organizations for APNs, international, national, and state nurse practitioner associations. Heale and Rieck Bbuckley (2015) explain that APNs have a right to choose if they want to join state, national, or international organizations that will support their professional journey, as well as, fighting for their rights at the capitol. This assignment will explore some of these organizations and their responsibility for APNs.  Although these organizations have different offerings, a majority of them shares some roles and responsibilities including assisting members to access continuing education, up-to-date professional information, email newsletters, job listings, local networking events, and annual conferences. 

One of the nursing organizations is American Association of Nurse Practitioners (AANP), which aims at empowering all APNs to advance the delivery of quality health care through leadership, research, advocacy, education, and practice. AANP explains that the American Association of Nurse Practitioners has approximately 96,000 members and they are united towards the provision of exceptional patient care. The AANP was formed in 2013 after the merger of the American College of Nurse Practitioners (founded in 1995) and the American Academy of Nurse Practitioners (founded in 1985) where it aims at providing nurses with a network where they advocates their issues and network across the country (Kleinpell, Cook, & Padden, 2018). According to Kleinpell et al. (2018), AANP was the first organization formed by nurse practitioners regardless of their specialties in the U.S. and is still the largest national membership for all specialties. 

The second organization is the American Nurses Association, which is among the largest nurses organization. This is my organization of choice as it has state connections. One advantage of ANA is that it helps members to access an online library with rich research and information. One of the reasons for choosing this organization is due to personal interest in continuing education. ANA provides member-only webinars on varying topics that explore varying specialty areas in nursing. Another advantage of ANA is that the webinars provide ANA members with contact hour. In addition, being a member of ANA adds weight to the resume of a student while seeking employment, an aspect I do not want to miss. 

Halstead (2017) argues that ANA members are at an advantage as they are in a position to access some of the top nursing journal and magazines, which eases the networking process with other nurses across the country. Generally, ANA is in line with my individual perspective towards nursing, which is a concern for the vulnerable, the injured, and the sick, as well as, social justice. These aspects are all represented in the ANA Code of Ethics for Nurses, which is a guiding principle for all nurses and their commitment to society. 

The last nursing association in this assignment is the National Student Nurses Association (NSNA). The NSNA, which was formed in 1969 Halstead (2017) is valuable for every nursing student in America. Every student while in school desires to get employment once they graduate. The NSNA is the best platform for the students, as it has career resources for students seeking employment. In addition, students can access educational journals and other nursing materials suitable for their educational programs. Halstead (2017) argues that NSNA provides leadership skill-building resources and educational meetings all which add more knowledge to the students. Lastly, NSNA provides scholarships to students an element, which is an incentive for students to further their learning skills. 

Controversies in Advanced Nursing Practice

APNs practice has been underpinned by regulatory mechanisms, as well as, state-specific practice regulations regardless of the knowledge and the wide-ranging abilities of APN, which range from diagnosing illnesses, interpreting diagnostic tests, prescribing medication, and treatment plans (Scanlon et al., 2016). According to the Institute of Medicine (IOM) (in Andrew Scanlon (2014), APNs should be allowed to practice to the full extent of their training and education based on the understanding of the contribution of nurses towards the delivery of high-quality care. However, several controversies exist on the aspect of APN practicing to the full extent of their abilities. Some of the challenges facing Advanced Practice Nurses include quality of educational programs, fragmentation/variability in standards, the scope of practice conflicts, differing educational requirements and degrees, the proliferation of APRN titles, and poor role clarification.  

Other issues result from lack of understanding of APNs roles, inaccessibility of educational programs globally, and lack of respect of the nursing profession. In his article, Heale and Rieck Bbuckley (2015) explain that APNs reported facing challenges in licensure requirements, prescriptive authority, and the scope of practice. Another issue that is greatly affecting the practice of APN is varying state regulations. According to Andrew Scanlon (2014), specific state regulations can restrict the aspects of APN including cultural barriers, institutional barriers, and legal/regulatory barriers. For example, it remains controversial in some countries whether health insurance companies should recognize APNs as providers or whether they should be reimbursed directly, reimbursed for services, sign orders for long-term care services, serve as primary care providers, or even admit patients. 

In addition, APNs continue to face institutional and cultural barriers, which limit their practice. For example, some health services have formed laws restricting health professionals such as who should admit patients in inpatient or perform specific procedures. According to Andrew Scanlon (2014), several of the controversies facing APNs result from outdated models of authoritarian leadership, which have defeated team-based and inter-professional collaboration. Generally, the APN variations in the world today are in respect to collaborative agreements, physician supervision, certification, oversight, requirements for prescribing privileges, and scope of practice. Heale and Rieck Bbuckley (2015) identify that the APN issues can be resolved at a global level through certification requirements, independent practice authority, role recognition, supervision requirements, standardized educational requirements, prescriptive authority recognition, country-specific regulations, and uniform scope of practice. Therefore, although APN continues to face issues, it can be resolved. 

References

America Nurses Association (ANA). (2019). Advanced Practice Registered Nurse (APRN). America Nurses Association. Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/

Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz Ph.D., R. N., Linda East Ph.D., R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online journal of issues in nursing, 19(2), 1.

Emergency Nurse Association (ENA). (2015). Scope of Practice for Advanced Practice Registered Nurses in Emergency Care. Emergency Nurse Association.

Halstead, J. A. (2017). Professional nursing organizations. Issues and trends in nursing: Practice, policy, and leadership, 107-118.

Heale, R., & Rieck Buckley, C. (2015). An international perspective of advanced practice nursing regulation. International nursing review, 62(3), 421-429.

Kleinpell, R., Cook, M. L., & Padden, D. L. (2018). American Association of Nurse Practitioners National Nurse Practitioner sample survey: Update on acute care nurse practitioner practice. Journal of the American Association of Nurse Practitioners, 30(3), 140-149.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), 129-142.