NUR 513 Compare two different advanced registered nurse roles with regard to ethical guidelines
NUR 513 Compare two different advanced registered nurse roles with regard to ethical guidelines
There are many avenues available for Registered Nurses within different types of Masters Programs. Advanced Nursing Practice Roles uniquely identify within different specialties. The two types of APN roles I have decided to compare includes Nurse Educator and Nurse Practitioner (Liaison International , 2022).
The Nurse Educator, whether it be college instruction or hospital bedside guidance, has a very important responsibility. Teaching and guiding nursing students, new grads and experienced nurses through gentle but firm instruction is an important balance (American Nurses Association, 2022). Ethical considerations can include providing constructive communication techniques for all facets of learning styles, maintaining confidentiality and anonymity, and recognizing potential of harm so the issue can be swiftly revised and improved. The nurse educator is an important resource for all areas of nursing, and performing this role with compassion and confidence directly influences healthy growth and success within all levels of nursing practices (DeNisco & Barker, 2019).
The Nurse Practitioner involves direct patient care and can span all types of specialties in medicine. Diagnosis and treatment as well as counseling in preventative care helps to create a healthy balance between the actual management of care and strategies needed for long term success. (American Nurses Association, 2022). Nurse Practitioners do not just treat the present problem but also the patient’s future health and happiness. Ethical considerations include voluntary participation of the patient, confidentiality, and informed consent (DeNisco & Barker, 2019).
There are many ethical differences within these two APN roles. The scope of practice highly differs between the two, which directly influences the associated ethical guidelines. One huge difference is the population served. Nurse Educators directly serve the nurses and institutions, while Nurse Practitioners directly serve the patients and institutions. Both roles utilize evidence-based practice and definitive ethical standards. The response to an ethical situation differs in the fact that the educator may identify and correct situations by improving knowledge gaps and training while the Nurse Practitioner may have to adjust the plan of care accordingly and follow up with different treatment modalities.
For example: A Jehovah witness patient is diagnosed with sickle cell crisis who is dangerously anemic and needs a blood transfusion. Ethical guidelines remain in place for respecting spirituality and religion. The hospital educator may consider addressing this situation with cultivating awareness by teaching the institutions employees, which leads to building understanding and acceptance for this patient population. The Nurse Practitioner will need to adapt the plan of care to this specific situation but also directly educate the patient on the high level risks associated with the denial of the blood transfusion. The NP can help the patient define personal limits and wishes associated with the plan of care without encroaching on the validity of the religious belief.
American Nurses Association. (2022). Advanced Practice Registered Nurse (APRN). https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/aprn
DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124
Liaison International (2022). Explore Health Careers. https://explorehealthcareers.org/field/nursing/
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The two different advanced registered nurse roles that I am going to compare is a nurse midwife and a nurse educator. Although all nurses need to abide by similar ethics there are additional guidelines to consider for these very different roles. Nurse educators have many responsibilities but one of the most important things that they must do is promote and encourage students to exercise around clinical judgement, practice using ethical standards, and support and respect their colleagues (National League for Nursing, 2012). Nursing educators need to treat all students fairly and stray away from racism. On the other hand, nurse midwives have a whole new world of ethical guidelines that need implemented. Midwives provide care to women at some of the most vulnerable times of their lives. They are responsible to keep women healthy as well as making sure their babies arrive healthy. What a huge responsibility that has a lot of moving parts. One unique ethical guideline to midwives is that they must develop a partnership with the woman that they work with and shares relevant information to help women make informed decisions, consent to an evolving plan of care, and acceptance of responsibility for the outcome of their choices (American College of Nurse-Midwives, n.d.). Respect for autonomy is basic to midwifery care and is foundational to a partnership that fosters open communication between a midwife and a woman (American College of Nurse-Midwives, n.d.). But all nurses whether that be an advanced registered nurse, or not should all have the goal to respect basic human right and dignity of all people, this is an important principal when caring for people.
American College of Nurse-Midwives. (n.d.). Code of ethics with explanatory statements. https://www.midwife.org/acnm/files/ACNMLibraryData/UPLOADFILENAME/000000000293/Code-of-Ethics-w-Explanatory-Statements-June-2015.pdf
National League for Nursing. (2012, January). Ethical principles for nursing education national league for nursing. https://www.nln.org/docs/default-source/uploadedfiles/default-document-library/ethical-principles-for-nursing-education-final-final-010312.pdf?sfvrsn=4b49d00d_0
The Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP) positions are two advanced registered nurse roles that are similar. They both require master’s level training in the field of nursing, but the clinical nurse specialist responsibilities tend to be more administrative with a strong focus on staff and patient education, research, and program development. The nurse practitioner’s role is more focused on assessment, diagnosing and management of disease processes. Nurse practitioners also tend to have more autonomy and work as an independent care provider. Depending on the regulatory laws of the state in which they practice, nurse practitioners can function under the supervision of a physician or unsupervised. Clinical nurse specialists’ approach tends to be more collaborative, and team centered (Gains, 2022). A Nurse Journal article sums up the differences between the two roles by stating that the nurse practitioner provides direct patient care, and the clinical nurse specialist manages patient care (Nurse Journal, 2022).
There are four Principles of Ethics for nurses. They are autonomy, beneficence, justice and nonmaleficence (Gains, 2021). The role of nurse practitioner is faced with a higher potential for ethical dilemmas due to the differences in duties from the clinic nurse specialist, especially regarding the principles of autonomy and nonmaleficence. One example is prescriptive authority of controlled substances. Nurse practitioners have prescriptive authority in 50 states and the authority to prescribe controlled substances in 49 states, clinical nurse specialists have no control substance prescriptive authority (Gains, 2022). Prescription drug abuse is currently a crisis in America and with the authority to prescribe controlled substances, comes the added responsibility that the medication is being prescribed safely and ethically.
Gaines, K., (2021, July 22). What is the nursing code of ethics?. Nurse.org. https://nurse.org/education/nursing-code-of-ethics/
Gaines, K., (2022, June 9). The differences between a clinical nurse specialists (CNS) vs nurse practitioner (NP). Nurse.org. https://nurse.org/articles/cns-vs-cnp-which-career-path-is-right-for-you/
NurseJournal. (2022, June 13). NP vs. CNS: What’s the difference?. Retrieved August 15, 2022 from https://nursejournal.org/resources/np-vs-cns/
Ethics involves understanding the moral rules and the system that they are made of such as the nature of purposes and justifications. One of the major challenges that nurses encounter is the ethical dilemmas and it is vital that nurses establish good ethical practices to ensure that there are better patient outcomes. Nurse practitioners are responsible for the provision of primary, acute, and specialized care across the lifespan (Fraze et al., 2020). They perform their role by assessing, diagnosing and treating illnesses and injuries. One of the major ethical issues that nursing practitioners encounter is having to deal with difficult patients and their family members. Behavioral issues and hopelessness can arise because of the complex nature of a patient’s problem which can also result in emotional and psychological problems. Despite the various challenges that may arise, nurse practitioners are responsible for catering to the patients need by fulfilling their ethical standards in their practice.
Psychiatric clinical nurse specialists are responsible for the provision of care to patients suffering from psychiatric issues. These nurses utilize evidence-based practice and standards of best practice in ensuring that they offer the highest quality of care to the patients. Caring for patients in this area may be challenging because of the diagnosis of mental illness (Mohr & Coke, 2018). Nurses need to be patient and empathetic to ensure that they can practice ethically without any form of bias. It is important for these nurses to be objective and contain their emotions when dealing with patients and not allow them to prevent them from effectively caring for the patients. Nurses should attempt to be neutral and provide patients with the highest quality of care.
Fraze, T. K., Briggs, A. D. M., Whitcomb, E. K., Peck, K. A., & Meara, E. (2020). Role of nurse practitioners in caring for patients with complex health needs. Medical Care, 58(10), 853–860. https://doi.org/10.1097/mlr.0000000000001364
Mohr, L. D., & Coke, L. A. (2018). Distinguishing the clinical nurse specialist from other graduate nursing roles. Clinical Nurse Specialist, 32(3), 139–151. https://doi.org/10.1097/nur.0000000000000373
“Ethical values are universal rules of conduct that provide a practical basis for identifying what kinds of actions, intentions, and motives are valued. Ethics are moral principles that govern how the person or a group will behave or conduct themselves.” (Haddad & Geiger, 2022) Ethical values are at the core of humanity. We are blessed that our healthcare profession holds to ethical values as strongly as they do. No matter what area of the healthcare field you choose to pursue, you will encounter them. And rightly so. The field of caring for diseases, acute injuries and administering medications, safety issues abound. Most especially, in the nursing field you will put ethics to use in practice every single day.
Advanced Practice Registered Nurse (APRN) is defined as a registered nurse who has additional knowledge and skills gained through an advanced formal education program. There are four roles that consist of certified registered nurse anesthetist (CRNA), certified nurse–midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). CNP may then be educated in another sub-specialty, Adult-Gerontology. I want to compare the CNM and the CNP with Adult-Gerontology training. As stated previously, in every area of life we should be striving to act in an ethical manner, but what differences does that mean for healthcare at different places in the spectrum of life? The CNM has training and strives to bring new life into the world with minimal complications while the CNP Adult-Gerontology is met with people on the other end, where people are living their last days. To let a young life go without life sustaining procedures would be unthinkable, and yet when a 90-year-old grandmother has a life-threatening disease, cancer for example, we do no curative treatments. Yet, both situations, opposite in the kind of care that’s offered, is considered ethical. To die with dignity, to be comfortable while death overtakes the body is ethical.
Haddad LM, Geiger RA. Nursing Ethical Considerations. 2021 Aug 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 30252310.
APRN Joint Dialogue Group Report, July 7, 2008, Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, https://ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008