Over the last decade, Advance Practice roles have gained a tremendous amount of popularity. The role of a Nurse Practitioner first gained its popularity back in 1965, when a public health nurse named Loretta Ford, a pediatrician, would establish the first NP certification program. It was then; primary care physicians would slowly start to move outward from a general practice type of setting to a more acute care complex setting. Over time, physicians alone could not keep up with the demands of their patients. By the 1970s, more structuralized NP programs would be federally funded, meaning better formalized and structured programs that could focus on how to deliver primary care to patients appropriately. To further help standardize this, the American Journal of Nursing writes “the Consensus Model for APRN regulation: Licensure, Accreditation, Certification, and Education was produced in 2008” (Ralston, Collier, & Fairman, 2015, p. 56) and by 2015 most schools had adopted this type of model. A more adaptive model would allow for a more collaborative effort, and the Affordable Care Act would help include provisions to the practice. It is no surprise that nationally there is a nursing shortage, but there is a growing shortage with Physicians and a increased need for help in acute and non-acute settings. Physicians continue to fall short of meeting the demands of their patients, which is why Advance Practitioners have been sought after in inpatient and outpatient settings. Since the inception of this role, APN's can contribute to a service model that allows for better health services to meet the needs of high quality and cost-effective medicine.
Advancing myself in this profession, I was very aware that I wanted my focus to be in Adult Gerontology. It wasn’t until 2011 that the Consensus Model would merge adult-gerontology into primary care and acute care. It was then recognized by the National Organization of Nurse Practitioner Faculties that it got its identified of its core competencies and would then be validated as a focus of this specialty among others such as Pediatric and Women’s Health. What exactly makes Adult Gerontology different from other specialties? This particular specialty focuses on patients from age thirteen to the advanced age of an adult. Practitioners in general, no matter what interest you choose to focus on, primarily work closely with Physicians in acute and non-acute settings. Often, this can cover anywhere from a primary care offices, in patient hospitals, long term care, palliative, and private practices. The role of the NP in practice can include diagnosing, managing acute and chronic disease, history intake, ordering and interpreting diagnostic tests, prescribing pharmacologic agents and therapies, ongoing teaching, and educate patients. Adult Gerontology role specifically provides care to young adults to older adults, with a focus on delivering more stabilization of patients in critical conditions, preventing further complications, restoring maximum health, and can include patients in need palliative care. Patients who are characterized as physically unstable, dependent, or are highly vulnerable to complications require ongoing monitoring and coordination by the Practitioner. Nurse Practitioners can further help meet the needs of patients by practicing autonomously with other providers within the group they work within if need be. Utilization of this can be crucial especially because of NP’s play a vital role in primary care workforces. With such rapid growth in healthcare alone, NP's are handy when used as a licensed provider, whether working independently or in adjunction with a primary care physician. As chronic illnesses and multimorbidity continue to rise with the advanced age, the demand for advanced providers will continue to be needed.
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With the overall population aging, chronic diseases and the overall complexity of chronic physical and mental illnesses, healthcare demands will only continue to rise. Nurses in the advanced practice role can continue to add value to the healthcare demands by strengthening healthcare, and this over time will lead to an expansion of this role and the autonomy it will share. Having better autonomy will be evident by having higher patient safety ratings and better clinical outcomes for their patients. A randomized trial concluded that 'NPs achieved consistently better results than their physician colleagues on measures of patient follow-up, consultation time, satisfaction, and the provision of screening, assessment, and counseling” (Stokowshi, 2010, p. 4). Overall, most patients when asked preferred to see a nurse practitioner as opposed to a physician due to more personalized and compassionate care, and excellent communication regarding their treatment.
As we look further into the Nurse Practitioner role, education and teaching is also another critical component that is provided by the practitioner. Even though teaching a patient about their illness is vital, patients need to be proactive in their own healthcare too. Before the patient can fully become an active participant, the practitioner must fully understand how the patient comprehends and understands what exactly is being educated to them. Millions of people living in America are considered to be illiterate, while it most can also not read or write, further complicating what is understood. Knowing this, having a better understanding of a patients socioeconomic background, language and culture, and a full assessment of a patients understanding can lead to better health adherence and outcomes. Incorporating education into the plan of care once you have a better understanding of how your patient learns, education and teaching effectiveness will be achieved. Providing excellent tools and resources for your patients, whether the material is printed, making sure layman's terms are used, or return demonstration can allow for better guidance when providing health information. Nurse Practitioners are unique to this because they will always play a role in health promotion, education, and advocacy.
Another primary role of the practitioner is autonomy. The autonomy an NP shares is not only with his or her patients but a collaborative agreement they share with a Physician. The amount of independence a nurse practitioner carries also varies by state. Currently, twenty-one states grant nurse practitioners full practice authority, which allows for diagnosing, managing primary illness, ordering and interpretation of tests, prescribing medications, and managing treatment of patients. This autonomy is significant because the 'US Department of Health and Human Services reported that approximately 20 million Americans have gained health care coverage as result of the ACA' (DiLascio, 2018, p. 7). While more Americans may have better health coverage and have better insurance, there remains a shortage among primary care physicians. Also, there is a significant shortage in rural areas, so even though more Americans are covered there still lacks the availability of providers to provide the care. Nurse Practitioners may be the solution to this problem by providing valuable services to areas where there is such a significant shortage by practicing independently or in conjunction with a primary care group.
Overall, Nurse Practitioners no matter what specialty you decide to choose will play an essential role in patient-centered care. There will be a continued critical need for Nurse Practitioners as we face challenges in the again population and rising healthcare costs. The combination of medical skills and nursing care that an NP can provide will strengthen the needs of not only primary care settings but community care settings. Health promotion and disease prevention will always be a priority to ensure a better quality of care. Making the transition in this role from Nurse to Nurse Practitioner can be stressful and taking some adjustment to your new position. Having a full understanding of your role is imperative as you go from novice to expert.
References
- DiLascio, T. M. (2018, June 1). Nursing Autonomy: Overview. Points of View: Nursing Autonomy, 5-8. Retrieved from https://eds-b-ebscohost-com.southuniversity.libproxy.edmc.edu/eds/pdfviewer/pdfviewer?vid=6&sid=eefab261-5a43-4306-9aad-9ef9a17d2d10%40sessionmgr101
- Ralston, B., Collier, T. H., & Fairman, J. (2015). The NP: Celebrating 50 years . American Journal of Nursing, 115, 54-57. http://dx.doi.org/http://dx.doi.org/10.1097/01.NAJ.0000471941.77288.a4
- Stokowshi, L. A. (2010, June 29). The Nurse Practitioner Will See You Now. Medscape Nurses, 1-5. Retrieved from https://www.medscape.com/viewarticle/723986_1
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