Question

The mid- to late 20th century was filled with amazing changes and events in professional nursing. Select one of these changes or events, describe it, and explain how that change or event has impacted quality of nursing practice today.

Answer 1

The emergence of the “advanced practice nurses”

• Advanced practice nursing has evolved over the years to become recognized today as an important and growing trend among healthcare systems worldwide. It is defined as an advanced level of clinical nursing practice that maximizes the use of graduate educational preparation, in-depth nursing knowledge and expertise in meeting the health needs of individuals, families, groups, communities and populations. It involves analyzing and synthesizing knowledge, understanding, interpreting and applying nursing theory and research, and developing and advancing nursing knowledge and the profession as a whole.
• APNs emerged as a result of the need to contain costs, improve access to care, reduce waiting time, serve the underprivileged, and maintain health among specific groups.
• Advanced practice nursing (APN) is an umbrella term for various nursing types and includes nurses acting in diverse advanced roles. APN today encompasses clinical nurse specialists, Nurse practitioner's, midwives and nurse anesthetists.
• They care for patients as well as interacting with the public, often serving as a liaison between the doctor and the families of patients. Their advanced training means they have greater levels of knowledge than their RN counterparts, manifesting in greater decision-making ability and expertise in areas such as diagnosis and assessment, planning and implementation, evaluation of healthcare and record-keeping.
• Although nurses have a long history of being subservient to the doctors or healthcare systems under which they work, advanced practice nurses have a chance to break this glass ceiling and become significantly more autonomous in their scope of practice and their ability to rely on their own knowledge to make decisions about patient health.
• Advanced practice nurses serve many functions in a clinical setting. These include:

1. Diagnosing patients as they come in
2. Performing physical exams
3. Performing other exam types, such as psychological, psychosocial, functional and developmental tests and diagnostics
4. Ordering lab tests and interpreting results
5. Developing differential diagnoses
6. Maintaining patient records and ensuring patient privacy and clinic or hospital compliance
7. Evaluating patient progress and responses to various treatments to modify treatment and care plans as necessary
8. Providing counseling to patients and families
9. Referring patients to other treatment facilities
10. Providing consultations to patients who have yet to choose a course of action
11. Dispensing medications to patients
12. Participating in research studies

While registered nurses (RNs) provide many of these same services, advanced practice nurses have considerably more freedom to make decisions, suggest treatments and courses of action, and determine care for the patients with whom they work. Not only that, advanced practice nurses often serve in a consulting capacity for the other nurses on their staffs. They may offer advice, give second opinions, help examine patients and craft treatment plans. They also often work to improve overall care in the settings at which they work and improve patient health delivery systems.

With population aging and the consequent global epidemic of chronic diseases, healthcare demands will only rise. Accordingly, nurses in advanced practice can add value and increase access to healthcare by, potentially strengthening the healthcare workforce.