Roles in Advanced Practice Nursing
Introduction
The roles of advanced Nursing include physical examine, diagnosing, prescribing and administering medication to patients. Advanced nurses have more freedom of making decisions and suggesting treatments and also serve as consultants to the junior nurses in the health sector According to the APRN Consensus Model there are four roles an APRN can hold: certified nurse midwife (CNM), certified registered nurse anesthetist (CRNA), clinical nurse specialist (CNS), and nurse practitioner (NP).
Role transition from Registered Nurse (RN) to Advanced Practice Nurses (APN) is a difficult task and may involve a lot of anxiety, loss of confidence in clinical skills, feeling of incompetence in the clinical filed and conflicts (Barnes, 2015). This transition happens in a series of phases. The purpose of this paper is to ensure that one student gets a chance to explore the roles of APN and come up with APN professional development plan. Second, it makes the students understand how difficult and time consuming it is to adjust to a new role, one should give him/ herself ample time to ease the self-doubt and anxiety that comes with the transition.
Below is discussion of the four APN roles which include CNP, CNS, CRNA & CNM.
Certified Nurse Practitioner (CNP) deliver intense care to patients in a clinical field. As stated by American Association of Nurse practitioners (AANP), CNPs work in close liaison with various healthcare providers to offer and avail a full range of healthcare services (Barnes, 2015). Some of the roles of CNP include; treating patients after close examination in addition to supporting the treatment of chronic diseases and educating patients and giving medication prescription. Work environment include; hospitals, outpatient settings, hospice and palliative care services and nursing homes. CNP are registered nurses with a master’s degree qualification.
Clinical nurse specialist (CNS) are the advanced practice nurses (APNs) primarily working in the field of oncology and they have more intradisciplinary and interdisciplinary consultative and collaborative skills in practice. A CNS is a specialist who improves patient’s outcomes and nursing care using evidences to train nurses (Colligon, et al., 2015). CNS often identifies opportunities for development and growth and also have interest in research thus updating institutional standards of care and aiding their nurses to adapt to them.
Certified registered nurse anesthetist (CRNA) provide anesthesia in rural facilities in countries like US. In well developed countries you will find a CRNA in every healthcare as it is a requirement in the health sector. CRNA are made up from student registered nurse anesthetist (SRNA) of which is a difficult transition. The role transition of CRNA starts when one is in school and continues for the first or two years once one gets into practice. Some of the factors that influence the transition of CRNA include; mastery of self-efficacy and confidence, supportive work environment, expert mentoring and guidance, previous experiences as a SRNA, peer support. Besides that there are also factors that impede transition of CRNA which includes: Practice Limitations, Harsh Work Environment and Case Complexity and Workload (Malina, & Izlar, n,d).
Certified nurse-midwives (CNM) are solely responsible for offering gynecological care and advice to women of all ages from adolescence to the time of menopause. The roles of CNM include; aiding women throughout the pregnancy that includes prenatal and postpartum treatment, providing woman-centered support hence enhancing normalcy in giving birth, taking care of newborns for the first few months (Fitzpatrick, & Kazer, 2006). CNM are based in hospitals, clinics, and may also attend home births when need. CNM is personnel who equally holds both gynecologist and midwives’ skills in clinical area.” As a rationale of choosing CNP against CNS, CNP is a certified nurse who has been give the authority of ambulatory practice, long term and acute care while on the other hand CNS is a nurse specialist who is only accountable for diagnosis and treatment of diseases, prevention of illness and health promotion among individuals and families (Fitzpatrick, & Kazer, 2006). Having studied the NP practices, I have come to learn and realize each role of the four has a different role, some of the roles are general in the clinical setting.
Transitioning from RN to NP clearly shows that these nurses will experience full transition of their roles within their first year of practice. The scope of work of RP is totally different from that of RP and this makes it even hard for a well-trained RP in transition to NP. Scope of tasks of RN and NP are defined by the state laws and board of nurses (MacLellan, et al., 2015). In US, an example of board of nurses is the American Association of Nurse Practitioners. RN are responsible for evaluating the effects of medication on patients and subsequently report the findings to the NP for close examination while facilitates the development of an alternative treatment plan. The main difference between these two roles is brought about by the fact during studies NP nursing students learn advanced assessment skills with a focus on creating a difference in medical diagnosis; therefore, NP nurses are able to execute lab orders and treatment options (MacLellan, et al., 2015). The NP is then responsible and well trained in interpreting test, and also executing and directing works within the NP’s scope of work to identify patient outcomes in a well-organized manner.
Factors to consider for a smooth transition from RP to NP include understanding the transition and supporting the transition. In understanding the transition, one has to get the difference between the two scopes of practices and appreciate them. It is important to introduce and establish a strong relationship with a mentor who will be responsible for supporting the student during the transition during the early stages of the transition which is in graduate school (Barnes, 2015). Strategies to consider for a smooth transition include using your experience carefully and setting realistic expectations.
Conclusion
Inconclusion, this study has greatly enabled me to understand how transition happens from being a RN to APN and from being RN to NP. CNP are responsible for delivering intense-care to patients in clinical fields. CNS are APNs primarily working in the field of oncology. CRNA are solely responsible for the provision of anesthesia in facilities located in rural areas. CNM are APN who are responsible for the offering gynecologic care to women in all aspects of pre-maternity and post maternity care. This has also made me to appreciate the different roles of APN and their working areas and more so the reason as to why CNP is preferred to the other roles. This discussion will also aid in showing a learner the need to advance his/ her academic status in nursing after practicing for a couple of years.
References
Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178-183.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).
Colligon, S., et al., (2015). The NP and CNS: Advanced Practice Nurse. Retrieved from; https://www.accc-cancer.org/docs/Documents/oncology-issues/articles/ND15/nd15-the- np-and-cns-advanced-practice-nurse-roles
Malina, D., & Izlar, J. Education and Practice Barriers for CRNAs” by Debra Malina. OJIN: The Online Journal of Issues in Nursing, 19(2).
Fitzpatrick, J. J., & Kazer, M. W. (2006). Encyclopedia of nursing research. New York: Springer Pub.
MacLellan, L., Levett‐Jones, T., & Higgins, I. (2015). Nurse practitioner role transition: A concept analysis. Journal of the American Association of Nurse Practitioners, 27(7), 389- 397.
Barnes, H. (2015, July). Nurse practitioner role transition: A concept analysis. In Nursing Forum (Vol. 50, No. 3, pp. 137-146).
