There is an increased demand for cost-effective healthcare provision, which has caused a shortage of physicians in primary healthcare. An increase in the aging population, the increased prevalence of long-term conditions, and increased access to healthcare caused by the Affordable Care Act (ACA) have increased the number of people requiring treatment hence causing the shortage of physicians. These challenges have increased the need for advanced practice nurses (APN) who provide high quality and cost-effective care. They also relieve physicians to focus on more complex health issues. The transition from a registered nurse to an NP is difficult, and, therefore, novices need to adopt strategies that will allow them to succeed in this role. This paper will discuss the roles and competencies of APNs and the improvement of healthcare outcomes through scholarship engagement.
Types of APNs and their Roles
APNs include a category of registered nurses who have undergone further training. They receive post-graduate education (master's, post master's, and doctoral) and receive national certification for specialization in specific health fields (Woo et al., 2017). In the U.S, there are four APN types; namely, clinical nurse practitioners (CNPs), certified registered nurse anesthetists, clinical nurse specialists (CNS), and certified nurse-midwives (CNM). CNPs work in specialty areas such as pediatrics (PNPs), family health (FNPs), women's health, among others (ANA, n.d.). They have increased autonomy to diagnose and manage acute and chronic conditions. Certified registered nurse anesthetists provide anesthesia to various patients in many settings. They provide care to patients of all ages requiring surgery and those who are seriously ill, including terminally ill and incapacitated ones. CNS specializes in various areas of medicine depending on factors such as type of care offered, population served, disease or health issue of specialty, and healthcare setting or unit such as critical care, surgery unit, or emergency room. CNMs provide a blend of services provided by midwives and gynecologists. They help women with all reproductive health issues such as family planning, contraceptive use, monitoring, and providing care throughout the pregnancy cycle. These functions include initial consultations, prenatal visits and exams, assisting during delivery, and providing postpartum care for the mother and her baby. They can work in different settings, such as hospitals or women's homes, to independently make critical care decisions.
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Competencies of APNs
There are several competencies that APNs need to acquire to perform the roles that separate them from registered nurses. A study by Cassiani et al. (2018) identified core APN competencies to include ethical and legal practices, research, evidence-based practice, collaboration and interprofessional practice, consultancy, care management, autonomy of practice, clinical and professional leadership, education, health promotion, cultural competence, communication, education and teaching, and quality and safety management. Sastre-Fullana et al. (2017) provided core APN competencies that match those identified by Hamric's Model of Advanced Nursing Practice. Direct clinical practice, collaboration, consultation, research skills, ethical decision making, expert coaching and advice, and professional leadership were the core competencies established. These competencies are vital for the different types of APN, following the type of care they provide and the intended target population and outcome.
The rationale for Choosing CNP Role
CNPs are trained based on a combination of medical and nursing knowledge. They have the capacity to diagnose and manage chronic and acute conditions (Woo et al., 2017). In clinical settings or interprofessional teams, they may order, conduct, and interpret diagnostic and laboratory tests. They also prescribe pharmacological and psychotherapy interventions for patients and may counsel them. The flexibility and diversity of CNPs, if utilized well, can ease the burden on other healthcare providers. This gives them the capability to act as the first contact for many health issues. They often practice in underserved communities and rural areas by filling the gaps left by the shortage of physicians in the U.S (Du, 2020). I want to be a CNP to get the clinical training to serve patients directly and alleviate the burden on the U.S healthcare system. Specializing in a category such as family and women would allow me to provide patient-centered care for my patients. This is because I would have responsibilities that would be beyond those of an RN. The autonomy to set up my own practice or independent work within a hospital would result in a higher income than the RN role.
Plans for Clinical Practice
APNs play a major role in primary healthcare. They help bridge access to general practice teams and offer high cost-effective healthcare services that match or surpass those provided by physicians. The ACA has transformed healthcare delivery and created additional requirements that have provided gaps for APNs to fill (Woo et al., 2017). For instance, it has increased access to healthcare and raised the standard of care available to everyone. Most NPs work with populations whose primary medical coverage is Medicare and Medicaid. Nurse practitioners are the most prevalent type of APNs in primary healthcare, with 89% prepared for it and 75% providing it (AANP, n.d.). Their versatility in working in different settings and across different populations has made NPs the most likely to offer rural communities service. The community and several vulnerable populations benefit a lot from APNs since they increase access to healthcare.
I want to provide patient-centered care, which is difficult for physicians to provide due to their workload. Patients report better recovery when they have a physical and emotional connection to a nurse who is with them every step of their care process (Moretta Tartaglione et al., 2018). This increases patient satisfaction, especially for those suffering from chronic conditions or undergoing a transitional period between hospital discharge and home/external care. Provision of patient-centered care and allowing patients the degree of choosing their preferred care plan is possible through widening the scope of these nurses and encouraging them to maximize their education and training. The research on APNs has given me the motivation to pursue a role in the field to help patients the best of my ability.
Role Transition
The role transition period occurs between graduate school and the first year of practice in the CNP role. This period is difficult due to the fears, stress, and hard work required to handle this role's increased responsibilities and autonomy. The experience one has as an RN is important but cannot fully account for other factors that impact the transition period (Barnes, 2014). This is especially considering one is moving from the certainty developed as an experienced RN to a novice in the CNP role. Environmental and intrinsic factors impact this transition period. Environmental factors include the amount of support and guidance offered by learning institutions and clinical settings. Intrinsic factors include a candidate’s expectations and insecurities towards the CNP role. The CNP role's increased responsibilities may scare new nurses who feel incompetent or not ready due to anxiety caused by the internal pressure to succeed (DU, 2020). The new role's challenges could also overwhelm a new CNP, especially if they rely on the new responsibilities being similar to those they had as RNs. These two factors need to be managed to ensure a successful transition period for new CNPs.
Supporting CNPs during their entry into practice is significant due to the workload-related stress and high nurse turnover. Formal integration has been found to be the most important way of helping CNPs in the transition role (Barnes, 2014). This involves the direction and support structure in the training content and procedures, such as creating post-graduate residency programs or the guidance offered by a preceptor nurse. It would be advisable for a new CNP to find a preceptor nurse and mentor who can guide them through the transition period and gradually increase their autonomous decision-making and authority to become independent healthcare providers. Another strategy would be for a candidate to remind themselves why they chose to pursue advanced nursing, such as providing healthcare to underserved and marginalized populations (DU, 2020). This will boost their self-confidence, beliefs, and perceptions of the requirements of the new role. It would also give candidates a chance to gauge their personal abilities and overcome the fear associated with the change, setting up realistic targets for the new role.
Scholarship Engagement in improving Health Outcomes
Engaged scholarship refers to scholarship, which increases academic knowledge while involving and benefiting the community. This calls for engaging in scholarly activities that benefit society, such as involving the community in forming research questions and evaluating the importance of the research to the community (ESC, n.d.). Healthcare researchers, teachers, and students are, therefore, encouraged to form key partnerships in society. Structuring teaching and training that is meant to help solve prevalent health problems in the community is a good example of this effort. Medical students should approach their studies from a communal perspective, such as researching problems facing their community. Community health-focused teaching and research will help them identify health problems in society and possible solutions. This will also contribute to creative and innovative solutions that help target specific vulnerable populations. APNs, for example, focus on health promotion campaigns and disease prevention strategies as part of their training and practice. This focus helps teach and raise awareness of certain diseases and conditions for the whole community. Thus, the training of nurses, physicians, and other professionals should take a community approach.
Conclusion
The demand for healthcare is causing a shortage of healthcare professionals, thus reducing healthcare access for many individuals. APNs carry out many advanced duties and more responsibilities than regular nurses and can support the stretched U.S healthcare system. There are several competencies and strategies that these nurses need to have to perform those increased duties and handle autonomy in decision making. One of their duties is health promotion and disease prevention, which is especially important when working with underserved and rural populations, which most CNPs serve. Therefore, training programs need to incorporate engaged scholarship by setting community-based projects and programs that help APNs research and tackle communal health issues and increase health outcomes.
References
AANP. (n.d.). Nurse practitioners in primary care. American Association of Nurse Practitioners. https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioners-in-primary-care
ANA. (n.d.). Advanced practice registered nurses (APRN). American Nurses Association. https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
Barnes, H. (2014). Nurse practitioner role transition: A concept analysis. Nursing Forum , 50 (3), 137-146. https://doi.org/10.1111/nuf.12078
DU. (2020, April 2). Strategies to transition to advanced nursing . Duquesne University School of Nursing. https://onlinenursing.duq.edu/blog/strategies-transition-advanced-nursing/
Cassiani et al. (2018). Competencies for training advanced practice nurses in primary health care. Acta Paulista de Enfermagem , 31 (6), 572-584. https://dx.doi.org/10.1590/1982-0194201800080
ESC. (n.d.). What is engagement scholarship? Engagement Scholarship Consortium. https://engagementscholarship.org/what-is-engagement-scholarship/what-is-engagement-scholarship
Moretta Tartaglione et al. (2018). The excellence of patient-centered healthcare: Investigating the links between empowerment, co-creation and satisfaction. The TQM Journal , 30 (2), 153-167. https://doi.org/10.1108/tqm-11-2017-0138
Sastre-Fullana et al. (2017). Advanced practice nursing competency assessment instrument (APNCAI): Clinimetric validation. BMJ Open , 7 (2), e013659. https://doi.org/10.1136/bmjopen-2016-013659
Woo, B. F., Lee, J. X., & Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Human Resources for Health , 15 (1). https://doi.org/10.1186/s12960-017-0237-9
