Advanced nursing practice refers to the provision and coordination of patient care that includes both primary and specialty care. As much as the exact scope of advanced nursing practice varies by state, it is imperative noting that it is performed in different healthcare settings, which may include clinics, nursing care facilities, physicians’ offices, and hospitals (Barton & Allan, 2015). Furthermore, the cited literature suggests that advanced nursing practice always entails caring for the patients while interacting with the public simultaneously in which the advanced nurses serve as a liaison between the families of patients and the doctors. The scope of practice in advanced nursing, therefore, implies that the professionals involved undergo advanced training, which is essential in the obtainment of greater knowledge levels compared to other types of nurses. In advanced nursing, it is useful to note, the nurses involved always depict greater decision-making abilities as well as expertise in the different areas of the nursing profession.
From the definition of advanced nursing practice, it is can be deduced that advanced nurses perform several functions. According to Schober (2015), advanced nurses obtain the health histories of patients and undertake in-depth physical examinations on them, which may include developmental, psychosocial, and functional analyses. The same cited study suggests advanced nurses can order and interpret laboratory reports as well as other forms of diagnostic studies, create differential diagnoses, engage in research studies, organize for patient consultations and referrals, offer patient and family education and counseling, and maintain patient records. Furthermore, advanced practice nurses may create or order therapeutic care plans for their patients.
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Literature reports further that advanced practice nurse is a general designation for all types of nurses that have an advanced educational background in the nursing field (Barton & Allan, 2015). The cited author suggests that advanced nursing practitioners could be categorized into Certified Nurse Midwife, Clinical Nurse Specialist, Certified Nurse Anesthetist, and Nurse Practitioner. It is plausible to suggest, therefore, that a Nurse Practitioner is a type of Advanced Practice Nurse. However, a slight distinction has been advanced in literature, and it suggests that Nurse Practitioners can work independently in private practices and clinics because of their higher training levels while the Advanced Practice Nurses cannot be considered to work independently, which is why they often practice in healthcare setting where they have access to doctors and physicians for help if needed (Blair & Jansen, 2015).
I aspire to engage in research in my role as an Advanced Practice Nurse. I have interacted with patients for a considerable amount of time, and I have always been interested in understanding the effectiveness of the treatments and therapies that doctors and nurses give them. My interest has always been on the prognosis of diseases for which the patients are treated, and I feel that being a researcher would satisfy my inquiries. My philosophy has always been to use evidence-based practices in the delivery of patient care, and it has always driven me to read widely on interventions that may be applied in clinical and community settings to improve the wellbeing of patients. I am convicted that my attributes and philosophy fit me into the research role as an Advanced Practice Nurse.
Selected Advanced Practice Role
I visited the Anushka Cosmedical Centre in West Palm Beach region of Florida to interview Dr. Bonnie Marting. Dr. Marting is a renowned Nurse Practitioner and also the Co-Chair Florida Coalition of Advanced Practice Nurses. Her opinions have been sought by several people, including researchers because of her accomplished record in Medical Facial Aesthetics. The objectives of the interview were to find out the legal and regulatory requirements in the State of Florida, the professional organizations available for membership based on Advanced Practice Nursing role, and the competencies required. In the interview, we further discussed the organizational setting, colleagues, and population with whom I plan to work.
Concerning the legal and regulatory requirements for Advanced Practice Nurse researching, I learned that the interviewee wanted me to state whether I wanted to practice in a position of her status, which is if I wished to be a Nurse Practitioner. She indicated that only then would she be able to respond effectively to my question because of her experience in the field. During the interview, it was mentioned that a written protocol between a physician and a Nurse Practitioner is mandatory in the State of Florida. Dr. Marting indicated further that extend of the supervision and the method used should always be determined by the physician in the protocol. For example, while citing Fla. Admin. Code §64B9-4.010, she advised that general supervision by a physician is a requirement in the protocol, and that it should a thorough description of the duties of the Nurse Practitioner and those of the physician. Furthermore, the document should highlight the management areas that would be allocated to the nurse, and other conditions.
Dr. Marting advised that I would not be possible for me to stick to the research role without interacting with patients in the clinical and community settings, which is why I should consider doing a series of other roles with which Nurse Practitioners are identified with in the country and around the state. She cited Fla. Admin. Code §464B9-4.012, and indicated that in my prescriptive duties, I needed to stick the terms documented n the protocol. Chapters 458, 459, and 464 of the Florida laws, the interviewee indicated, allowed Nurse Practitioners to practice primary patient care, and to provide medical service that are usually offered without the need for referral from other health care providers.
The interview also revealed the existence of a range of professional Nurse Practitioner bodies around Florida. While she mentioned the Florida Nurses Association and other bodies, she described only the Florida Nurse Practitioner Network because she felt that it would be the most relevant for my area of interest. The interview revealed that the mission of the organization is to promote networking among members throughout the state, offer professional and educational development for the members, act as a resource for members, their patients, and the rest of the consumers of health care services and products. Lastly, the body seeks to enhance excellence in research, policy, education, and practice of Advanced Practice Nursing.
The interview revealed the availability of certification for all accredited doctoral, post-graduate, and masters programs within chosen population focus. Furthermore, in Florida, the state licensing body recognized the need for the practitioners to attain national certification. The certification process in the state is guided by the APRN Consensus Model. The new model first considers the roles of the Nurse Practitioner before looking at the population focus of the nurse’s choice. The model, Dr. Marting insisted, stressed the need for proper educational preparation for the Nurse Practitioner’s roles instead of specialty preparation. Currently, in Florida, the Florida Board of Nursing is in charge of licensing Advanced Practice Nurses, including Nurse Practitioners.
I desire to work at the Florida Hospital Waterman, which is a free clinic that engages in the provision of adult primary care to persons who are uninsured and eligible in the North Lake County of Florida. The organization offers non-emergent health care that addresses the spiritual, emotional, and physical needs of the patients. The hospital has sixty-seven physicians, nurse practitioners, physician assistants, and support staff.
Leadership Attributes of the Advanced Practice Role
I prefer the democratic leadership style, which is described in relevant literature as a shared or participative leadership (Lee, Yoong, & Abdullah, 2016). I always prefer to include groups in the decision-making procedures. Because of the desire to make informed decisions that would help the entire organization, democratic leaders can work in a range of contexts, including the public and private domains (Lee, Yoong, & Abdullah, 2016). My leadership traits, which include the fact that I prefer to include others in the decision-making process, inspire others to feel part of the organization, I could also fit into the transformational leadership context. According to Sadler (2013), transformational leadership is a model of leadership, which inspires follows to keep changing, and improving themselves. The two approaches to leadership, therefore, share the idea of charisma (Sadler, 2013). In this case, both transformational and democratic leaders will always want to be role models to their followers, which is why they would want to empower them to have a sense of belonging to a group. The figure of the leader in the two approaches to leadership is that of providing direction for the rest of the people through valuing their potential contributions to the success of the organization.
In my professional practice, I would always prefer the democratic leadership style. My interest in research, I will always be required to work with teams to design the study designs, collect and analyze data, and interpret the findings. Consequently, challenges that come with working in groups are bound to happen. In my leadership capacity, I would always encourage the rest of the people with whom I work to seek each other’s opinions before developing strategies to address problems that would emerge out of their interactions. Since I would always be required to make decisions that would communicate a sense of direction for the groups, I would also be keen to understand the views of my followers before making reaching a consensus instead of enforcing ideas on them. Furthermore, I would encourage the followers to always air their views when crises happen and to interact freely with me—I feel that a big power distance between leaders and their followers always intimidates followers and discourages them from interacting.
Health Policy and the Advanced Practice Role
FNP/AGNP
The path towards being a Nurse Practitioner could be rewarding for individuals who take the course. While some of the states around the country allow full autonomy to their Nurse Practitioners to oversee their activities, some of them do not do so. Currently, twenty-three states allow full autonomy for their Nurse Practitioners, while the rest still restrict the way the nurses operate. Precisely, the states of Wyoming, Washington, Vermont, South Dakota, Rhode Island, Oregon, Oklahoma, North Dakota, New Mexico, New Hampshire, Nevada, Nebraska, Montana, Minnesota, Maryland, Maine, Iowa, Idaho, Hawaii, Connecticut, Colorado, Arizona, and Alaska have allowed full autonomy to their Nurse Practitioners ( States with Full NP Practice Authority, 2018 ).
The list of states with NP Full Practice Autonomy obviously excludes Florida. In Florida, Nurse Practitioners are required to operate under full supervision of physicians—the issue was one of the most expressed in the interview with Dr. Marting. The issues around fully autonomy in the practice of Nurse Practitioners have significant connections with the need for the country to address physician shortages that have been reported in the recent years. For instance, literature reports that the country would a shortage of between 46100 and 90400 physician by before 2025 ( Nurse Practitioner Autonomy: A Shift to More Independent Practice, 2018 ). Meanwhile, trends indicate that the country’s demand for health care services and products has been rising over the past few years because of the aging baby-boomer population and healthcare legislation. It is anticipated that allowing full autonomy in the practice of Nurse Practitioners would increase the volume of people with the competence of handling diagnostic and other treatment procedures that were initially restricted to physicians and doctors. As much as the argument for autonomous practice has been a trend in the recent years, opponents of the suggestion suggest that the educational and training levels that Nurse Practitioners undergo may not be sufficient to attain the levels of competency associated with physicians.
The transforming health care environment of the US and its population profile will always require significant shifts in the system of care delivery. Specifically, it should be noted that the concerns in the shortage of primary caregivers in the country, has been prompted by restrictive practices for nurse practitioners. Some of the barriers that have been identified in literature include institutional culture and barriers, outdated models of reimbursement and insurance, state and federal laws, and other aspects. Addressing each of the identified issues in the current healthcare system would be one of the best approaches to solving them. One of the ways of doing this would be to stick to the guidelines specified by the NCSBN, National Council of State Boards of Nursing, and the Model Nursing Practice Act ( Butler & Shern, 2016 ). Comprehending the provision of the identified legislations could be fundamental in understanding the way in which full practice autonomy has been expounded and measured by the relevant laws and different regulatory boards. Consequently, policymakers that would be useful in the process of changing the scope of practice of Nurse Practitioners would include Congress, and state legislators.
I would use a variety of methods to sensitize policymakers towards the need for changing policy on full autonomy in the practice of Nurse Practitioners in Florida. One of the ways concerns my area of interest in the state, which is the fact that I would use evidence-based practices and research to highlight the contributions of Nurse Practitioners to the practice of medicine and health care. The second approach that I would use would be policy advocacy through writing white papers to congress and the state legislature in Florida on the need for policy review to incorporate Nurse Practitioners into the health care practices by increasing their autonomy. With significant levels of comprehension about the role of Nurse Practitioners, and the possible capabilities that they would bring to the health care system, the policymakers would be convinced to ease their regulatory framework. Lastly, I would join other professionals in the different and many Nursing Practitioner organizations, such as the one in Florida, to campaign for autonomy for Nurse Practitioners. The approaches identified, therefore, highlight the need for the process of pushing for change to have a diverse team of stakeholders to enhance the quality of decisions reached and raise the chances of succeeding.
References
Barton, T. D., & Allan, D. (Eds.). (2015). Advanced Nursing Practice: Changing Healthcare in a Changing World . Macmillan International Higher Education.
Blair, K. A., & Jansen, M. P. (Eds.). (2015). Advanced practice nursing: Core concepts for professional role development . Springer Publishing Company.
Butler, S.H., Shern, L . (2016). National Academies of Sciences, Engineering, and Medicine. Assessing progress on the Institute of Medicine report The Future of Nursing . National Academies Press.
Lee, H. C., Yoong, S., & Abdullah, A. G. (2016). Principal's Transformational Democratic Leadership: The Impact of Principal's Transformational Democratic Leadership Style on Teachers' Job Satisfaction and Commitment . LAP Lambert Academic Publishing.
Nurse Practitioner Autonomy: A Shift to More Independent Practice . (2018). NP Now The Nurse Practitioner Search Firm . Retrieved 1 December 2018, from https://www.npnow.com/nurse-practitioner-autonomy-a-shift-to-more-independent-practice/
Sadler, P. (2013). Leadership and organizational learning. Handbook of organizational learning and knowledge , 415-427.
Schober, M. (2016). Introduction to Advanced Nursing Practice: An International Focus . Cham: Springer International Publishing.
States with Full NP Practice Authority . (2018). Maryville Online . Retrieved 1 December 2018, from https://online.maryville.edu/nursing-degrees/np/states-granting-np-full-practice-authority/
