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Analysis of Advanced Practice Nurse Roles and Issues

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Analysis of Advanced Practice Nurse Roles and Issues

Evolution of Advanced Practice Nursing within the US Health Care Delivery System

Depending on whom you talk to or which book you pick up, there are different opinions about the roles of the advanced practice nurse (APN). According to Trujillo (2012),

If the past is any indicator of the future, then the growth and expansion of the Advanced Nursing Practice Role still has many miles yet to go on its journey toward recognition, respect, and earning its place at the elusive “provider power table.” Nursing still struggles to define itself as a profession, and lack of autonomy on the part of the Advanced Practicing Nurse leaves one to wonder what defines professional in the world of nursing if a vital component of being a professional is missing. History demonstrates themes over time that have not only contributed to helping nursing to grow as a profession, but have also held the Advanced Practicing Nurse back from establishing the much coveted chair at the table of healthcare professionals. (para. 1)

It is clear the role has developed significantly from its start to now. DeNisco and Barker (2013) explored the trajectory of advanced practice nursing and described the different milestones in its development:

The evolution of the advanced practice nurse role began with the expansion of education provided for these advanced roles requiring specialty skills. Doctoral nursing programs can be thought of as having four phases. The first phase occurred between 1900 and 1940 in which the doctoral of education or another functional degree was available. (p. 30)

Continuing their description of the background of the APN role, DeNisco and Barker (2013) stated:

Phase two occurred between 1940 and 1960 when the degree could be obtained in a basic or social science discipline with no nursing content. Phase three occurred between 1960 and 1970 when a basic or social science PhD was available with a minor in nursing, and Phase four began in 1970 with the rapid progression of the DNSc and nursing PhD programs. (p. 30)

Trujillo (2012) reported the following definition of APN practice:

Loosely based on the American Nurses Association Scope and Standards of Advanced Practice Registered Nursing, Advanced Practice Nursing is defined as “the application of an expanded range of practical, theoretical, and research based competencies to phenomena experienced by patients within a specialized clinical area of the larger discipline of nursing. Although the definition provided appears simple, concise, and applicable to the role, much conflict still surrounds the lack of consensus on a true definition of this type of nursing that is clear to those in the profession of nursing and outside of it. Current challenges to achieving a satisfactory definition that is acceptable to all include confusion about what specialty nursing versus Advanced Practice Nursing is, title confusion, as well as debates about who is and who is not an APN, and the discrepancies in educational preparation for APN’S. (para. 2)

Trujillo (2012) explained the further development of the APN role:

Several historical events have contributed to the development of the Advanced Practice Nurse role. Wartimes helped to advance the scope of practice of nurses, produced the first graduate courses for nurses, and influenced the United States Government to provide funding for nurse education via programs such as the GI Bill. Although specialized nursing such as nurse anesthesia, public health nursing, psychiatry, and nurse midwifery boast the deepest historical roots, wartimes helped to provide the medium for even more specialization within the advanced practice nursing community. Oncology nursing became a specialty due to new knowledge and technology linking chemical warfare with cancer, revealing a new need for Oncology nurses to care for these patients. Flight nursing also emerged as a specialty during wartime. The Vietnam conflict bore a new foundation from which advanced practice nurses could advance their education, and the title of Clinical Nurse Specialist was first recognized. Nurses who wished to become advanced practice nurses had to possess a Bachelor’s of Science Degree in Nursing in order to obtain higher education in their field. (para. 3).

Roles and Issues Representing an Area or Problem in Advanced Practice Nursing

Trujillo (2012) continued reviewing the developmental path of the APN profession, stating that in addition to war stimuli,

The shifting economic climate illustrated the need and effectiveness of Family Nurse Practitioners during periods of increased immigration, the Great Depression, as well as wartimes when extra resources were pulled to support the military. Historically, Public Health Nurse Practitioners have demonstrated their effectiveness at providing primary care since the 1800’s when they cared for the poor and underserved via the use of a nurse clinic environment, home visits, and the use standing orders provided by physicians as a guide. The 1950’s saw another period of increased immigration where Nurse Practitioners were again heavily relied upon for primary care. Although physicians initially supported the use of Nurse Practitioners for primary care, they did so at the whim of the economic climate. The Great Depression was a time of challenge for Nurse Practitioners. Physicians struggled to maintain their incomes and they viewed Nurse Practitioners as financial competition. The American Medical Association “Old’ boys club” has always presented itself as the single biggest barrier to the full advancement of the Nurse Practitioner role in the Primary Care setting, with Nurse Practitioners receiving their limited support when it didn’t impede on their own practice. (para. 4)

Concluding the review, Trujillo (2012) stated:

Regardless of wartime, economic climate, or the progression of different advanced practice nursing roles history has demonstrated that nurse research linking the effectiveness of nursing care with patient care outcomes still persists as another large barrier to the overall advancement of the APN (para. 5).

Importance of Looking at Concepts in Depth within Advanced Practice Nursing Specialties

In the past, few nurses pursued an advanced degree, as it was not a requirement in hospital practice. DeNisco and Barker (2012) stated:

Beginning in the 1970’s several new doctoral programs in nursing emerged educating individuals in the field of nursing occurred and doctoral education in nursing



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