NUR 513 Describe how the role of advanced registered nurse transformed over time

Sample Answer for NUR 513 Describe how the role of advanced registered nurse transformed over time Included After Question

Topic 1 DQ 1

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and
expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and
responsibilities continue to evolve and emerge as the American health care system changes?

A Sample Answer For the Assignment: NUR 513 Describe how the role of advanced registered nurse transformed over time

Title: NUR 513 Describe how the role of advanced registered nurse transformed over time

The role of advanced registered nurse has transformed over time primarily by shifting from a role to fill shortage in availability of physicians, to a role with structured education and professional definition. Historically, advanced practice nursing roles including nurse practitioners, nurse midwives and nurse anesthetists came into being as an attempt to improve care access in regions, or specialties, where access to physician care was limited (DeNisco & Barker, 2019).

However, these roles, initially had variable educational requirements, and authority often based on region. This lack of role definition was paralleled by other advanced practice nursing roles that did not necessarily have direct clinical contact with patients such as nurse educators, nurse managers and nurse researchers. In 2004 the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as:

“Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.”

While this definition continues to leave room for variable interpretation, this has served as a point of delineation regarding current and future educational requirements (DeNisco & Barker, 2019). Undoubtedly, the role of advanced registered nurse will continue to be refined by professional and regulatory bodies. The responsibilities of the advanced registered nurse will evolve to continue to meet population health needs, while maintaining strong roots in nursing practice and applications. 

American Association of Colleges of Nursing (AACN). (2004). AACN position statement on the practice doctorate in nursing. Retrieved from https://www.aacnnursing.org/Portals/42/News/Position-Statements/DNP.pdf

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

A Sample Answer 2 For the Assignment: NUR 513 Describe how the role of advanced registered nurse transformed over time

Title: NUR 513 Describe how the role of advanced registered nurse transformed over time

The role of registered nursing has come a long way since the 19th century when Florence Nightingale revolutionized modern nursing on the front lines of the Crimean war and Lillian Wald’s nurses elevated nursing to provide primary medical care for inner city low income families. Initially education of nurses who provided advanced specialized care was in the form of apprenticeship training, but it is now a requirement to have obtained a master’s degree or higher to qualify as an official Advanced practice Nurse. Currently there are four degrees that meet  the criteria to qualify as an advanced practice nurse (APRN).

NUR 513 Describe how the role of advanced registered nurse transformed over time
NUR 513 Describe how the role of advanced registered nurse transformed over time

They are Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist (DeNisco & Barker, 2019). As the demands and expectations of the healthcare system continue to increase, the number of roles qualifying to be an advanced practice nurse are bound to expand. Two roles that have potential to be included as APRNs are the roles of case managers, and nurse navigators. Along with the expansion of the field of APRNs in the near future, there will also be an increase in the expectations of their education, training and responsibilities. 

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One example of how the education and training of an Advanced Practice Nurse has changed over time is in the role of nurse practitioner(NP). From the time that the role of nurse practitioner was formally developed in 1965 by Loretta Ford, EdD and Henry Silver, MD, until the 1980s and 1990s, when it moved to the university setting as a master’s level program, most NP training programs were continuing education programs. (DeNisco & Barker, 2019). The goal of the American Association of Colleges of Nursing was to have all entry level Nurse Practitioners be educated at the Doctorate level by 2015, but this has proven “impossible to achieve” (DeNisco & Barker, 2019, p. 30).

Doctorate-level nursing education has become the bar for the role of nurse practitioner because NPs have been proven to be a cost effective way to provide high quality care, and the expectations of nurses in this increasingly complex healthcare system are becoming more demanding. The Institute of Medicine (IOM) has “identified the need for nurses to be placed at the forefront of healthcare” (DeNisco & Barker, 2019, p. 24).

Nurse practitioners are currently working alongside other doctorally prepared clinicians such as physicians (MD), pharmacists (PharmD), and physical therapists (DPT) to name a few (DeNisco & Barker, 2019). Requiring nurse practitioners to be doctorally prepared would ideally elevate them to be equal with other doctorally prepared clinicians in their respective fields. 

Reference:

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.) Jones & Bartlett Learning.

A Sample Answer 3 For the Assignment: NUR 513 Describe how the role of advanced registered nurse transformed over time

Title: NUR 513 Describe how the role of advanced registered nurse transformed over time

The medical sector has always been and will continue to evolve in response to a seemingly limitless number of obstacles. As a result, the precise functions of medical professionals have evolved dramatically and will certainly continue to do so. It is believed that the position of the advanced practice nurse began in the 1960s (Weberg et al., 2018). Initially, the advanced practice nurse was responsible for providing care to patient populations with limited access to healthcare (DeNisco, 2019). In essence, advanced practice nurses were utilized as a less expensive alternative to conventional healthcare at the time.

In the 1960s, when the role of the advanced practice nurse was originally introduced, the process did not always involve university study; rather, the majority of these individuals became advanced registered nurses through continuing education, often lasting between three and twelve months. In the 1980s and 1990s, obtaining a master’s degree became a prerequisite for becoming an advanced registered nurse, as the role and scope of practice grew with time (DeNisco, 2019).

Currently, the phrase advanced practice is utilized. Clinical nurse specialists, nurse practitioners, certified nurse midwives, certified registered nurse anesthetists, and registered nurses are all examples of registered nurses. Beyond this, numerous new responsibilities have been established for registered nurses, the most of which require additional education. Nurse administrators, public health nurses, policymakers, clinical nurse leaders, and nurse educators are a few of these roles (DeNisco, 2019).

It is difficult to fully forecast how the position of the advanced practice nurse will evolve in the future, but it is certain that the responsibilities and scope of practice will continue to evolve to meet the ever-changing requirements of the global patient population. The endeavor to expand access to high-quality healthcare without rising costs will undoubtedly have a significant impact on the evolution of the advanced practice nurse. It is anticipated that numerous new nursing professions will be established to help manage care for an aging population, chronic diseases, gender-specific healthcare, etc (DeNisco, 2019). Although the future of advanced practice nursing is unknown, imagining how the role will change is really exciting.

References

DeNisco, S.M. (2019). Advanced nursing practice: knowledge essential to the profession. Jones & Bartlett Learning.

Weberg, D., Mangold, K., Porter-O’Grady, T., & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Jones & Bartlett Learning.

There are different types of advanced registered nurse. Just as we have the nurse practitioner (NP), Certified Registered certified Anesthetist (CRNA), Midwife Nurse (CNM), or Clinical Nurse Specialist (CNS), (DeNisco, 2019), as some advanced registered nurse so is their role. Nursing have been formalized since 2008 so is their role which plays an important role in meeting the complex diverse health care needs of the population they serve (Deborah Rugs PhD, et, al)

Year 2020 been referred to as the “Year of the Nurse” has shown how important the role of advanced registered nurse in the health care sector with the urgent need of nursing professionals stepping up to fill the gap of the physician shortage (DeNisco, 2019). Also, with the pandemic of COVID-19, the shortage situation got worst. Despite the criticism of the education and knowledge ability of NP to practice without a Physician (DeNisco, 2019), (Brennan, 2020) where the advance in nursing was highly question with the patient care without the supervision of a physician.  This number is increasing exponentially in response to emerging and anticipated future service needs and population demand in the future, Advanced nursing practice has been operating in international world more than 5o years, which started here at home (USA) since 1960s (Kerr, et at 2020) and internationally.

Just like USA, where more nurses are expected to work at an advance level, is the same over at the Republic of Ireland, as the educational journey for ANPs shortened from 7 to 2 years post-registration (Kerr, et at 2020) making it even more possible to acquire the education needed and encouraging students. Promotion and development of networks to support nurses, working in or towards advanced practice roles, could be enhanced with advanced nurse practitioner, nurse educator and practice development coordinators’ involvement and not to mention fund toward the cause (Deborah Rugs PhD, ET, AL 2020)

Despite practice limitations experienced and still experiencing some due to  a variety of state regulations and legislation, such as supervisory physician requirements, limited or no prescription privileges, and varying degrees of autonomy while working within diverse settings, the “The Future of Nursing” as published by the Institute of Medicine emphasizing the importance of nurses working to the fullest extent of their education and training to help with the health care demand for quality service. This fact made Advance Registered Nurse a crucial care provider yet to be used to their full potential (Deborah Rugs PhD, ET, AL 2020).

There are funds gearing toward encouraging candidate to further their education to advance nurses to improve Evidence Base Practice for better patient outcome (USDOL). Evidence have shown that with advance education, creating structures, and support (from all regulations) for Advance Registered Nurses to practice to the fullest extent of their education and training has reduced the wait times to primary care the first line in identifying and treating chronic conditions at the Veteran Affairs (Deborah Rugs PhD, ET, AL 2020). With today’s shortage of providers in the system, nurse practitioners (NPs), together with physicians and physician assistants, provide most of the primary care in the United States. Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. not to forget the interdisciplinary collaboration of the health care dynamic in system, the current state of telehealth, and examine the role that NPs can play in furthering its adoption all these required a nurse to advance academically.

Brennan C. Tracing the History of the Nurse Practitioner Profession in 2020, the Year of the Nurse. J Pediatr Health Care. 2020 Mar-Apr;34(2):83-84. doi: 10.1016/j.pedhc.2019.12.005. PMID: 32063262.

Deborah Rugs PhD, Peter Toyinbo MBChB, PhD, CPH, Blake Barrett MSPH, Christine Melillo PhD, MPH, BSN, Margeaux Chavez MA, MPH, CPH, Linda Cowan PhD, APRN, FNP-BC, CWS, Penny Kaye Jensen DNP, APRN, FNP-C, FAAN, FAANP, Christine Engstrom PhD, CRNP, AOCN, FAANP, Catherine Battaglia PhD, RN, Suzanne Thorne-Odem DNP, APRN, FNP-C, Sheila Cox Sullivan PhD, RN and Gail Powell-Cope PhD, RN, FAAN

Engineering And Medicine National Academy Of Medicine Committee National Academies Of Sciences. (2021). FUTURE OF NURSING 2020-2030 : charting a path to achieve health equity. National Academies Press.

According to the American Nurses Association, the advanced registered nurses are the primary care givers and play a critical role in provision of preventive care services to the general public. They include nurse specialists, nurse anesthetists and nurse midwives (ANA, 2022). The notable advancement has been achieved through tremendous transformation in the past century. 

Nursing has had a dynamic history of meeting the ever-evolving needs of its patients, populations and systems. Nursing is considered, “one of the oldest healing practices in human history, it is also one of our youngest professions ” (DeNisco, S. M. (2019)).

In the 20th century, the rise of Advanced Practice Nursing, specifically the role of a Clinical Nurse Specialist (CNS) was to meet the societal need for providing advanced care to specialty populations such as psychiatric. Currently, as the United States healthcare system has become more complex, dynamic and a societal push towards greater access to healthcare for all people, APNs have the ability to meet the financial responsibility of the health systems and providers by maximizing care to more diverse and specialty populations. 

Additionally, the culture of healthcare has shifted in the direction away from disease/organ problems to a holistic, whole person approach. What nursing was described as being in a vertical power relationship within healthcare, with taking orders from a physician and carrying them out, is now a collaborative relationship; advocating for educational advancement in nursing, and seeking greater autonomy in their own practice to enhance their credibility in the profession and provide better patient outcomes. 

Advanced practice nurses are well positioned to meet the comprehensive needs of the whole person and population’s health and function within the current and continually changing health environment.