NSG 517 Discussion What is an NP?

Advanced Practice Nurse Practitioners have advanced skills and experience in undertaking different healthcare activities. Advanced nurse practitioners have diverse roles in the delivery of healthcare processes (Fawkes & Moore, 2019). They are able to influence different diagnosis and treatment processes through development of effective policies and research processes. Undertaking further nursing education is necessary in ensuring acquisition of knowledge and skills necessary for one to become advanced practice nurse practitioner. Today, there are a number of complications that ought to be managed in the healthcare settings. Nurse practitioners work in many settings including primary care, acute care and gerontology . Advanced Practice Nurse Practitioners often assume independent care positions as nurse-midwifes and nurse practitioners (Tracy, 2019). These roles are always reserved for the healthcare experts with advanced qualifications. A career as a nurse practitioner can lead to specialization in different areas of practice. As you mentioned, the educational path for NPs and MDs are different. Medical school is longer and require a more rigorous studies as doctors hold a higher level of responsibility and a wider range in scope of practice.

References

Tracy, M., O’Grady, E. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier. Fawkes, K., & Moore, J. (2019). Newly registered nurses’ experiences of delivering patient education in an acute care setting: an exploratory study. Journal of Research in Nursing, 24(8), 556-567. https://journals.sagepub.com/doi/abs/10.1177/1744987119869770 (Links to an external site.)

I enjoyed reading your response, it really helped to capture what a nurse practitioner is and I can relate to the personal motivators for choosing this career path. I currently work in primary care doing triage. I often have patients who will call in for an appointment and state, “I only want to see a doctor and not an NP.” I also think to myself why this is and feel that in many cases it may be a lack in education on what an NP is and how much they can do. NPs are becoming a popular choice for patients when receiving healthcare. They work along side other healthcare professionals to provide patients the care they need and can work in a variety of setting. According to the AANP, “What sets NPs apart from other health care providers is their unique emphasis on the health and well-being of the whole person” (2021). NPs are important to the healthcare system because they are mentors, educators, researches, and administrators. They also lower health care costs for patients while still providing high-quality care. Every year NPs make 1.06 billion visits and patients report an extremely high level of satisfaction with the care they are receiving. Lastly, the provide more than 325,000 solutions to the primary care shortage (AANP, 2021).

What’s a nurse practitioner (NP). (2021). AANP. Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

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Scenario #1: You are at Thanksgiving Dinner and Uncle Roy asks you, “What are you in school for again, super nursing school? Why didn’t you just go to medical school?” How would you reply?

Uncle Roy, I am in school to become a Family Nurse Practitioner. This is a role that is under the “Advance practice registered nurse” category. Advanced practice nursing is a new concept for people. You may have heard of Nurse Midwives or a Nurse anesthetist; these two jobs also fall into the APRN category. The advance practice of nursing builds on the foundation of nursing values and skills that I have already acquired over the last few years as being a bedside nurse. I will be in the primary care setting, managing patients with chronic illness, as well as acute illness. I will be able to follow up with my patients and provide information on preventative care, as well as diagnose and treat those patients.

I chose to go the route of an FNP over going to medical school for many reasons. One main reason being the length of school and how much time it would take out of my personal life. 90+ hours a week in residency and swimming in my student loan debt didn’t sound interesting to me. But to be honest I never really thought about the idea of medical school for too long. I wanted to be a bedside nurse and learn those skills. I wanted to be there for patients in their most vulnerable state and be the person they confide in. You don’t get that experience going through medical school.

Tracy, M., O’Grady, E. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

This is an interesting and far too common scenario that most of that decide to go the graduate route encounter. When I graduated with my BSN, one of my mother’s friends congratulated me for finally graduating as a doctor. This is because I started out as an LPN then went on to get my Associates RN. So naturally it seemed to him that I was in Medical school and was finally graduating as a doctor. I like that you explained the APRN role and included the other advance practice nurses of Nurse Midwives, Nurse Anesthetists and Certified Nurse Specialist. As a registered nurse, I have come to highly encourage my family members to embrace the roles and services of nurse practitioners where possible. This is because care provided by APRNs has been found to affect care outcomes positively. The four APRN roles have been found to provide effective and high-quality care that was similar to and way better than that provided by physicians. For CRNA, there was equivalent number of complications rates compared to that of physicians. Care provided by Certified Nurse Midwives resulted in lowered cesarean sections, less use of epidural medication, lower episiotomy rates and higher breastfeeding rates. Nurse Specialists additionally resulted in lower costs of care, higher satisfaction rating and a decreased length of hospitalizations. Nurse practitioner driven care resulted in more effective blood glucose and lipid level control (Tracy et al., 2019).

In a study conducted at the Hague in Netherlands, it was determined that emergency room Nurse Practitioners showed high diagnostic accuracy of 97.3% for patients presenting to the ED with injuries. This is a high accuracy level that showed no significant differences between nurse practitioners and physicians related to diagnoses of injuries and management in the emergency room (van der Linden et al., 2010). This goes to show a high level of confidence for nurse practitioner driven care, patients can confidently and comfortably seek the services of a nurse practitioner knowing that they will receive expert care given in collaboration with the/their physician.

References

Tracy, M. F., O’Grady, E. T., Hamric, A. B., & Hanson, C. M. (2019). Hamric and Hanson’s Advanced Practice Nursing: An integrative approach. Elsevier.

van der Linden, C., Reijnen, R., & de Vos, R. (2010). Diagnostic accuracy of emergency nurse practitioners versus physicians related to minor illnesses and injuries. Journal of Emergency Nursing, 36(4), 311–316.

Scenario #3: You go into a room to see a patient you have never seen before. You introduce yourself as the nurse practitioner. The patient states, “I thought I was seeing a doctor. What is a nurse practitioner and when is the doctor coming in?” How will you reply?

I completely understand your question given the multiple and ever expanding roles of the different providers in healthcare today. There is often confusion about the role of the nurse practitioner in comparison with our physician and nurse peers. Let me first explain how a nurse practitioner differs from a registered nurse. There are three specific criteria that differentiate nurse practitioners from registered nurses (Tracy & O’Grady, 2018). Nurse practitioners are advanced practice registered nurses who have attended additional schooling and developed mastery in advanced topics, such as pharmacology, physiology, and physical assessment. All nurse practitioners must obtain a master’s level graduate degree, and some have obtained a doctorate level degree (Tracy & O’Grady, 2018). Secondly, nurse practitioners have obtained a national certification by passing a comprehensive exam which establishes a consistent standard of knowledge. Lastly, all nurse practitioners must have a practice focused on patients and families (Tracy & O’Grady).

Like physicians, depending on the state regulations, nurse practitioners can actually practice as independent primary care providers, with the ability to order and review diagnostic tests, diagnose and treat conditions, prescribe medications and other treatments, and manage a patient’s care, as well as counsel and educate patients (AANP, 2021). Additionally, studies have shown that APRNs provide the same high quality care as physicians, and often with higher levels of patient satisfaction (Tracy & O’Grady, 2018). Nurse practitioners often spend more time with patients, and provide a special focus on wellness, strengthening adherence, and tailoring individualized plans for patients. Some studies have even shown that patients managed by nurse practitioners had decreased emergency room visits and improved long term lipid, glucose, and blood pressure control, with an impressive decreased overall cost of care (Tracy & O’Grady, 2018). In respect to you seeing a doctor, there is no plan for you to see a doctor today. Of course, you have the right to see a different provider if you so wish, but please also know that as a nurse practitioner and a member of the team in this clinic, I have the ability to consult with other members of my team when necessary to troubleshoot complex issues. We work together to provide the best, holistic care to our patients. I hope you will give me the chance to show you just how effective and meaningful a visit with a nurse practitioner can be to your overall health.

References

American Association of Nurse Practitioners (AANP). (2021). What’s a nurse practitioner (NP)? https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner (Links to an external site.)

Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s Advanced Practice Nursing – E-Book (6th Edition). Elsevier Health Sciences (US). https://bookshelf.vitalsource.com/books/9780323447706 (Links to an external site.)

This is a question that happens frequently, I have been asked multiple times the difference between these two professions! I think you nailed it with the information you provided to the patient! I loved that you told the patient that he has the choice of choosing a different provider but you are part of a team that works collaboratively and if you needed you could always have assistance! Working in this field is all about collaboration, not one individual knows everything and having different opinions can help provide better care for a patient.

My provider is an FNP and I love working with her, she really makes me feel comfortable and able to open up about what I am experiencing. APRNs bring a different approach to care, they have the nursing knowledge and experience with the added masters education and clinical experience. They are “registered nurses who have gained added knowledge and skills through post-basic education and clinical experience.” (Tracy & O’Grady, 2018). They tend to really focus on the patient and spend extra time with them, sympathizing and understanding their needs, something we learned through being bedside nurses.

I think you did an excellent job making this information very clear!

Tracy, M. F., & O’Grady, E. T. (2018). Hamric & Hanson’s Advanced Practice Nursing – E-Book (6th Edition). Elsevier Health Sciences (US). https://bookshelf.vitalsource.com/books/9780323447706

Mr. Patient, thank you for your statement and question. You should know who is taking on your health care. I can see from your chart you are used to seeing Dr. Medicine in the past. I am a Nurse Practitioner and what that means is that I have a master’s level degree and a license from the state to practice similar to a physician in family medicine (Tracy & O’Grady, 2019). I am not a doctor, you are correct. I do however have significant clinical experience focused in family health and wellness, disease diagnosis and management, pharmacology and I work as a part of the interdisciplinary team of medical professionals (AANP, 2021).

I can appreciate with the ever changing dynamics in health care and variation of roles, it can be hard to trust something new. And I will tell you, Mr. Patient, you are your best advocate. With that being said NPs have been providing care in the acute and specialties settings for over 50 years. We are able to order and interpret diagnostic tests, order and interpret labs, make diagnosis, along with designing plans for treatment and management (AANP, 2021). Often patients who have an NP as a PCP find we have more time to dedicate to your specific patient and family needs and therefore are more satisfied with their relationship to the health care system (Tracy & O’Grady, 2019).

With all that said, Mr. Patient, you have to be satisfied with your provider. You have a choice that we will honor to see either myself or reschedule with your physician. I do want you to know that Dr. Medicine and myself are in this practice together and like him, I have the ability to consult with and refer you to any specialist we might think necessary.

Can I answer any questions about the NP role?

Would you like a few private minutes to think about how you want to proceed today?

American Association of Nurse Practitioners (AANP). (2021). All About NPs https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner Tracy, M., O’Grady, E. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach. St. Louis, MS: Elsevier.

NSG 517 Discussion What is an NP?