Changing role of ANPs in healthcare industry

Critical analysis of the role of the Advanced Nurse Practitioner (ANP).

One of the greatest foundations based on which the healthcare industry is reaching new heights of success is the dedicated and sincere health care workforce, and the nursing workforce is one of the greatest strengths of the healthcare industry. The nursing workforce is the facilitator of the care that is provided to the patients, and along with that the nurses are also the most fundamental communication channel with the responsibility of hearing and advocating the grievances and demands of the patients, and in turn strengthening the patient-centeredness of the care that is provided to the patients (DeNisco & Barker, 2013).

Hence, the nursing profession is the imperative part of the healthcare industry and without them, the care delivery will be disrupted (Iglehart, 2013). The nursing profession in the present time is diverse and there are several different designations and positions; and each designation has predetermined set of roles and responsibilities and has a significant importance in the care delivery scenario. One recent addition to the list of nursing designations is the advanced nurse practitioner or ANP. As the name suggests, the roles of an ANP are advanced and specialized in critical scenarios demanding critical practice skills and expertise (Blais et al., 2015). This assignment will attempt to explore the professional roles and responsibilities of an advanced nurse practitioner, their practice standards with respect to national and international protocols, critical application on the present workplace scenario and personal interpretation, and appraisal of the professional role in the health care industry.

Researchers are of the opinion that the role of ANP in the present context is changing in accordance with the changing health needs of the patient populations. The changes in patient populations and their lifestyles have given rise to long-standing factors such as cost-increase, judging the impact of care interventions on care outcomes, health protection and prevention, quality enhancement and cost-cutting by improving safety is inevitable. Hence, in order to address the challenges that are increasing every day with modifications due to changing patient populations and diseases in the present scenario, the nursing workforce has modified and improved their practice scope and skills to address each and every issue with expert knowledge and evidence-based practice (Hamric et al., 2013). There has been many initiatives taken by the healthcare industry to enhance the care provided to the patients, especially the ones that are critical and in need of specialized care; the advanced nursing practice is one of the greatest achievements of these initiatives. This has provided the patients with the opportunity to be cared for by a nursing professional with advanced knowledge and skill set to aid them in their critical and specialized care needs. The advanced nursing practice has changed over time and the professional roles and responsibilities associated with the advanced nurse practitioner have also changed with respect to the changes that have been brought forward to the regular or normal standard of the scope of practice of nurses at the point of registration. According to Lowe et al. (2012), the standard scope of practice continues to change and improve every day with response to the changing primary care needs of the patients and along with that the advanced nurse practitioner skill set and professional responsibilities have also changed.

Professional roles and responsibilities of an ANP

In order to better understand the professional roles and responsibilities of advanced nurse practitioner, it has to be mentioned that there are multiple models and definitions that can describe the advanced nursing practice but the most suitable definition for advanced nurse practitioner in the healthcare scenario is that of a hybrid role (Donelan et al., 2013). On a more elaborative note, the professional roles and responsibilities of an advanced nurse practitioner are considered to be integrative of the role of a nurse and doctor. This is due to the fact that this particular profession holds true to the fundamental requirements and underlying philosophies of nursing practice. On the other hand, the professional responsibilities of an advanced nurse practitioner also encompass the expertise and skill-set which is traditionally considered to be that of doctors (Yee et al., 2013). The overall professional roles and responsibilities of the advanced nurse practitioner include:

• Undertaking comprehensive and extensive physical or mental health assessment of the patients that are having specialized care or are in a medical crisis.
• Interpreting the results of various assessments and investigations for diagnosing the condition the patient is suffering and then plan and deliver care (Williamson et al., 2012).
• Making competent ethical, clinically reasonable evidence-supported decisions and interventions while facing any complexity and assessing or managing any risk that is associated with the decisions taken.
• Implementing therapies like cognitive behavioral therapy while caring for patients with mental disorders either in isolated one to one setting or as an occupational therapeutic intervention. For a patient suffering from any chronic physical long-term condition (Kleinpell, 2013).
• Prescribing medication and collaborating with allied health care professionals to administer and manage the prescribed medications.
• Practicing independently but all the while collaborating within a multi-disciplinary care team scenario and establishing values-based leadership.
• Planning and delivering skilled and competent patient centred advanced care to meet the myriad of overall care needs involving the referral to other allied healthcare professionals within the multidisciplinary team as appropriate (Shiu, Lee & Chau, 2012).

Hence, the importance of the advanced nurse practitioner and the professional roles played by this designation is imperative. The reason behind their crucial importance in the healthcare industry is not just the fact that they can be substitute for doctors in the ever-rising crisis for general practitioners; but also by the fact that they help a patient  get the care they need faster, as the need to refer to a doctor, and the delay in care delivery associated with the referral process, is eliminated (Wheeler, 2013).

The healthcare practice is filled with critical and complex professional responsibilities and even a minor error or negligence can lead to even lethal consequences for the patient. Hence, the need for strict and compliant adherence to practice based solely on skill set and expertise is crucial for the care workforce. The practice standards serve as the legal framework that enables different designations within the nursing care workforce with their exact professional responsibilities correlating with their scope of practice (Buppert, 2014). Hence, all different kinds of care professional designations have separate practice standards, and the advanced nurse practitioner is no exception to that. Although, the practice standards might differ considerably based on the national and international healthcare norms or legislation. Illustrating the standard of practice of advanced nurse practitioner on a national level, evidence from the standard practice guidelines from the NMBA can be of excellent help (Melnyk et al., 2014).

The NMBA recognizes the designation of an ANP as a nurse practitioner and describes the designation as a professional continuum across which the nurses build their occuptional knowledge, clinical judgment, behavioural characteristics and skills up to the level of highest capabilities. Furthermore, according to NMBA, the practice of an ANP is equivalent to the advanced level occupational leadership, research and education into their clinical practice (Nursingmidwiferyboard.gov.au, 2018). Elaborating on the standards for practice as directed by the NMBA, there are four standards clearly defining the practice scope of the nurse practitioner. The first standard is “Assesses using diagnostic capabilities”; this standard has three subdivisions. the standard 1.1 guides the ANP to demonstrate extensive knowledge of the human body system, broad and methodical skill in collecting relevant and authentic patient data, assessing the complex care needs, assessing the impact of the co-morbidities, expertise in clinical patient assessment, synthesizing and interpreting complex care cues accurately, and critically evaluating the impact of the social determinants of health on the patient. The standard 1.2 instructs a nurse practitioner to decide the use of person-focused diagnostic investigations, demonstrating the accountability with respect to access, expense, clinical efficacy and the informed consent of the patient, ordering or performing critical screening and diagnostic interventions, taking the responsibility for the interpretation of results and for subsequent follow up, and using effective communication strategies for proper patient education and information sharing (Nursingmidwiferyboard.gov.au, 2018). The standard 1.3 guides the nursing practitioner to make use of diagnostic reasoning expertise to formulate a diagnosis.

Importance of ANPs in healthcare industry

The 2^nd standard is the “Plans care and engages others”; this standard has also 4 subdivisions. The standard 2.1 is focused on the translating and integrating evidence into the planning of care by the means of taking personal accountability to critically evaluate and incorporate relevant research evidences into the process of decision making, exploring therapeutic options and its possible implication on care, and being proactive and analytical in gathering new knowledge. The standard 2.2 guides the nurse practitioner to educate and support the patients to facilitate their active participation in the care scenario by respecting the right of informed decision making of the patient, using appropriate learning theories and strategies to provide diagnostic information, communicating critical diagnostic findings, and meeting identified patient education needs (Carney, 2016). The standard 2.3 guides the ANP to consider quality utilization of the medication and therapeutic interventions in order to plan care, by developing an individual patient centred plan of care, having a comprehensive understanding of pharmacology and pharmacokinetics, and verifying the suitability of the evidence-based treatment interventions. The standard 2.4 discusses the ANP to refer and consult for care decisions so that outcomes can be attained for the person that is receiving the care; this is achieved by accepting appropriate referrals and consulting and collaborating with allied health servi8ces for optimal care planning and implementation.

The third standard is “Prescribes and implements therapeutic interventions” and there are three subdivisions to this standard. The standard 3.1 discusses the role of the ANP to prescribe indicated non- pharmacological and pharmacological interventions safe and acutely evidence-based prescription of therapeutic intervention and evidence-informed invasive or non-invasive intervention all the while demonstrating effective professional integrity and ethical conduct with therapeutic product manufacturers and pharmaceutical organizations. The standard 3.2 discusses the role of the ANP to prioritizing the establishment and maintenance of the therapeutic relationship by supporting, educating, coaching and counselling the patient on the aspects of diagnosis, prognosis, self management and the personal response of the patient to the illness. The standard 3.4 discusses practicing with respect to the federal, state and territorial legislation and professional regulation that govern the ANP practice (Nursingmidwiferyboard.gov.au, 2018).

The fourth and last standard is “evaluates outcomes and improves practice”; and this standard has only 2 subdivisions. The standard 4.1 discusses the role of an ANP to evaluating the outcome of own practice by monitoring and documenting the treatments in accordance with person determined goals, planning for appropriately ceasing and/or modifying treatment, and applying best available evidence to practice and clinical supervision. The standard 4.2 discusses the role of advocating and leading the support of safe care delivery and professional growth. Hence, the standard for practice for ANP in Australia is extensive and inclusive of the role of both a nursing practice and the practice of a doctor in many cases.

Standards of practice defined by NMBA

Now, comparing the roles and practice standards with the international aspects, the guidelines of ICN or international council of Nursing can be considered. The ICN through its International Nurse Practitioner or Advanced Practice Nursing Network has provided a clear understanding of the definition of ANP and the professional roles and responsibilities associated with it. According to the guidelines of the ICN, the scope of advanced nursing practice is attained by a registered nurse by acquiring expert knowledge, critical decision-making attributes along with critical competencies that allow expanded and specialized practice (Melnyk et al., 2014). Along with that, the document, the standard of practice is shaped by the context and the country where the nurse is credentialed to the practice. According to the guidelines of the ICN, a masters level degree is mandated for a registered nurse to apply for the position of the ANP and formal system of licensure, registration, certification and credentialing is also needed. the standards for practice includes, incorporating research, education and practice management, high degree of professional autonomy and independent practice, case management, advanced patient assessment, decision making and diagnostic skills, Recognizing advanced clinical competencies, provision of consulting, collaborating and supervising other health providers, planning, implementing and evaluating programs and recognizing the role of being the first point of contact for the clients (International.aanp.org, 2018). Hence, the role or standard of practice for the ANP internationally is also very similar recognizing the role to be an amalgamation of compassionate patient centred care approach of a nurse and the clinical expertise of a general physician.

The role of the nurse practitioner is very versatile and extensive encompassing various different domains of practice within the care profession. It has to be mentioned in this context that the practice role of the ANP in a global perspective is based on the fundamental concept of it being the remit for the doctors. Both national and internationally the role of the ANP is focused on the idea of being the middle ground between the practice of a nurse and a doctor providing a specialized and advanced care to the patients in the need for acute care interventions for co-morbid chronic disorders eliminating the delay associated with referring to a doctor. According to O’connell, Gardner, and Coyer (2014), the role of an advanced nurse practitioner had been to address the global increase in the complexity of the healthcare needs, poly-pharmacy and aging populations with advanced unsustainable health care needs. In support, Scanlon et al. (2012), have stated that the core components of the ANP practice are autonomous practice, critical thinking, and advanced clinical reasonable decision making and value-based care. However, as mentioned by Carney (2016), the professional; roles and responsibilities of the ANP does not end in the above mentioned clinical skills and expertise, rather, the roles of advanced nurse practitioner is illustrated to the task of managing and leading a multidisciplinary care team while providing the specialized and multifaceted care to the patients. Hence, it can be deduced that the role of an advanced nurse practitioner surpasses that of a regular nursing profe4ssioanl and encompasses some if not all professional responsibilities of a doctor while addressing the patients with critical care needs (Gerrish et al., 2012).

Concerning the personal interpretation, I would like to illustrate the fact that in our scenario of practice, the importance of an ANP in the practice scenario is supreme as it does not just entertain an autonomous practice for the critical care unit patient but also helps in managing, leading, and guiding the care team to make evidence-based patient centred practice (Buppert, 2014). In my personal workplace scenario of an acute care facility, I have observed that the acute care facilities often have care needs and requirements that surpasses the scope of practice for a regular registered nurse. In critical emergencies, we often are faced with the task of clinical decision making in areas that are above our scope of practice or expertise. In such cases, the aid of an advanced nurse practitioner guiding and supervising the care decision making will help inadequate care planning and delivery for the patients with critical care needs. Along with that, the shortage of general practitioners and their unavailability during emergencies can be easily managed by the autonomous and independent practice expertise of the ANP.

Conclusion:

On a concluding note, it has to be mentioned that advanced nurse practitioner is a role in the healthcare industry that has helped bridge the gap between a general practitioner and a registered nurse so that optimal care can be provided to patients with complex care needs. The essay has outlined the roles of the ANP excellently and has illustrated it with the standards of practice both nationally and internationally. The critical appraisal of the role was demonstrated by the means of literature evidence, although, the literature available had not been successful in outlining possible limitations of the role. Although, the importance of the ANP in the care scenario is undoubtedly imperative in the wake of the changing care needs of the patient population. Hence, there is a need for more emphasis on expanding the ANP educational opportunities so that more nursing professionals can apply for the position and aid in the care scenario

References:

Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice: Concepts and perspectives (p. 530). NJ: Prentice Hall.

Buppert, C. (2014). Nurse practitioner’s business practice and legal guide. Jones & Bartlett Publishers.

Carney, M. (2016). Regulation of advanced nurse practice: its existence and regulatory dimensions from an international perspective. Journal of nursing management, 24(1), 105-114.

DeNisco, S., & Barker, A. M. (Eds.). (2013). Advanced practice nursing: Evolving roles for the transformation of the profession. Jones & Bartlett Learning.

Donelan, K., DesRoches, C. M., Dittus, R. S., & Buerhaus, P. (2013). Perspectives of physicians and nurse practitioners on primary care practice. New England Journal of Medicine, 368(20), 1898-1906.

Gerrish, K., Nolan, M., McDonnell, A., Tod, A., Kirshbaum, M., & Guillaume, L. (2012). Factors influencing advanced practice nurses’ ability to promote evidence?based practice among frontline nurses. Worldviews on Evidence?Based Nursing, 9(1), 30-39.

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2013). Advanced Practice Nursing-E-Book: An Integrative Approach. Elsevier Health Sciences.

Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners–risks and rewards. The New England journal of medicine, 368(20), 1935-1941.

Kleinpell, R. M. (2013). Outcome assessment in advanced practice nursing. Springer Publishing Company.

Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of advanced nursing, 68(3), 677-685.

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15.

NP and AP Roles – ICN Nurse Practitioner / Advanced Practice Nursing Network. (2018). Retrieved from https://international.aanp.org/Practice/APNRoles

Nursing and Midwifery Board of Australia – Nurse practitioner standards for practice – Effective from 1 January 2014. (2018). Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/nurse-practitioner-standards-of-practice.aspx

O’connell, J., Gardner, G., & Coyer, F. (2014). Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. Journal of advanced nursing, 70(12), 2728-2735.

Scanlon, A., Cashin, A., Watson, N., & Bryce, J. (2012). Advanced nursing practice hours as part of endorsement requirements for nurse practitioners in Australia: A definitional conundrum. Journal of the American Association of Nurse Practitioners, 24(11), 649-659.

Shiu, A. T., Lee, D. T., & Chau, J. P. (2012). Exploring the scope of expanding advanced nursing practice in nurse?led clinics: a multiple?case study. Journal of advanced nursing, 68(8), 1780-1792.

Thompson, W., & Meskell, P. (2012). Evaluation of an advanced nurse practitioner (emergency care)—An Irish perspective. The Journal for Nurse Practitioners, 8(3), 200-205.

Wheeler, K. (2013). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company.

Williamson, S., Twelvetree, T., Thompson, J., & Beaver, K. (2012). An ethnographic study exploring the role of ward?based Advanced Nurse Practitioners in an acute medical setting. Journal of Advanced Nursing, 68(7), 1579-1588.

Yee, T., Boukus, E., Cross, D., & Samuel, D. (2013). Primary care workforce shortages: Nurse practitioner scope-of-practice laws and payment policies. National Institute for Health Care Reform Research Brief, 13, 1-7.