Discussion

The roles and responsibilities of a nursing professional is diverse and it encompasses an array of activities ranging from assessing the care needs of the patents to advocating for their best interests. Carney (2016)have described the nurses to be only health care professionals that have the opportunity and accountability to develop strong therapeutic alliances with the patients and their family members as well. Hence, the patients also spend the most of their time with the nurses developing a comfort level that allows them to open up to the nurses regarding their issues and grievances that they are suffering from. Hence, the nurses have a fundamental role in the health care scenario and they are central to the delivery of optimal patient centred care to the patient population.

However, the roles and responsibilities a nurse often overlaps and that is why there are various specific designation guiding the nurses through better understanding of the exact roles and responsibilities they are to be addressing while in practice (McDonnell et al., 2015). The advanced nurse practitioner is a job role that has evolved in the recent years encompassing more specific, detailed and critical nursing responsibilities and patient care requirements. This essay will attempt to explore the roles and responsibilities of an advanced nurse practitioner (ANP) and critically analyse the literature, ultimately applying the data gathered to explore the effectiveness of the role of an ANP in our hospital setting.

Advanced nurse practitioner is a very new and recently developed designation in the nursing field in comparison to its other counterparts. It has been developed in the wake of the different issues the nursing workforce had been facing as well as the health care industry. As discussed by Bryant?Lukosius et al. (2016), the health care scenario has been changing rapidly in since the last few decades and as a result the impact of the changes has led to development of more specialized designation to handle the more critical aspects of patient care. on a more elaborative note, the aging population, deteriorating health habits and lifestyle of the individuals, growing prevalence of the long term health adversities, the rising frequency of non-communicable diseases, complicating care needs, and lastly and the most importantly, the ever-increasing demand for nursing staff, had been a few notable challenges that has led to the rise of the specialist nurse roles. The advanced nurse practitioner is one such designation and the definition of the ANP is very complex due to the overlapping and complexly diverse job roles and responsibilities. In argument, many authors have mentioned that internationally there are multiple variants of the role of ANP and the exact characteristics of the role often differs based on the different national guidelines, health care framework and the demands experienced in the nation. Tracing back the origin of the role of the ANP, the designation first arose in the healthcare industry of USA in the late 1960s in order to address the staff shortage in the USA in that period and address the more complicated care needs of the patients. However, there is also considerable argument stating the emerging of the role of the ANP had been to address the issue of health inequalities in ethnic minorities (Iglehart, 2013).

Advanced nurse practitioner, the origin of the designation and the description of the roles

However, the role of an ANP has emerged drastically from that, and even though different nations have different practice guidelines for ANPs, they are undoubtedly have become an integral part of the nursing workforce. Considering the roles and responsibilities of an advanced nurse practitioner is focused mainly on patient education, disease management, treatment, illness prevention, and health promotion. In the context of advanced nurse practitioner in the Australian health care context, the NMBA or the Nursing and Midwifery Board of Australia has defined the role of the ANP to be associated with a nursing practice level that uses experience, comprehensive expertise, and knowledge in proving care (O’keeffe, Corry & Moser, 2015).

The roles of an advanced nurse practitioner is diverse and it mainly encompasses critical and complicated aspects associated patient care involving clinical governance and critical judgments. They are the highest division in the nursing workforce which entails that they have to be associated with taking most clinical decisions that can affect the patient care directly. As discussed in the article by Jennings et al. (2015), the role of an advanced nurse practitioner often overlaps with the role of a doctor, in the decision making authorities and scope of practice. Exploring the roles further, many Jenkins, Docherty and Cain (2018) have argued that the skillset that an advanced nurse practitioner has to be reflecting is associated with is considered to be that of doctors. As a result, in certain cases of emergencies, the advanced nurse practitioner can also take a number of clinical decisions which generally is taken by doctors.

The roles and responsibilities of the advanced nurse practice includes undertaking an array of comprehensive or sophisticated assessments involving both physical and mental health assessments for the patients that are suffering from complex health care needs. As discussed by the authors, the advanced nurse practitioners are required to carry out a through interpretation of the results of the different array of assessments and investigations that have been carried out for the patient, therefore, they have a strong role in carrying out diagnosis of the patient. Along with that, Andregård and Jangland (2015)have also mentioned that the role of an Advanced Nurse Practitioner also expands to providing therapies such as the cognitive behavioural therapy and other such psychotherapies to the patients with complex mental health care needs that are in isolation or for the patients that have been also suffering from any long term physical condition. Additionally, it is also the responsibility of the advanced nurse practitioners to make confident and competent ethical and evidence based decisions in care intervention planning and administration. Similarly, the ANPs are also required to perform risk identification and risk mitigations associated with the decision that have been taken ANP for the patient. Many authors have argued that ANPs majorly work independently, although it is also the responsibility of the ANPs to prescribe and work with the different health care professionals within a multidisciplinary care team scenario. Collaborating with the patients and working with them is also a very important aspect of the care that the ANPs have to Prescribe and work with patients to manage their medicines. Lastly, it is the one of the most fundamental responsibilities of the advanced practice nurses to plan and provide care that is skilled and competent, meeting their health and social care needs either directly or making referrals appropriately (Landsperger et al., 2016).

Standards of Practice associated with the role nationally and internationally

As mentioned above, although the roles and responsibilities of the advanced practice in nursing is similar, the scope of practice or practice standards differs drastically between different nations. Considering the Australian demographics, the scope of practice of an advanced nurse practitioner is set out by the practice standards developed by the Nursing and Midwifery Board of Australia in collaboration with the AHPRA or Australian Health Practitioner Regulation Agency (Ahpra.gov.au, 2018). These health authority boards define the Advanced Nursing Practice to be a professional continuum along which the nurses are given the opportunity to develop theirclinical reasoning and judgement, professional knowledge, and skills to higher levels of capacity. They also mention the advanced nurse practitioners to be following the roles of professional leadership, research and education into their clinically based practice. The advanced practice nurses practice in either the general or specialist setting and they are accountable in handling patients with complex health care requirements. As discussed by the NMBA, the advanced nurse practitioner designation does not encompass just a role, it is a level of practice which is specific to the individual within their context of practice (Nursingmidwiferyboard.gov.au, 2018). The NMBA has the power to allow endorsement to the role of advanced nurse practitioner for the registered nurses with certain accreditations and enhanced specialist training and education. On a more elaborative note, the nurses have to carry out a three years full-time experience in the advanced clinical nursing practice level within six years for obtaining the endorsement. There is also an evidence model used by the registered nurses that are applying for endorsement as a nurse practitioner, where the registered nurses will have to follow each of the requirement criteria of the model to be able to gain endorsements as an advanced practice nurse.

The main context of practice for the advanced practice nurse is health care agencies, educational organizations, and private practice. The Advanced nurse practitioner can continue practice in any location or demographic area including a rural, urban or remote location. The practice of an ANP also encompasses activities such as health promotion, research and management. There are 4 different practice standards that a practicing ANP has to perform includes a variety of domains of practice in the clinical practice. First and Foremost, the standard one refers to assessment of using diagnostic capability. This standard discusses the ability of the advanced practitioners to conduct comprehensive assessments, use diagnostic interventions, and apply diagnostic reasoning. The second standard of practice for an ANP is associated with planning care and engaging with others, which directs the nurses to integrate and translate evidence into practice (Nursingmidwiferyboard.gov.au, 2018). The third practice standard for the ANP is associated with “Prescribes and implements therapeutic intervention”, which directs the nurses to administer indicated non-pharmacological and pharmacological care interventions in accordance with federal, territorial, and state  legislation and professional regulation. The last practice standard of ANPs as governed by the NMBA and AHPRA is associated with evaluating outcome and improving practice (Ahpra.gov.au, 2018). This standard is associated with evaluating outcomes of personal practice and support safe care by advocating, participating, or leading systems, along with facilitating collaborative partnership and professional growth. Hemingway, Rogers and Elsom (2014) have discussed that the practice standards for the ANPs as set out in Australia mimics the international practice scope effectively as well, for example in the NHS setting, the role of ANPs is more abundantly used to replace the GPs to combat the rising shortage of GPs, although the scope practice is largely similar. On the other hand, in the American practice scenario, the practice standards of ANPs are outlined differently, yet the practice scope is similar as well.

The advanced nursing practice in the emergency setting or a crisis situation has been appraised by many research evidences, although there is very limited data available on how the role would fit in an aged care setting. My workplace setting is an aged care where the elderly patient are provided residential and outpatient services, and we have never had the role of an ANP in the facility. Based on the effectiveness of the designation and the array of practice services that are provided, there are many benefits or advantages that can be brought forth by implementation of this designation in the facility. As discussed by Bentley et al. (2016), the affirming interactions between the ANPs and the patients are vital to develop a therapeutic alliance and communication comfort with the elderly than the doctors. As discussed by Jackson and Carberry (2015) in their systematic review, the patients feel more comfortable in interacting with the advanced practice nurses, sharing more details regarding their preferences and grievances with the nurses. Fougère et al. (2016) also have stated in their article that APNs have the potential to increased patient satisfaction, increased consultation length, and more investigations performed than GPs with no noticeable differences were found in health outcomes or prescription. Hence, as the aged members of the society require far more medical attention from the doctors for their numerous and critical health conditions that can deteriorate very fast, the need for more general practitioners for geriatric patients is increasing everyday. The advanced nurse practitioners in this case can address the need for more general practitioners without affecting the care outcomes at all. Along with that, the nurse led memory clinics or fare facilities are becoming more common for remote and rural locations to address the staff shortage scenario. Another article by McDevitt and Melby (2015)have exhibited a decrease in mortality rates with the implementation of the ANPs in the geriatric wards. Along with that the articles by Iglehart (2013), clinical outcomes, care, services usage, and cost-efficiency of the care services provided by APNs have been reported to be extremely successful. Clark et al. (2013) in his systematic review has revealed the fact the health care needs of the aging population is increasing every day and coupled with the emerging staff shortage situation, the need for more advanced care workforce is expanding every day. The advanced nurse practition3rs bring together the benefits of both a nurse and a general practitioner, delivering quality safe and effective care to the patients in a compassionate and empathetic way. Although, the article has also mentioned the lack of evidences on nurse practitioners in aged care, which is a very important aspect associated with the practice of ANPs in aged care for Australian care settings.

Along with the benefits, there are certain possible limitations as well, associated with implementing the role of ANPs in aged care. As discussed by (Nursingmidwiferyboard.gov.au, 2018), the first practice standards allows the ANPs to practice as a doctor in the crisis situations, which represents both advantages and risks. Elaborating further, it has to be mentioned in this context that the advanced nurse practitioners only engages in diagnosis when there is a crisis or emergency where a doctor is unavailable, hence their expertise and experience is very minimal. As a result, on one hand where in the crisis situation the ANPs can facilitate care for the patient without waste of time in referrals, the lack of practice in diagnosis and other critical doctor level care activities can lead to misdiagnosis as well. Hence, there is need for more enhanced emphasis on training the ANPs and evolving their practice skills before implementation in practice under the guidance of GPs (Cain, 2016).

Conclusions:

On a concluding note. The role of an advanced practice nurse is diverse and the applicability of this role in practice is also extremely high. Given the current condition of staff shortage, the need for general practitioners are increasing by the day and the lack of GPs in these primary care settings such as an aged care facility, the ANPs can be an excellent replacement. This essay has successfully identified the benefits that the ANPs can bring forth in the aged care sector, while addressing the critical care needs of the patients that are generally handled by a GP and also providing safer, more compassionate and cost effective care to the patients. Hence, even though there are certain drawbacks of implementation of ANP as a designation in an aged care, these limitations can be easily addressed with training and educating the potential candidates. Hence, from the essay, it can be deduced that the need for ANPs in the aged care practice is extreme and with proper training given, the implementation in our facility will also be a success.

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