NRNP 6552 Discussion: Different Roles of the Nurse Practitioner
The shortage of physicians allows non-physician professionals to practice to the full extent of their education and training which gives patients more options for types of services (ANA, n.d.). Many non-physician health care providers are trained and willing to help meet this need but are not permitted to do so because of limitations in their scope of practice. Given the shortage of primary care physicians, allowing non-physician professionals to practice to the full extent of their education and training gives patients more options and more types of services (ANA, n.d.)
Advanced practice registered nurses (APRNs) can practice to the full extent of education, training, and certification with regard to individual State practice regulations concerning requirements such as clinical supervision or mandatory collaboration with physicians. A certified registered nurse practitioner (CRNP) competencies include functioning as an independent practitioner while demonstrating the highest level of accountability for professional practice. APRN’s provide the full spectrum of health care services including health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end-of-life care (NONPF, 2017). Providers use advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings. Diagnostic screening and strategies aid in the development of diagnosing disease. Medications are prescribed within the scope of practice. Patients with acute and chronic diseases are managed while providing patient-centered care that recognizes cultural diversity (NONPF, 2017).
A physician’s assistant (PA) role is comprised of primary care and specialty care in the medical and surgical fields. Professional competencies for physician assistants include effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice (AAPA, 2013).
The scope of practice for certified nurse midwives (CNMs) includes primary health care for women from adolescence through menopause, contraceptive care, prenatal and postnatal care, care of the newborn during the first month of life, gynecology, family planning services, health promotion, disease prevention, and individualized wellness education and counseling (Marzalik et al., 2018). Prescriptive authority varies from state to state (Marzalik et al., 2018)
Influence on my future practice as an APRN will come from clinical practicum and learning experiences. The PA profession is an emerging profession that provides a substantial contribution to the healthcare workforce in all medical specialty areas (Kulo et al., 2021). PA’s practice under a physician giving them a broad knowledge base. This background will challenge my thought process when it comes to diagnosing and treating patients. A surgical PA would be able to provide procedural techniques such as suturing that I may not have exposure to in a primary care office setting. Though similar to an advanced practice nursing degree, the PA’s role with provide a different view and approach to treatment through their diverse training and education. A CNM can provide specific training regarding women’s health, and neonatal health. Their specified education is targeted of women’s health and allows for the expertise that the specialized field requires. A CNM will help expand my role as a Family Nurse Practitioner (FNP) my bridging primary care with women’s health. Healthcare providers educated to provide primary healthcare services such as CNM’s are projected to play a key role in meeting the demand of access to affordable healthcare since the passing of the Affordable Care Act in 2010 (Hastings-Tolsma et al., 2015). A CNM can provide me with insight into caring for a pregnant woman and specific considerations for the high-risk pregnant population. While working with an FNP during my first clinical rotation I quickly realized the vast amount of knowledge a primary care provider must possess in order to adequately manage patients of all populations. Initiating insulin treatment for a type 2 diabetic and starting statin treatment when lifestyle modifications have not improved cholesterol levels are examples of treatment plans I learned from my previous primary care preceptor. Gaining and applying knowledge from different mid-level providers can improve practice and clinical skills to create a well-rounded FNP.
American Academy of Physician Assistants (AAPA) (2013). Competencies for the Physician Assistant Profession. https://www.aapa.org/wp-content/uploads/2017/02/PA-Competencies-updated.pdf
American Nurses Association (ANA). (n.d.). Scope of Practice. https://www.nursingworld.org/practice-policy/aprn/
Hastings-Tolsma, M., Tanner, T., Hensley, J. G., Anderson, J., Patterson, E., Dunemn, K. N., & Purcell, S. K. (2015). Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives. Policy, Politics & Nursing Practice, 16(3/4), 97–108. https://doi-org.ezp.waldenulibrary.org/10.1177/1527154415601477
Kulo, V., Fleming, S., Gordes, K. L., Jun, H.-J., Cawley, J. F., & Kayingo, G. (2021). A physician assistant entry-level doctoral degree: more harm than good? BMC Medical Education, 21(1), 274. https://doi-org.ezp.waldenulibrary.org/10.1186/s12909-021-02725-5
Marzalik, P. R., Feltham, K. J., Jefferson, K., & Pekin, K. (2018). Midwifery education in the U.S. – Certified Nurse-Midwife, Certified Midwife, and Certified Professional Midwife. Midwifery, 60, 9–12. https://doi-org.ezp.waldenulibrary.org/10.1016/j.midw.2018.01.020
The National Organization of Nurse Practitioner Faculties (NONPF). (2017). Nurse Practitioner Core Competencies Content. https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf
So true the shortage of Physicians and non-physicians has allowed APRNs to have more professional responsibilities. An Advanced Practice Nurse can work as either an FNP or Midwife with the appropriate training. Although both of these clinical positions are underutilized in some communities, each of these disciplines can facilitate cost-saving and effective care when collaborating together (Casey et al., 2017). The FNP works in tandem with the Midwife, the symbiotic relationship can help reduce pregnancy-related deaths in the United States (Krishnaswami & Del C Colon-Gonzalez, 2019). The collaboration should foster respect and communication (Smith, 2016).
Maternity patients must receive timely medical care from the perinatal point to the postnatal time frame. An FNP typically provides medical management, family planning, and management of patients in the beginning months of their pregnancies (Van Hecke et al., 2019). For complicated cases and pregnancies beyond the first trimester, the FNP can refer the case to the Midwife’s practice or to an obstetrician.
Casey, M., O’Connor, L., Cashin, A., Smith, R., O’Brien, D., Nicholson, E., O’Leary, D., Fealy, G., McNamara, M., Glasgow, M. E., Stokes, D., & Egan, C. (2017). An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. Nurse Education Today, 56, 35–40. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2017.06.004
Krishnaswami, J., & Del C Colon-Gonzalez, M. (2019). Reforming Women’s Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. American journal of lifestyle medicine, 13(5), 495–504. https://doi.org/10.1177/1559827619838461
Smith, D. C. (2016). Interprofessional Collaboration in Perinatal Care. The Journal of Perinatal & Neonatal Nursing, 30(3), 167–173. doi:10.1097/JPN.0000000000000187.
Van Hecke, A., Goemaes, R., Verhaeghe, S., Beyers, W., Decoene, E., & Beeckman, D. (2019). Leadership in nursing and midwifery: Activities and associated competencies advanced practice nurses and midwives. Journal of Nursing Management. 2019;27(6):1261-1274. doi:10.1111/jonm.12808
Discussion: Different Roles of the Nurse Practitioner
The term ‘history” is broad in meaning. Within that broad framework archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.
So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties.
For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.
Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).
Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.
By Day 3
Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues’ posts on two different days and provide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Week 1 Discussion: Career Goals, Strength and Challenges
Certified Registered Nurse Practitioner (CRNP), Certified Nurse Midwifery (CNM), and Physician Assistant are all mid-level providers yet have different roles in the health care system. Mid-level providers have their position and specialty in providing care to other areas of health care. Also, every state has its unique scope on how they function and providing care to the individual. Manning et al. (2018) described that as paradigms of health care delivery evolve, mid-level providers such as nurse practitioners and physician assistants have become an essential consideration in the health care workforce planning and patient care. According to the AMA Journal of Ethics (2021), physician assistants are health care professionals licensed to practice medicine under physician supervision. Their role is to conduct physical exams, diagnose and treat illnesses, order, and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions (AMA Journal of Ethics, 2021). AANP (2021) described that the Nurse Practitioner has autonomously and collaborates with health care professionals and other individuals; NPs provide a full range of primary, acute, and specialty health care services. A nurse-midwife is a licensed health care professional who specializes in women’s reproductive health and childbirth. In addition, attending births, perform annual exams, give counseling, and write prescriptions (Staff Writers, 2021). In a profession as dynamic as nursing, and with evolving health care demands, changes in the scope of practice and overlapping responsibilities are inevitable in our current and future health care system. Each of these roles will have a significant impact on my practice as a Nurse Practitioner. Mid-level providers working in different areas and specialties significantly impact each other by providing care to each area that the patient needs it.
For example, last semester, I did my clinical rotation for adults across the life span. I had a female patient came to the clinic with an annual pap smear. The result came in, and it was positive; my preceptor was able to refer the patient to Gynecology for further examination and treatment. Another example, when I have a patient who came in with non-compliance Type 2 diabetes with acute kidney injury. My preceptor and I are able to refer the patient to Endocrinologist, nutritionist, nephrologist, and community group for diabetes. The number of patients with multiple and chronic medical conditions is increasing globally, which causes functional and emotional impairment to increase in health care demands. Ang et al. (2021) explain that collaboration in health care has been shown to enhance patient outcomes, including reducing preventable adverse drug effects, lowering morbidity and mortality rates, and adjusting medication dosages, especially in medical-based departments in a hospital. Besides improving patient care, health care providers have also benefited from teamwork, including reduced overlapping tasks, reduced burnout, and increased job satisfaction (Ang et al., 2021).
AANP. (2021). What’s a nurse practitioner (NP).https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner
AMA Journal of Ethics. (2021). Illuminating the art of medicine.https://journalofethics.ama-assn.org/article/physician-assistants-and-their-role-primary-care/2012-05
American Nurses Association (ANA). (n.d.). Scope of practice.https://www.nursing-world.org/practice-policy/scope-of-practice/
Ang, W. C., Abd Rahim, S. N., Abd Rahman, N. F., Muhamad, S. N., Rokimi, W. R., & Ng, S.C. (2021). Healthcare Professionals’ Experiences on Interdisciplinary Collaboration in a Medical Department of a Malaysian General Hospital. Medicine & Health (Universiti Kebangsaan Malaysia), 16(1), 246–255.https://doi-org.ezp.waldenulibrary.org/10.17576/MH.2021.1601.20
Manning, B. T., Bohl, D. D., Hannon, C. P., Redondo, M. L., Christian, D. R., Forsythe, B., Nho, S. J., & Bach, B. R. (2018). Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine. Orthopaedic Journal of Sports Medicine, 6(4), 1–7.
Staff Writers. (2021). What is a certified nurse-midwife (CNM)?https://www.nursepractitionerschools.com/certified-nurse-midwife/
Discussion Post: Different Roles of the Nurse Practitioner
Nursing roles have been evolving, especially in the face of medical advances and the shortage of medical personnel. This has created a need for nurses’ roles to be redefined, as their numbers increase and they take on more responsibilities. In fact, a new generation has been created among nurses with state regulations governing their supervision, prescriptive authority, and scope of practice (Schober, 2016). Generally, advanced practice registered nurses (APRN) have a broad scope of practice that includes assessing, diagnosing, and treating medical conditions, as well as prescribing medication and equipment, and ordering and interpreting diagnostic exams like MRIs and bloodwork (Zaccagnini & Pechacek, 2019). There are three main groups of APRNs with distinctive roles as discussed. Firstly, are certified registered nurse practitioners (CRNP). This is a type of APRN with a nurse practitioner (NP) license. Their role is to help improve patient satisfaction, lower health care costs, and address the continuing primary care shortage. They are differentiated from other APRNs as they look at the patient wellbeing and health from a whole-person perspective. Besides that, they are involved in policy advocacy to improve health care and access, particularly for low-income individuals, children, and other marginalized groups (Stewart & DeNisco, 2020). Secondly, are certified nurse midwives (CNM). This is a licensed nurse specializing in women’s reproductive health and childbirth. They give counseling, perform annual exams, give primary care, and perform gynecological exams. Additionally, they provide parental education, prenatal care, and family planning services. Also, they offer training programs, maintain medical records, collaborate with other medical personnel in providing specialized care, educate expectant and new parents on nutrition, measure and monitor fetal development, and give intrapartum, postpartum, and newborn care (DeNisco & Beauvais, 2020). Thirdly, a physician assistant (PA) works interdependently with licensed physicians to diagnose and treat diseases and illnesses and to prescribe medication. They can treat patients independently of a physician. Furthermore, they can write prescriptions, order and interpret laboratory tests, assist in surgery, perform minor bedside procedures, diagnose patients, develop treatment plans, and obtain patient histories (Joel, 2018). In this respect, it is clear that CRNP, CNM, and PA have distinctive roles as APRNs.
DeNisco, S. M. & Beauvais, A. M. (2020). Advanced Practice Nursing: Essential Knowledge for the Profession (4th ed.). Jones & Bartlett Learning, LLC.
Joel, L. A. (2018). Advanced Practice Nursing: Essentials for Role Development (4th ed.). F.A. Davis Company.
Schober, M. (2016). Introduction to Advanced Nursing Practice: An International Focus. Springer International Publishing.
Stewart, J. G., & DeNisco, S. M. (Eds.) (2021). Role Development for the Nurse Practitioner (3rd ed.). Jones & Bartlett Leaning, LLC.
Zaccagnini, M., & Pechacek, J. M. (Eds.) (2019). The doctor of nursing practice essentials: a new model for advanced practice nursing (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.