The Advanced Practice Nurse is established within a regulatory framework that impacts their professionalism (Canadian Nurses Association, 2008). The adopted framework paves the way for the incorporation of the national approach while at the same time allowing the flexibility at the county levels. This flexibility is meant to allow the development of new roles that are region-specific and permit quality nursing services. One of the regulatory standards requires APNs to be licensed and registered by an authorized body. International standards are also part of the regulatory framework that governs the roles and mandate of APNs. According to Heale (2015), the international council of nurses has made a tremendous effort in enhancing APN. The council has also provided a definition that presents a threshold for qualities and credentials of an APN. However, application of the definition slightly varies due to differences in legal regimes around the globe. In the US, state-specific regulations such as the affordable care act affect APN. The Obamacare act intended to enhance patient protection and the same had been articulated in the roles and mandates of APNs. A change in such a federal legislation would also require nurses to update their service charter. Abrams et al. (2011) have explained that the Obamacare reforms encouraged innovation and teamwork which is one of the goals of APN.
Registration and licensing further require the professionals meet a minimum threshold regarding academic qualification (Hanson, 2016). To register as an APN, one has to acquire a masters or doctoral degree in APRN from a recognized institution of higher learning. It is required to acquire a national certification in a population focus area recognized by APRN. Another requirement includes undertaking at least three credit hours of studying a recent pharmacotherapeutic course. Nurses are also required to constantly engage in ongoing CE hours of a similar course to enhance relevance. It is important to note that, regulations articulate credentials for APN. The two instruments are aimed at improving the professional standards of APNs.
Regulatory barriers, progress, and way forward
According to Brassard and Smolenski (2011), federal laws, state regulation, and hospital policies can become a barrier to APN. Some of the states in the US have laws that limit the full practice authority for ANPs. These laws restrict the practice of ANPs which also affects the recommended roles and mandates associated with this profession. State laws and federal policies that support outdated insurance models or institutional laws have also been identified as barriers.
There is a need for individual states to remove the restrictions on the practice of ANPs. The states should give room for the ANPs to practice the responsibilities, incorporate innovation, make decisions and conduct additional research. Both the federal government and the state governments should develop a legal framework that encourages ANPs to practice fulfill their roles and mandates. The legal reforms include amendment of critical issues in the current legislation that prevents APN from fulfilling their roles. Current Medicare programs prevent APNs from conducting patient admission, assessment and certification of patients for admission.
The emergence of technology is an important area that APNs have to consider. Technology has the potential to enhance consistency and accuracy among ANPs. For instance, ANPs have to make use of electronic healthcare databases to enhance patient-centered care. The current Medicare programs should be amended to allow APNs to conduct patient admission, assessment and certification of patients for admission.
According to Parkera and Hill (2017), the approach adopted in China can be emulated to help improve APN. The nursing role should be expanded from the hospital to community, which will improve disease prevention as well as patient-centered care. A clinical career ladder framework should be developed to encourage career development. A special accreditation system should be established and integrated with practice models to enhance the fitness of nurses to perform in complex roles.
Profession and professionalism in APN
APN is required to adhere to a set of professional standards that enable them in making ethical decisions during the practice. Advanced practice nurses have a responsibility to demonstrate an advanced level of clinical nursing. Some of the critical issues related to this profession demand are the adherence and application of graduate knowledge. It is required that professionals in this area demonstrate the ability to analyze and synthesize knowledge. The nurses are also expected to exhibit excellent understanding, interpretation, and application of a range of nursing theories or conduct research. Advanced nurses are also expected to make a positive contribution towards the development of nursing knowledge as well as profession. It is required that APNs demonstrate a high sense of accountability in the nursing practice. The professionals are required to demonstrate leadership that positively contributes to service provision in the health sector. Competencies in clinical decision making, communication, interpersonal competencies, management, and teamwork are expected from APNs.
It is important to understand the existing differences between the advanced practice nurses and the registered nurses. The difference stems from the levels of education between the APN and RN (Brassard & Smolenski, 2011). Registered nurses are required to have at least an associate degree in nursing while the APN are required to acquire at least a masters degree in nursing. While the APNs profession is characterized by the ability to make medical decisions, RNs lack adequate training to make similar decisions. Another difference is that the APN can analyze patient data and the RN can take over the process of implementation.
Historical factors that contributed to the development of advanced practice nursing role
In the US, the nurse practitioner role emerged over 40 years ago and included formal training of care providers, legalization as well as certification. This made the nursing practice a recognized profession in the field of health. One of the pioneer institutions included the University of Rochester Hospital Pediatric Centers. According to Parkera and Hill (2017), Loreat Ford and Henry Sliva joined forces to improve child care and child management. These pioneers established that nurses could be involved in the development of protocols to enhance the processes of diagnosis, assessment, treatment, monitoring, and evaluation of patient situations. From then, the contributions from professional nurses towards patient care have increasingly been appreciated. The developer has been characterized by improvement in ethical standards, academic standards, and professionalism. According to a presentation by Pulcini (2015), the precursor period of development of APN occurred between 1965 to 1970. The roles of APN, the definition of APN and legitimization of the nursing practice occurred between 1971 and 1974. It has been stated that the expansion period of APN took place between 1991 and 2001, which was later accompanied by education expansion from 2002 to date.
Abrams, M., Nuzum, R., Mika, S., & Lawlor, G. (2011). Realizing health reforms potential: How affordable care act will strengthen primary care and benefit patients, providers, and players. The Commonwealth Fund Publication, 1466, vol. 1. Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jan/1466_Abrams_how_ACA_will_strengthen_primary_care_reform_brief_v3.pdf
Brassard, A., & Smolenski, M. (2011). Removing barriers to advanced practice registered nurse care: hospital privileges. AARP Public Policy Institute. Retrieved from https://assets.aarp.org/rgcenter/ppi/health-care/insight55.pdf
Canadian Nurses Association. (2008). Advanced Nursing Practice: A national framework. Retrieved from https://cna-aiic.ca/~/media/cna/page-content/pdf-en/anp_national_framework_e.pdf
Hanson, C. M. (2016). Understanding regulatory, legal, and credentialing requirements. Retrieved from https://nursekey.com/understanding-regulatory-legal-and-credentialing-requirements/
Heale, R. (2015). An international perspective of advanced practice nursing regulation: APN regulation. International Council of Nurses. Retrieved from https://www.researchgate.net/publication/278045776_An_international_perspective_of_advanced_practice_nursing_regulation_APN_regulation
Parkera, J. M., & Hill, M. (2017). A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong Special Administrative Region (SAR), China. International Journal of Nursing Sciences, 4(2), 196-204. Retrieved from https://doi.org/10.1016/j.ijnss.2017.01.002.
Pulcini, J. (2015). Advanced Practice Nursing in the United States. Retrieved from https://fhs.mcmaster.ca/globalhealthoffice/documents/AdvancedPracticeNursingintheUnitedStates.pdf
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