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Four advanced practice nurse roles
Four advanced practice nurse roles
Four advanced practice nurse roles
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Advanced Nursing Practice
The name DNP implies expertise in clinical practice, the ability to deliver comprehensive, evidence
based care to individuals, families or populations. The AACN identifies DNP programs as “providing
preparation within distinct specialties that require expertise…and mastery in an area of nursing
practice…within the larger domain of nursing.” (p. 16) It is the terminal degree for nurses interested in
their practice specialty. It implies the culmination of each of the previous seven competencies and
encompasses and expands the nine core NP competencies as defined by the NONPF, advanced nursing
practice (Rothacker-Peyton, 2017).
Summary of Learning
“Although there are many health care challenges, the burden of mental illness compels us to address the needs of individuals, families, and communities that are at risk for, or experiencing, mental health problems” (Fitzpatrick, 2017,
…show more content…
p.710).
The DNP/PMHNP is critically poised to address these needs. Nevertheless, barriers to practice continue to exist for the DNP. While research supports the safe, efficacious care provided by the FNP/DNP, there are still challenges to entry into practice, scope and practice restrictions in all but 21 states, discrepancies with titling, and confusion about the DNP degree. Moreover, there are additional challenges for the PMHNP/DNP. There have been the initial concerns about preparation for the role, challenges around the education preparation for the ANCC certification exam, the creation of a new ANCC certification exam for the PMHNP, and retirement of the previous certification exams. The Consensus model assists policy makers and others outside of nursing understand the DNP preparation for entry into advanced practice
nursing and the AACN Essentials of Doctoral Education for Advanced Practice Nursing articulates the competencies for advanced practice nurses practicing at the doctoral level. Through the process of writing this synthesis paper, I have had the opportunity to read about some of the nursing organizations that have formulated policy and practice for the DNP and the PMHNP. I have strengthened my comprehension of DNP practice and the competencies that differentiate the DNP from my current NP preparation. While aware of the diversity of nurse practice acts, it was enlightening to compare the differences between full practice states and some of the challenges that restricted practice states face. Brown & Kaplan (2016) articulate it best when they asked if Loretta Ford could have seen a time when NPs would have doctoral education, “similarly, what might we imagine is on the other side of the door the DNP degree has opened?” (Brown & Kaplan, p. 42).
Ja Young, thank you for breaking down what the difference are between diagnostic, formative, and summative assessments that demonstrates mastery of nurse practitioner competencies. After reading your post, I also felt it is important to examine the mastery of “policy” through courses such as health policy, which we will be taking in our program. It is important for nurse practitioners to not only understand the changing policies regarding scope of practice, but also how to advocate and contribute to the development of health policies (Dzubur, 2015). As nurse practitioner students, we can increase our exposure to political changes to practice by joining organizations such as California Association of Nurse Practitioners (CANP) and attending events such as Lobby day.
According to Weis/Tappen (2010) competency is defined as “the demonstrated ability to carry out specific tasks or activities with reasonable skill and safety that adheres to the prevailing standard of practice in the nursing community” (p. 262). To be competent a person should be able to perform a set skill at an expected level. Pertaining to nursing, competence is shown by skill provided in healthcare with safety and understanding of how it is to be performed. The nurse is responsible for continuing competency throughout his/her career in order to meet the performance level set by the healthcare facility they are employed by.
I am delighted in my career as a professional nurse and seeking the Doctor of Nursing Practice (DNP) gives me the opportunity to expand my knowledge base in order to practice at a higher level, and obtain the terminal degree in my profession. My goal is to become an adult nurse practitioner, with primary focus to improve the practice of nursing. The Doctor of Nursing Practice will equip me with knowledge and skills needed to understand and appreciate research and facilitate the process of putting evidence into practice, with the overall goal of achieving improve patient safety, satisfaction and outcomes. The Doctor of Nursing Practice will enable me to assume more leadership role, in practice and in research. I should be able to participate in research and formulate nursing models guided by evidence based practice models of care. Having practiced as a professional nurse for five years, obtaining the Doctor of Nursing Practice gives me the opportunity to foster my professional growth and development.
Nurse practitioners (NPs), one type of advanced practice nurses, are licensed by the states where they practice and certified by private boards. Nurse practitioners hold advanced degrees in clinical practice and function in a wide variety of settings and across the life span. They provide a broad array of healthcare services ranging from managing treatment plans, to prescribing medications, to implementing health promotion services. As of 2014, 205,000 NPs were licensed in the United States with 86% of those prepared to deliver care to patients in primary care settings (NP Facts, 2015). The progression of the Nurse Practitioner movement that occurred in the 1960 and 1970s emerged as a creative and
Nursing, as a crucial part of the health care system, keeps evolving while dealing with an increasingly complex clinical situation that involves quality of patient care. Therefore, to successfully handle these scenarios, nursing needs to become more advanced, clinically and academically. A DNP degree is needed in this situation because according to Dunbar- Jacob, Navito & Khalil (2013), a DNP degree is considered to have more impact on nursing than a Master’s or Bachelor’s degree due to the advanced clinical education a DNP provides (p. 425). Hence, the DNP degree has an enormous impact in nursing practice especially in terms of improving clinical care, promoting leadership roles, and improving educational status.
As a result of state regulations, public awareness of the role and market forces, graduate psychiatric nursing programs began modifying training programs to meet the requirements for NP credentialing (ANA, 2014). The first PMHNP certification exams were created in the early 2000’s and the role of the PMHNP was clearly described and delineated by the creation of the Psychiatric-Mental Health Nurse Practitioner Competencies in 2003 by the NONPF (ANA, 2014; APNA 2010). Throughout the early 2000’s there were four advanced practice psychiatric mental health nursing credentials, the Adult Psychiatric-Mental Health CNS, the Child/Adolescent Psychiatric-Mental Health CNS, the Adult Psychiatric-Mental Health NP, and the Family Psychiatric-Mental Health NP. The availability of four credentials for PMH-APNs led to confusion amongst nurses, other health disciplines, employers and the
In the United States alone, 57.7 million individuals suffer from mental illness. These illnesses range anywhere from mood disorders to anxiety disorders or to personality disorders and so on (The Numbers Count: Mental Disorders in America). 18 to 25 year olds make up about 30% of these individuals alone (Survey Finds Many Living with Mental Illness Go Without Treatment). These individuals require care from medication to psychiatry or even to confinement. However, of these 57.7 million individuals with mental illness, studies have found that less than one in three of these individuals receive proper treatment (Studies Say Mental Illness Too Often Goes Untreated).
The acceptance of the DNP has not come without some hesitation. There were many leaders in nursing who had some beliefs that the practice doctorate would somehow take away the spotlight from the research being done in the field of nursing (Zaccagnini & White, 2017). Many physicians also view the DNP as trying
She stated that the knowledge and skills acquired and the focused-population competencies have served as a reference where she can draw on at any time. In fact, the use of an advanced assessment skill and critical thinking can help determining abnormal findings, diagnose a patient as early as possible, and manage disease as well. The same sense of curiosity pushed the interviewer to ask Sarah how she applies the care delivery system core competencies in her current practice. She believes that in a daily basis, she must collaborate with other disciplinary team to ensure an appropriate quality care to patients. For instance, the act of referring high risks pregnant women for consult to maternal fetal medicine engages an inter-professional communication and exchange between providers with aim to enhance the quality of care. In addition, HIV and Zika positive pregnant women are reported to the health department for statistics and epidemiologic purposes. Thus, the care delivery system core competencies are of importance for the practice. The interest in determining the implementation of the core competencies in practice continues with this last question about technology and information literacy competencies use in the practice. According to Sarah, the competencies acquired in nursing class about information technologic have helped in her current practice to manage patient care information through the electronic health record, communicate with other healthcare disciplinary team in the delivery of quality and safe
These core competencies are guidelines that build upon existing core competencies and help to prepare NPs in implementing a full scope of practice as a licensed practitioner (National Organization of Nurse Practitioner Faculties, 2012). These competencies promote consistency and quality.
“A few gaps were identified between CNS core competencies and CNS role expectations in current practice.” (Baldwin, Clark, Fulton, & Mayo, 2009, p. 193). Core competencies from the NACNS are well founded from the view of practicing CNS’s as stipulated by Baldwin et al. These core competencies serve as the framework for CNS’s. “The competencies are specific enough to facilitate an understanding of the role by nursing leaders who are not CNSs yet who are responsible for evaluating CNS practice within an organization.” (Baldwin, Clark, Fulton, & Mayo, 2009, p. 200). Findings from evaluation of the CNS job are being used by the American Nurses Credentialing Center (ANCC) as for a new core CNS test that is in
The development of mental health policy has gone through many changes in the course of the twentieth century. Today, mental health policy is totally different from the policy hundreds of years ago. Because of this, it is important to emphasize the fact that mental health policy has shifted from the indifference and isolation of people with mental illness, to the delivery of social services and community integration. In other words, mental health policy has experienced a serious change that has changed the attitude of policy makers, health care professionals, ordinary people, and also to people with a mental illness. Today, people with mental health problems are no longer outsiders as they used to be. Instead they are seen as people who have different needs and social geared towards their integration into the community. The federal government now has a policy that addresses the problems faced by people with mental illness, gives the community a chance to understand these people, and sets a standard in providing mental health services. There are over seventy actions in The Federal Mental Health Action Agenda. “It offers an unprecedented opportunity to fundamentally alter the form and function of the mental health service delivery system in this country to one that puts individuals-adults with mental illnesses, children with emotional disturbances, and family members-at its very core” (The Federal Action Agenda: First Steps. Web. 24 Mar. 2014).
What is the central component of advanced practice nurses (APNs) direct clinical practice and patient/families?
As a nurse with several decades of experience, I have noticed that these “core competencies” have changed slightly over the years and Hood addresses these changes in the first part of her book. Shifting from the 1973 generic list of “standards for professional nurses that would apply across practice settings” (Hood, 2018, pg. 6), the newer model provided by the American Nursing Association (APA) addresses the need to “develop standards of practice for nursing speciality areas” (Hood, 2018, pg. 6) by collaborating with nurses within these areas, including psychiatric and mental health, forensic, hospice and palliative care, and nursing administration. In addition to these new guidelines that move beyond the generic and towards a more comprehensive approach to the areas of nursing specialities, the APA emphasizes how the study of the humanities brings an important aspect to the art and science of nursing. One may at first believe the liberal arts aspect of the BSN to be superfluous. Yet, when we
The interdisciplinary course is a core requirement in the after-degree nursing program as it incorporates the principles of self-directed learning and promotes critical thinking, which is an essential element in nursing practice. As a final year nursing student, I believe that knowledge from this course will enhance my ability to provide patient-centered care.