M2 Discussion – Primary Care NP and other APN roles
Primary Care NP Role vs. APN Roles
Compare the primary care NP role with other APN roles. What are the similarities among the roles, what are the differences, and how would you communicate the role to a healthcare provider and a consumer?
AP1 Discussion 2
Primary care NPs and APNs play critical roles in patient care and ensuring better and improved patient outcomes. Even though they both play important roles, the roles have both similarities and differences. It is important for the practitioners as well as other entities, such as consumers and healthcare providers, to understand the roles. They are both licensed registered nurses having substantial abilities and knowledge, and they exhibit clinical competencies and adhere to standards put forth within a jurisdiction (Schober, 2018). APNs are those who have a master’s or a doctorate degree after completing respective programs and passing the national certification exams in specialty areas such as CNM, CNS, CRNA, or NP. Advancing in either of the four roles requires that the individuals have exhibited family-centered and patient-centered practices and aspects such as advanced pharmacology, advanced pathophysiology, and advanced health assessment. While a CNS role may not need a pediatric clinical rotation, a primary NP needs such.
The roles have various similarities too. For example, they all focus on offering patient-centered care in the healthcare environment. In addition, their practice is governed by the education and training they have obtained and their certifications. Their roles are also governed by rules and regulations within various jurisdictions. The implication is that the scope of practice faces various restrictions and limitations depending on the state. The roles are also characterized by ethical decision-making, education, consultation, collaboration, leadership, evidence-based practice, and direct clinical practice (Kristofersson et al.,2022).
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These roles can best be communicated to patients and healthcare providers when there is a patient diagnosis such as diabetes in primary care. In case the patient has various questions concerning medication and various lifestyle changes for better diabetes care, the primary physician may request that the patient consults with the diabetic CNS (Wilson et al.,2019). Patient-focused care is then formulated by the CNS in collaboration with the physician. Therefore the role of the APN can well be understood by the patient.
Kristofersson, G. K., Higgins, A., & Kilkku, N. (2022). Role and Competencies of Advanced Practice Mental Health Nurses. In Advanced Practice in Mental Health Nursing: A European Perspective (pp. 19-42). Cham: Springer International Publishing. Doi: 10.1007/978-3-031-05536-2_2
Schober, M. (2018). Global emergence of nurse practitioner/advanced practice nursing roles. Journal of the American Association of Nurse Practitioners, 30(4), 182–184. Doi: 10.1097/JXX.0000000000000029
Wilson, M., Chen, H. S., & Wood, M. (2019). Impact of nurse champion on quality of care and outcomes in type 2 diabetes patients. JBI Evidence Implementation, 17(1), 3-13. Doi: 10.1097/XEB.0000000000000156
M2 Discussion – Primary Care NP and other APN roles
There are approximately 290,000 nurse practitioners licensed in the United States (U.S.) (AANP, 2020). In the early 1900s, there was an accelerated growth of hospital nursing schools in the U.S. Some important dates in the history of nursing include 1931, 1955, 1965, and 1985 when the American Association of Nurse Anesthetists (AANA), the American College of Nurse-Midwife, the Pediatric Nurse Practitioner (PNP) certification program, and the American Association of Nurse Practitioners (AANP) were respectively created (Cockerham & Keeling, 2013). The four most common advanced practice registered nurse (APRN) or advanced practice nursing (APN) roles are – nurse practitioner (NP), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and certified nurse-midwife (CNM).
An APN is a registered nurse who has obtained a graduated degree from an accredited school (master’s or doctorate) and, upon completion of the program, passed a national certification exam to achieved certification in a specific specialty (NP, CRNA, CNS, or CNM). All APN programs should have practices focused on the patient and families and offer standard courses such as advanced health assessment, advanced pathophysiology, and advanced pharmacology before specifically advance the education in one of the four roles. For example, an NP program should include pediatric clinical practice rotation, while a CNS program may not require this rotation. Also, all APN programs require a minimum of clinical hours in order for a student to graduate.
The similarity between all APN roles includes direct clinical practice, evidence-based practice, leadership, collaboration, consultation, education, and ethical decision making (Hamric, 2013). Also, the scope of practice for all APN includes assessment, diagnosing, and autonomy to practice. However, the autonomy of practice may vary from states, where some states allow APN to practice without a physician overseeing.
Some difference between APN roles includes the population specialization that an APN focus such as neonatal, women’s health, adult health, community health or psychiatric health. It can also have a more specific practice, like diabetes, oncology, wound care, and transplant.
The primary care NP role was created in the 1960s as a primary care specialty and differs from the other APN roles due to emphasis on primary care. A primary care NP is an APN trained to promote health, assess, diagnose, interpret diagnostic tests and treat disease based on a holistic approach to direct patient care (Pohl & Kao, 2013) (Taylor et al., 2021).
An example of effective communication between APN, healthcare provider, and consumer is when a patient is first diagnosed with diabetes by his primary care provider (PCP). The patient has many questions about diabetes self-management, diet exercises, and medication; for this reason, the PCP asks a diabetes CNS for a consult. Then, the diabetes CNS in collaboration with the PCP, develops a specific care of plan for this patient resulting in a patient-focus care where the patient can actively participate on the planning and be more engaged and responsible for his or her health.
In conclusion, a primary care NP is the largest number of APN roles (AANP, 2021). All APN share similarities in competencies and core values and show some differences regarding the scope of practice. Although all NP and other healthcare workers have differentiation and strengthening of their own specialty, all providers should have a patient-centered care approach.
American Association of Nurse Practitioners (AANP). (2020, March 3). More Than 290,000 Nurse Practitioners Licensed in the United States. https://www.aanp.org/news-feed/290-000-nps-licensed-in-us.
American Association of Nurse Practitioners (AANP). (2021, May). NP fact sheet. https://www.aanp.org/about/all-about-nps/np-fact-s… (Links to an external site.)
Cockerham, A. Z., & Keeling, A. W. (2013). A Brief History of Advanced Practice Nursing in the United States. In A. B Hamric, C. M. Hanson, M. F. Tracy, & E. T. O’Grady (Eds.), Advanced Practice Nursing: An integrative approach (5th ed., pp. 01-26). Elsevier. ISBN: 978-1-4557-3980-6.
Hamric, A. B. (2013). A definition of Advanced Practice Nursing. In A. B Hamric, C. M. Hanson, M. F. Tracy, & E. T. O’Grady (Eds.), Advanced Practice Nursing: An integrative approach (5th ed., pp. 67-85). Elsevier. ISBN: 978-1-4557-3980-6.
Pohl, J. M., & Kao, T. S. A. (2013). The Primary Care Nurse Practitioner. In A. B Hamric, C. M. Hanson, M. F. Tracy, & E. T. O’Grady (Eds.), Advanced Practice Nursing: An integrative approach (5th ed., pp. 396-428). Elsevier. ISBN: 978-1-4557
Nurse Practitioners (NPs) and Advanced Practice Nurse (APNs) are registered nurses with a vast knowledge base and skill set. They apply clinical competencies for practice based on the guidelines indicated in their jurisdiction. Changes in healthcare today have diversified the roles NPs and APNs play. The discussion explores the similarities and differences in the NPs and APNs’ roles and determining how to communicate those roles to healthcare practitioners and consumers.
Starting with the similarities, NPs and APNs offer their services in diverse settings such as clinics, hospitals, long-term care settings, and outpatient centers. According to Schober et al. (2020), these professionals can perform the role of doctors, thus sometimes referred to as physician extenders. NPs and APNs perform functions such as diagnosing and prescribing treatment and medication, depending on state laws. They can also admit patients. Hence, based on the educational requirements, the two nursing professionals should have a master’s degree as an entry-level practice as required by law. In the process, they should engage in continuing education programs for relicensing, widening their clinical competencies to practice as physician extenders.
However, there are significant differences between NPs and APNs. For instance, APNs can specialize in executing their roles as nurse anesthetists, midwives, or clinical nurse specialists (CNS). Staff Writers (2021) inform that to achieve this, the nurse anesthetists need certification of practice from the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA). Further, nurse-midwives receive accreditation from the American Midwifery Certification Board (AMCB) (Staff Writers, 2021). On the other hand, the NPs perform their roles as primary care providers in clinics and private practice since they can offer their services independently. Since they serve diverse populations in primary care, they do not have to seek certification to practice in a specific field like the APNs.
When communicating to healthcare providers and consumers about the NPs and APNs roles, it would be essential to inform the area of practice of the two nurses. In this case, it would be crucial for the healthcare providers and consumers to know that the APNs specialize in different areas such as women’s healthcare like the midwives. Also, Schober et al. (2020) inform that they can execute their roles in surgical settings as nurse anesthetists. On the other hand, it would be necessary to inform the target audience that NPs offer a wide range of healthcare services since they are primary healthcare professionals. Generally, mentioning the scope of practice for these two nurse professionals would enable the healthcare providers and consumers to understand how their roles slightly differ.
Overall, the NPs and APNs’ roles in the healthcare setting are crucial since they help meet the unique patients’ needs. As much as the APNs engage in specialty practice to foster evidence-based nursing and influence holistic care in the defined field of practice, they support hospitals in quality care. Similar to NPs, their expertise in various healthcare fields helps them provide comprehensive care to diverse patients. Therefore, contributions in the healthcare settings have a fundamental role in transforming the quality of care.
Schober, M., Lehwaldt, D., Rogers, M., Steinke, M., Turale, S., Pulcini, J., … & Stewart, D. (2020). International Council of Nurses Guidelines on advanced Practice Nursing2020. International Council of Nurses. https://www.icn.ch/system/files/documents/2020- 04/ICN_APN%20Report_EN_WEB.pdf
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