- Conduct a scholarly ‘search’ of the literature to locate an article that you can use to construct your discussion. Keep in mind the key word here is article. Be sure to utilize APA style guidelines as you construct both in-text and reference citations.Write substantive response of 200-250 words to the question below and include in-text citation. APA format.
- References and citations should conform to the APA 6th edition.
TYPE – Scholar Practitioner
- Locate an article that relates to how the roles of the advanced practice nurse have historically evolved.
- Provide a summary of the article and how the information in this article relates to the evolution of the APN role in current practice.
- In your responses to other students, discuss how the information provided helped you to better understand the roles of the NP and the evolution of this field.
- The peer postings should be at least one paragraph (approximately 100 words) and include references as indicated by the instructor.
- References and citations should conform to the APA 6th edition.
Many of the articles I have read portray nurse practitioners (NPs) as physician extenders. I disagree with this limited view of NPs. NPs serve the public in a variety of roles from primary care to hospital emergency departments. NPs possess a skill set that enables medically underserved individuals to receive access to needed healthcare.
For more than 75 years, nurses have provided care to underserved populations and served autonomously as providers of care (Keeling, 2015). One example is the Henry Street Settlement (HSS) started in 1893 by Lillian Wald. The nurses dispensed medications and provided treatment to patients using nursing judgement without a physician on the premises (Keeling, 2015). HSS nurses served immigrants and the US public (Keeling, 2015). By 1900, the nurses were travelling into the community and providing care to 26,600 persons (Keeling, 2015).
In 1903, the state nursing registration act was passed but it did not clarify the practice of medicine or the treatment of disease (Keeling, 2015). In 1906 the Food and Drug Act passed which required disclosure of alcohol, opium, morphine, and other mind altering substances on medication labels (Keeling, 2015). Lillian Wald formed an oversight medical advisory committee that provided standing orders for the nurses (Keeling, 2015). By 1926, Henry Street nurses were performing 300,000 home visits yearly (Keeling, 2015).
A second example is the Frontier Nursing Service (FNS) started by Mary Breckenridge in the early 20th century (Keeling, 2015). FNS nurses travelled by horseback to remote Appalachian homes providing nursing care, dispensing medications and treatments (Keeling, 2015). Orders from the physician advisory committee were vague, allowing nurses to make their own judgement related to pain severity and the dispensing of narcotics (Keeling, 2015).
The American Association of Colleges of Nursing (AACN) states that advanced practice nurses should be able to practice to the fullest extent of their education and training. Nurses in the aforementioned examples did perform to the fullest extent of their education and training. In the mid twentieth century, after WWII, nurses began to work more in hospitals where boundaries were clearly defined and nurses did not need to diagnose and treat disease (Keeling, 2015).
A sentence written at the end of the ANA1955 definition of nursing changed the practice of nursing. The American Nurses Association (ANA) wrote: “The foregoing shall not be deemed to include acts of diagnosis or prescription of therapeutic or corrective measures” (Keeling, 2015, p. 26). That sentence may have unwittingly created and inter-professional conflict over nurses’ rights to diagnose and prescribe.
As a means to bridge the gap, the NP role was defined and initiated in 1965 by Loretta Ford and pediatrician Henry Silver (Keeling, 2015). The idea was to meet the healthcare needs of all ages by helping to provide access to quality healthcare (Keeling, 2015). A problem that continues today is the blurring of boundaries of medicine and nursing (Keeling, 201l 5).
NPs provide interventions that improve health care outcomes (Sidani et al., 2016). Until NPs are allowed to practice with autonomy (full practice authority in every state), boundaries will continue to be blurred and access to care will continue to suffer. NPs have the backing of the Institute of Medicine, the National Council of State Boards of Nursing and the Federal Trade Commission. Now all we need is legislative backing.
Keeling, A.W. (2015). Historical perspectives on an expanded role for nursing. The Online Journal of Issues in Nursing, 20(2), 23-29. Doi: 10.3912/OJIN.Vol20No02Man02
Sidani, S., Manojlovich, M., Doran, D., Fox, M., coell, C.L., Kelly, H., Jeffs, L., & McAllister, M. (2016). Nurses’ perceptions of interventions for the management of patient-oriented outcomes: A key factor for evidence-based practice. Worldviews on Evidence-Based Nursing, 13(1), 66-74. doi: 10. 10.1111/wvn.12129
This particular article was about the effectiveness of utilizing nurse practitioners (NPs) in the hospitalist role. Early on, NPs were used primarily in the office setting but as time has gone on more and more of these individuals are branching out to different settings. The role of the NP is now useful in many specialties and is being recognized everywhere. This article looked at hospital records over a period of time to examine the cost effectiveness as well as the length of stay of the patient when cared for by an NP. It also took into account both the patient and nurse satisfaction of having an NP as the provider. The study concluded that by utilizing a pediatric NP team to see patients with acute bronchiolitis and asthma, the length of stay could be shortened which ultimately decreased hospital costs. This also allowed for more teaching by both the NP’s and the nursing staff. This had a direct benefit on the patient and their family. By utilizing the pediatric NP team, the residents and medical staff were freed up to focus on teaching which is essential to a good residency program. This study was done in Colorado where NPs have a great deal of autonomy and prescriptive authority. In other states, this may not be possible. I think this article shows that the medical field is beginning to utilize NPs more and more. I believe that as the limits of our scope of practice are explored we will see greater autonomy and more freedom to practice independently. This makes me feel both excited and apprehensive of what the future holds for my role as an NP.
Wall, S., Scudamore, D., Chin, J., Rannie, M., Tong, S., Reese, J., & Wilson, K. (2014). The
evolving role of the pediatric nurse practitioner in hospital medicine. Journal Of Hospital
Medicine, 9(4), 261-265. doi: 10.1002/jhm.2162