Describe how the role of advanced registered nurse transformed over time
NUR 513 Topic 1 Discussion Question One
Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?
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Re: Topic 1 DQ 1
The role of advanced registered nurse has transformed over time in so many ways. We focus on how nursing has rapidly evolved. There was the traditional Registered Nurse than over time it has evolved into many distinct categories of nursing which involved (CRNAs), certified nurse–midwives (CNMs), clinical specialists (CNSs), and nurse practitioners (NPs) then Doctor of nursing practice (DNP) (DeNisco & Barker, 2016).
The shifts of scope and expectations in the 20th and 21st centuries have not change as much as we think. “Clinical nurse specialists (CNSs) have been providing care to patients with complex cases across healthcare settings since the 1960s. The CNS role originated to satisfy the societal need for nurses who could provide advanced care to psychiatric populations.
Following this implementation, the usefulness of the role became apparent, and schools of nursing began to educate nurses across specialties, including oncology, medical-surgical, pediatric, and critical care nursing” (DeNisco & Barker, 2016). “Nurse practitioners have been providing care to vulnerable populations in rural and urban areas since the 1960s. The role was born out of the shortage of primary care physicians able to serve pediatric populations.
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Today, nurse practitioners are the largest group of advanced practice nurses. More than 192,000 NPs are licensed and practicing with some level of prescriptive authority in all 50 states. Nurse practitioners work are educated and hold board certification in a variety of specialty areas, including pediatrics, family, adult gerontology, women’s health, and acute care.” (DeNisco & Barker, 2016). Midwives are essential.
“In the 1920’s when the first midwifery school began because of high mortality rates and poverty in Kentucky which led to the demand of Midwives brought about change to these rural communities.” (DeNisco & Barker, 2016). Midwives are needed more than ever in so many areas of nursing especially when pregnant women are not comfortable being in a hospital setting. Nurse anesthetists have a crucial role in nursing because they provide anesthesia during surgery.
“Nurse anesthetists are licensed as independent practitioners, and they provide care autonomously and in collaboration with surgeons, dentists, podiatrists, and anesthesiologists. The shortages of physicians qualified to administer anesthesia during wartimes continued, and nurse anesthetists were the main providers of anesthesia care for U.S. military personnel on the front lines for World War I, World War II, the Korean War, and the Vietnam War; nurse anesthetists also provide care in the current conflicts in the Middle East.” (DeNisco & Barker, 2016).
Advanced registered nurse role and responsibilities will continue to evolve and emerge as the American health care system changes by technology and continued education. Nurse educators are essential for keeping registered nurses informed of all the new policies and procedures we must abide by.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Peer Responses
Re: Topic 1 DQ 1
You bring up a great point about the difficulty with being an advanced practice registered nurse (APRN). Even though its been 20 years since the Institute of Medicine released their report “The Future of Nursing: Leading Change, Advancing Health” recommending that nurses work to the full extent of their education and training, some people and regulatory bodies are still hesitant to allow this (Institute of Medicine, 2011).
My mother was a Nurse Practitioner (NP) trained in acute cardiovascular care. I remember how frustrated she would get because the physician she worked under wouldn’t allow her to do certain procedures or tests that she was capable of performing because he would rather her handle the paperwork. I find it sad that it has been such a struggle for nurses to break through these barriers to be able to do what they are capable of. I also think it does the patients a huge disservice.
References
Institute of Medicine (2011). The Future of Nursing: Leading Change, Advancing Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209881/
Re: Topic 1 DQ 1
I really enjoyed your post and the inclusion of some of the nontraditional APRN roles. Many of these nonclinical, or nontraditional roles do require knowledge and experience beyond the bachelor’s degree level of education. I was surprised to learn that all Nurse Administrators are not required to have a graduate level degree (DeNisco & Baker, 2016).
Nurse Educators are another vital nontraditional APRN role that is tasked with preparing the nursing workforce in a clinical setting (DeNisco & Baker, 2016). There has been debate about the content that should be taught to future nurse educators; whether its advanced clinical knowledge or teaching techniques.
In my mind both components seem necessary to adequately do the job. I agree that the National Council of State Boards of Nursing (NCSBN) should reassess the current APRN roles. I think you hit the nail on the head when saying that reevaluating the APRN roles would better serve nurses and patients alike with our ever-evolving healthcare system.
Porter-O Grady and Malloch (2018) stated that “an understanding of change and innovation is not an option for nurses but rather it is a professional obligation” (p.52). This professional obligation to transform and innovate extends to the NCSBN and their duty to redefine the APRN role.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Porter-O Grady, T. & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones &. Bartlett Learning. ISBN-13: 9781284146530
Re: Topic 1 DQ 1
The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).
These four roles all seemed to have stemmed from disparities in our healthcare system, whether it be a shortage of physicians, under-severed rural areas, vulnerable populations, or times of war. A great example of this is the advancements within the CRNA field. CRNAs were initially brought about during World War I due to a physician shortage during wartimes (DeNisco & Baker, 2016).
The continuation of wars through United States history gave the CRNA field a strong foothold as a chief provider of anesthetics to the frontline. This expansion of the nursing scope of practice in anesthetics eventually led to credentialing and the American Association of Nurse Anesthetists (AANA) to monitor and regulate this growing field (DeNisco & Baker, 2016).
Similarly, the growth and expansion of the other original APRN roles through the end of the 20th and 21st century required the nursing field to define graduate-level educational requirements and each specialty’s nursing role. The transformation of traditional APRN roles has now begun to open doorways for other nontraditional advanced practice nursing areas like public health nursing, clinical nurse leaders, nurse administrators, nursing research, and nurse educators.
DeNisco and Baker do a great job of laying out the ongoing evolution and need of the APRN role in the American healthcare system and the need for more advanced practice educators to sustain the APRN field’s continuous growth (2016). With a growing and aging population and a continuing shortage of physicians, the APRN roles offer a cost-effective solution that can also improve patient satisfaction (DeNisco & Baker, 2016). I will say that this week’s reading has made the decision to continue my education in nursing even more appealing and necessary.
References
DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning. ISBN-13: 9781284072570
Re: Topic 1 DQ 1
Advanced registered nurse roles and responsibilities will forever be evolving due to changes in policy such as health care acts, aging populations, and the overall need for advanced registered nurses. Furthermore, the responsibilities of advanced registered nurses have already started to expand. Densico and Barker 2016, shed light on the importance that barriers for advanced practice nurses be identified and resolved.
In some states, nurse practitioners (NPs) do not work in primary care due to some state restrictions; however, the Institute of Medicine (IOM) released a report stating that NPs be allowed to practice independently with full autonomy. There have been many reports validating that NPs provide high-quality care, while also being extremely cost-effective.
Moreover, according to Denisco and Barker, “the Health Resources and Services Administration (HRSA) has projected a large increase in demand for nurses, from approximately 2 million full-time equivalents in 2000 to approximately 2.8 million in 2020” (2016). The demand for nurses in the year 2020 came from the idea that people born in the 1960s (baby boomer generation), would put a strain on the healthcare system due to their size in population and the fact they were an aging generation.
However, no one would fathom that the actual demand for nurses in 2020 would be due to a pandemic. Shifts in scope of practice and expectations have already been seen in the 21st century. Mainly focusing on expectations, universities have started to phase out nurse practitioner programs and replacing NP programs with doctoral nursing programs (DNP). This is partly because DNP programs provide more resources and opportunities to bring forth better health outcomes for patients. However, NP vs. DNP does not change scope of practice.
References
DeNisco, S., & Barker, A. (2016). Advanced practice nursing: essential knowledge for the profession (Third). Jones & Bartlett Learning. https://doi.org/ISBN978-1-284-07257-0
According to the American Nurses Association, the advanced registered nurses are the primary care givers and play a critical role in provision of preventive care services to the general public. They include nurse specialists, nurse anesthetists, and nurse midwives (ANA, 2022). The notable advancement has been achieved through tremendous transformation in the past century.
For instance, the current role of advanced registered nurses is based on the basics 20th century practices of nurse midwives and nurse anesthetists. Over time, four different advanced practice nursing roles have emerged; the nurse midwife (CNM), the nurse anesthetist (CRNA), the clinical nurse specialist (CNS), and the nurse practitioner (NP) (Hanson & Hamric, 2003).
Over the years, the role of advanced registered nurses has transformed in three distinctive phases. The first phase in evolution of the role was initiated by changing patient needs and treatment opportunities. In this case, the introduction of anesthetic agents offered the foundation for CRNA role (Hanson & Hamric, 2003). Initially, the nurse was supposed to make an evaluation of the patient’s status prior to selecting the appropriate analgesic treatment.
Nursing education and training is the key factor in the second phase of evolution. In the early years of the 20th century, nursing roles involved activities that were not valued by physicians and in instances where physician supply was insufficient. This led to evolution of advanced registered nursing roles through education. For example, the introduction of the nurse practitioner certification project in 1965 helped prepare nursing practitioners offer comprehensive care and provide preventive health services to manage common health problems (Keeling, 2015).
Finally, the need for standardization and the emergence of graduate education has transformed the role of advanced registered nurse. In the past 50 years, the demand for specialized education has greatly expanded these roles. Since the 1990s, three nursing specialties have evolved the expectation of master’s level education. These include CNS, NP, and CRNA (Hanson & Hamric, 2003). As a result, migration from one role to another by practitioners is a common practice.
References
ANA. (2022). Advanced Practice Registered Nurse (APRN). Retrieved september 14, 2022, from American Nurses Association: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn/
Hanson, C. M., & Hamric, A. B. (2003). Reflections on the Continuing Evolution of Advanced Practice Nursing. Nurs Outlook 51, 203-211.
Keeling, A. W. (2015). Historical perspectives on an expanded role for nursing . Online Journal of Issues in Nursing, 20(2).
Advanced practice registered nurses (APRNs) are masters prepared nurses responsible for providing clinical care to patients in different healthcare settings. Traditionally, the role of APRN was commonly associated with clinical roles and specialties that included clinical nurse specialists, nurse practitioners, certified nurse midwives and certified registered nurse anesthetist.
The American Association of Colleges of Nursing (AACN) in 2004 defined the advanced nursing practice as “any kind of nursing intervention which impacts healthcare outcomes for individuals or populations (Brykczynski, 2023). These include direct care of individual patients, management of care for populations and administration of nursing as well as health care organizations. However, the roles of advanced nurses have continued to transform based on the changes and situations in the health sector, especially the need to expand access to healthcare services for populations.
The shortage of physicians in the 1970s led to the federal government funding the establishment of more APRNs through training so that they can bridge the gap, especially in rural areas. The implication is that many APRNs can now diagnose and treat patients for different conditions as some states recognize them as primary care providers (DeNisco, 2019). The transformation in healthcare delivery models in 20th and 21st centuries has also led to a system that focuses on patient based on the concept of patient-centered care. Imperatively, the roles of advanced practice nurses have expanded as evidence shows that they should be allowed to practice to full extent of their training and education. Today, APRNs work collaboratively with other professionals to deliver quality care to individual patients and health populations.
The caring patterns of the advanced registered nurses will continue to shift because of the transforming healthcare system that focuses on value-based care and other innovative care delivery models. Advanced registered nurses will continue to expand their practice as they become specialists to cater to diverse patient needs (Zaccagnini & Pechacek, 2019). Working in teams will expand their roles as patient managers and leaders at the organizational level, especially with attainment of terminal degrees like PhD and DNP.
References
Brykczynski, C. L. M. K. A. (2023). Role development of the advanced practice nurse. Hamric
& Hanson’s Advanced Practice Nursing-E-Book: An Integrative Approach, 98.
DeNisco, S. M. (2019). Advanced Practice Nursing: Essential Knowledge for the Profession:
Essential Knowledge for the Profession. Jones & Bartlett Learning.
Zaccagnini, M., & Pechacek, J. M. (2019). The doctor of nursing practice essentials: A new
model for advanced practice nursing. Jones & Bartlett Learning.
Over the past century, the function of the advanced practice nurse has evolved significantly. Beginning in the 1960s, the major function of the nurse practitioner was to offer primary care in underserved communities (DeNisco, 2021). Over the subsequent decades, NPs pushed to shift the political and socioeconomic perspective of society, opening the path for NPs to be viewed as more than just a cost-effective method of providing healthcare to the underprivileged. In the 1980s and 1990s, NP education migrated to the university environment as a master’s-level program.
Realizing that education also leads to credibility, NP education followed the adage “education is power” (DeNisco, 2021). Nonetheless, misunderstanding regarding the APRN’s role continued into the early 2000s. As a result, a consensus model was developed to define the qualifying roles and education of an advanced practice registered nurse (APRN).
As nursing is a profession that requires lifelong learning, it is not surprising that nurses desired to further their education by pursuing PhD degrees. The American Association of Colleges of Nursing (AACN) formally accepted the Doctor of Nursing Practice degree, which is currently recognized as the highest practice degree, in order to reduce misunderstanding regarding the range of available doctoral degrees.
The role of the APRN is presently developing before our eyes. Anesthesia is administered to surgical patients by CRNAs instead of an anesthesiologist. Similarly, ACNPs are replacing internists in intensive care units and emergency departments across the nation. Additionally, nurses are educated to treat patients, not diseases. The cornerstone of nursing enables patients to be active participants in their treatment, hence enhancing patient outcomes and health care compliance.
This holistic approach to patient care, combined with the NP’s extensive education and practical experience, will certainly make the NP the preferred primary care practitioner over the MD. As a personal objective for the nursing profession, I want nurses to have a voice in the political arena. Historically, nursing has been administered and perceived as an employee work group; hence, nurses’ engagement and presence in the political and public sector have been insufficient. (Weberg et al., 2019) I’d love to see the day when the public views APRNs and MDs in the same light, when the nurses’ unique perspective, education, and approach to patient care can be a driving force for our local and national public policy.
References
DeNisco, S. M. (2021). Advanced Practice Nursing: Essential Knowledge for the Profession (4th Ed.). Jones & Bartlett Learning.
Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2019). Leadership in Nursing Practice: Changing the Landscape of Health Care (3rd ed.). Jones & Bartlett Learning.
NUR 513 Topic 1 DQ 1
Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?
Re: Topic 1 DQ 1
Historically, when one spoke of advanced practice nursing, they meant one of four roles; certified registered nurse anesthetist (CRNA), certified nurse mid-wife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). In 2004, the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as “Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy” (Denisco & Barker, 2016).
Since this definition came out many other nursing roles, such as nurse administrators and public health nurses have also been thought of as advanced practice nursing roles. Whereas advanced practice nursing used to be mainly reserved for clinical practice, it is now branching out into non-clinical roles. With the ever-expanding role of nurses coupled with the push to expand access to and decrease costs of health care there will likely be many new roles developed for nursing practice. These roles will require advanced degrees even if they are not in clinical areas, therefore, they too should be thought of as advanced practice nursing.
Denisco, S.M. and Barker, A.M. (2016). Advanced Practice Nursing: Essential Knowledge for the Profession. Jones and Bartlett Learning. https://www.gcumedia.com/digital-resources/jones-and-bartlett/2016/advanced-practice-nursingessential-knowledge-for-the-profession3e.php
I agree with you that nursing practice is any form of nursing intervention that is meant to influence the care outcomes. The nurse practice has been evolving overtime especially with the transformation of the healthcare systems and healthcare policies. In the current healthcare industry where the focus is on the patient, what is commonly referred to as patient centered approach has ensured that the patient is given autonomy to choose on the best care practice that is appropriate and improves the patient’s health condition (American Association of Nurse Practitioners, 2019).
This has called upon the nurse training institutions to shift and adapt to the new and emerging trends in healthcare. The advanced nursing role has been the significant part that the Affordable Care Act aims to enhance health promotion measures among the aging US population (Woo et al., 2017). The research findings reveal that the advanced nursing role would be one of the professions at a highest demand by the year 2022.
References
American Association of Nurse Practitioners. (2019). Scope of Practice for Nurse Practitioners. American Association of Nurse Practitioners; AANP Website. https://www.aanp.org/advocacy/advocacy-resource/position-statements/scope-of-practice-for-nurse-practitioners
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (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
Re: Topic 1 DQ 1
The advanced practice registered nurse (APRN) has seemed to evolve based on shortages and demands of the population within our healthcare system. Deficits have expanded many nursing roles, leading to the need to define the nursing scope of practice and educational requirements. The traditional four roles of APRN, nurse practitioner (NP), certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS); have all grown exponentially since the 20th century (DeNisco & Baker, 2016).
These four roles all seemed to have stemmed from disparities in our healthcare system,
