Advanced Practice Nursing: Essentials for Role Development

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ISBN: 9780803611191 | 0803611196
Cover: Paperback
Copyright: 12/1/2003

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The book addresses the evolution of the Advance Practice Nurse (APN) role over time, the environment in which APNs practice, APN core competencies, evolving issues, challenges, and basic organizational and business skills that will allow the APN to survive and thrive. The author and her stellar list of contributors tackle the topics that all nursing graduate students need to be familiar with to function as an APN, such as: evidence-based practice, ethical decision-making, basic teaching skills, starking a practice and practice management, court cases involving the APN, and much more.

UNIT 1 THE EVOLUTION OF ADVACED PRACTICE

1 ADVANCED PRACTICE NURSING: DOING WHAT HAD TO BE DONE-RADICALS, RENEGADES, AND REBELS

Lynne M. Dunphy, Ellis Quinn Youngkin, and Nancy K. Smith

(28)

The authors chronicle the history of advanced practice specialties from their earliest days, showing the similarities and differences in their development, the strategic governmental and professional policy choices that enabled survival and growth, and the decisions that gave birth to the title of advanced practice nurse (APN).

2 EMERGING ROLES OF THE ADVANCED PRACTICE NURSE

Anne Keane and Deborah Becker

(27)

Attention is directed toward the circumstances that have moved the APN role into new and creative models. Examples include the acute care nurse practitioner, the psychiatric nurse practitioner, the blended clinical nurse specialist/nurse practitioner, and the clinical specialist in community health nursing. Several exemplars are provided.

3 ROLE DEVELOPMENT: A THEORETICAL PERSPECTIVE

Lucille A. Joel

(15)

There is only a role for the moment, not any role that will serve for the entire life of a career. Role modifications are dependent on a theoretical body of knowledge, more of it hypothetical than empirical research. These concepts and relationships will allow a comfortable paradigm shift as necessary, with an awareness of the elements of continuity from here to there. This chapter includes a theoretical perspective on the processes of knowledge and skill acquisition, and socialization. Also addressed are the consequent stresses and strains that challenge most role occupants, including how to cope with them

4 GLOBAL PERSPECTIVE ON ADVANCED PRACTICE

Madrean Schober

(26)

Nurses with advanced knowledge and skills, including prescribing, are present in numerous countries. Country context, the complexity of health care services, and the structure of the health care system all influence the promotion and support for advanced practice nursing globally. Descriptive information, examples, and models of international development are provided.

UNIT 2 THE PRACTICE ENVIRONMENT

5 PAYMENT FOR ADVANCED PRACTICE NURSING SERVICES: PAST, PRESENT, AND FUTURE

Karen R. Robinson

(23)

Even as we quickly move into a capitated system, reimbursement remains a major issue for all APNs. Today's health care spending is scrutinized so closely that no APN reimbursement opportunity can be left "untapped". This chapter will assist APNs to understand the reimbursement process, identify existing reimbursement roadblocks, and finally, strategize to improve reimbursement efforts.

6 ADVANCED PRACTICE NURSES AND PRESCRIPTIVE AUTHORITY

Jan Towers

122

(14)

Over 90% of the American public seeking medical attention receives a prescription for medicine at the conclusion of an encounter in the health care system. While practice patterns of APNs differ, the authority to prescribe is critical to all. Significant gains have been made over the past several years. The progress has been gradual and methodical, from supervised practice to plenary authority.

7 CREDENTIALING AND CLINICAL PRIVILEGES AND THE ADVANCED PRACTICE NURSE

Ann H. Cary and Mary C. Smolenski

136

(17)

Is the advanced practice legal credential a second license, or deemed status for the profession's certification, or some hybrid of both? To what degree does credentialing guarantee competency? Should title protection be inextricably bound to licensure? And what about clinical privileges? Privileging may allow admitting, treatment, consultation, and visiting rights. We have been slowest to see admitting privileges for nurses, except in rural areas. This is despite the fact that JCAHO and Medicare regulations permit us to hold this status. The authors describe what is, what could be, and how to get there from here.

8 PARTICIPATION IN MANAGED CARE

Rita Munley Gallagher

153

(18)

APNs are notably absent from managed care provider panels. Is this due to their predominant employee status? Are they hesitant to mobilize consumer support on their own behalf, or reticent to take on the full responsibility of a primary care provider?

9 MALPRACTICE INSURANCE

Marie C. Infante and Sharon E. Muran

171

(29)

On the surface, APN malpractice premiums appear low. Is this a reflection of public trust and quality practice? On the contrary, review of societal expectations, practice standards, state and federal governmental regulations, and escalating litigation indicate financial and professional risks for APNs have increased substantially. APNs can meet these challenges through an ounce of prevention in the form of adoption and integration of professional practices and risk-reduction strategies.

10 RESOURCE MANAGEMENT

Christina M. Graf

200

(27)

APNs function within organizations that, whether large or small, must generate a profit in order to continue to provide services and realize their missions. Effective, quality clinical care that also incorporates efficient resource management is the most desirable outcome for the patient, for the clinician, for the organization and for society. APNs need a clear understanding of issues and approaches related to resource management in order to influence organizational deliberations and ensure that clinical considerations are incorporated into fiscal and business decisions.

11 REPORTING RELATIONSHIPS: FOLLOW THE MONEY

Mary Lou S. Etheredge

227

(18)

There is wide variation of opinion regarding the reporting arrangements preferred by APNs. In fact, there may not be any one arrangement that the majority would agree upon. Despite the differences, there are common themes that emerge. This chapter explores these themes as they are described by APNs in practice.

12 CONFLICT RESOLUTION IN PRACTICE: AN ESSENTIAL ADVANCED PRACTICE NURSE COMPETENCY

Phyllis Beck Kritek

245

(12)

In interpersonal relationships, conflict is a constant, and as an official or symbolic leader, the APN is expected to respond. This chapter explores that reality and its implications for the nurse facing the challenges of advanced practice. It also posits that expanding conflict resolution competency is an opportunity to improve our work environments, and a choice worth making.

UNIT 3 COMPETENCY N ADVANCED PRACTICE

13 EVIDENCE-BASED PRACTICE

Deborah C. Messecar and Christine A. Tanner

257

(23)

Evidence-based practice is integral to advanced practice nursing. It builds on the process of research utilization, but includes much more, such as evidence from clinical expertise, the products of reasoning, and patient preferences, to name a few.

14 ADVOCACY AND THE ADVANCED PRACTICE NURSE

Susan C. Reinhard, Janet Grossman, and Karen Piren

280

(21)

This chapter defines the concept of advocacy, describing its historical roots, while noting the limited evidence base for its credibility. Three advocacy exemplars are discussed that focus on either the individual or the larger system within which health care and advocacy exist. The process of preparing to be an advocate is described along with the need for further didactic publications and research in this area.

15 THE KALEIDOSCOPE OF COLLABORATIVE PRACTICE

Alice F. Kuehn

301

(35)

The Institute of Medicine (2001) has called for the design of a new system of health care delivery for the 21st century focused upon cooperation among professional providers as reflected by active collaboration and communication. Historic roots of collaborative experiences between physician and nurse, historic flaws in the relationship, and factors that influence collaborative behaviors are described. A framework for collaboration is presented listing critical indicators of a highly collaborative practice, and comparing and contrasting examples of multi-, inter-, and transdisciplinary practice. Following a brief overview of role development for each of the four APN roles, key strategies for developing a successful collaborative team are given.

16 CASE MANAGEMENT AND ADVANCED PRACTICE NURSING

Patricia M. Haynor, Denise Fessier, and Marylou Yam

336

(21)

APNs and case management are almost a natural phenomenon. Nursing case management is a hybrid practice that mandates a wide variety of clinical expertise and patient management skills. The advanced practice nurse with additional academic knowledge and clinical practice enhanced by experience-based intuition can make significant contributions towards the coordination of multidiciplinary care. Vignettes are presented.

17 THE ADVANCED PRACTICE NURSE AND RESEARCH

Pamela Cipriano and Suzanne Burns

357

(16)

The APN is a consumer, facilitator, collaborator, and leader in research. The APN develops a research attitude in others, and fosters evidence-based practice through the integration of research findings into clinical practice. The APN applies the scientific method to clinical problem solving, and provides leadership in the use and conduct of research. Case studies illustrate the APN's role using research methods to influence systems changes, and to improve patient outcomes through changes in clinical practice.

18 THE ADVANCED PRACTICE NURSE AND COMPLEMENTARY THERAPIES

Nancy Oliver

373

(25)

Complementary therapies are a $32 billion a year industry for the American public. Additionally, these represent one area where the APN may assist patients with integrative health care practices. The relationship between complementary therapies and holistic nursing interventions provides a valuable foundation for advanced practice roles.

19 BASIC SKILLS FOR TEACHING AND THE ADVANCED PRACTICE NURSE

Marilyn H. Oermann

398

(32)

Teaching is an essential component of the APN role. This chapter provides an overview of the basic skills of teaching: assessment of the need for learning, strategies for assessment, the development of objectives and a teaching plan, teaching methods for the APN to use in the classroom and clinical setting, and formative and summative evaluation. Additionally, the qualities of effective teachers are discussed. Examples are provided of different teaching methods and a teaching plan.

20 A CULTURAL VARIABLE IN PRACTICE

Mary Germain

430

(25)

To fully enter the patient's experience and provide comprehensive care that is respectful of the patient's beliefs and practices, you wi11 need to find ways to bridge the linguistic and cultural challenges that are inherent in caring for an increasingly diverse population. It is uncomfortable to stretch our ethnocentric boundaries; much easier to care for replicas of ourselves. However, if you are open to learning from your patients, the transient discomfort that you experience from having your timehonored interventions and teaching strategies tested and found wanting will be richly rewarded and inform your practice for years to come.

21 MEDIATED ROLES: WORKING THROUGH OTHER PEOPLE

Thomas D. Smith and Maria L. Vezina

455

(22)

In both direct care and mediated roles, APNs are often dependent on the cooperation of others to achieve their therapeutic goals. These situations may involve formal referral and consultative relationships, or working with a variety of health care personnel, including other nurses. For example, referral involves handing a case over either for management by another specialist or for co-management among providers. Consultation implies the process of influencing behavior through bringing a higher order of knowledge and experience to a situation. The degree of authority inherent in all of these relationships is an important quality to assess. Exemplars demonstrate these relationships specific to each advanced practice role.

UNIT 4 ETHICAL, LEGAL AND BUSINESS ACUMEN

22 EVALUATION OF THE ADVANCED PRACTICE NURSE: COST EFFICIENCY, ACCOMPLISHMENTS, TRENDS, AND FUTURE DEVELOPMENT

Dorothy A. Jones and Jane Flanagan

477

(18)

The cost efficiency and therapeutic effectiveness of APN's (including the clinical nurse specialist, nurse midwife, nurse anesthetist, and nurse practitioner) has been discussed in many forums. This chapter provides a comprehensive synthesis of the contributions made by the APN to improve practice and enhance evidence-based outcomes. Also included is an overview of the work environments employing the APN, and a review of salaries and potential directions for expanding practice and using nursing knowledge to effect outcomes across populations and settings.

23 MEASURING ADVANCED PRACTICE NURSE PERFORMANCE: OUTCOME INDICATORS, MODELS OF EVALUATION, AND THE ISSUE OF VALUE

Shirley Girouard

495

(39)

APN's can no longer assume that it is adequate to be accountable to their patients alone. Consumers, purchasers of care, employers, and policy makers are demanding evidence that APN practice makes a difference in outcomes and is cost effective. This chapter will address reasons for and approaches to measuring performance and establishing the value of advanced practice nursing.

24 THE ADVANCED PRACTICE NURSE AS EMPLOYEE OR INDEPENDENT CONTRACTOR: IT MAKES A DIFFERENCE

Kammie Monarch

534

(19)

Employee status confers very definite legal rights and responsibilities. The choice whether to be an employee versus an independent contractor should be informed by knowledge of the differences. The author explores these differences as well as the details of executing written practice agreements governing the working relationship between the APN and other parties. This is a relatively new aspect of practice and it is important for the APN to understand the basic, foundational issues that need to be addressed in these written agreements. The author has identified a number of those issues, and also addresses the relevant case law.

25 PROMOTING ADVANCED PRACTICE NURSES TO THE PUBLIC

Donna A. Gaffney

553

(24)

How do we sell the APN to the public? Most of our market has been the poor and disenfranchised. For success and security, APNs need to sell their services to the critical mass that is Middle America.

26 STARTING A PRACTICE AND PRACTICE MANAGEMENT

Judith Pollachek

577

(35)

Independent practice allows the APN to maximize patient care, spend time on needed patient education, and encourage patient participation in determining their own health care regimen. But an entrepreneurial spirit, a fine-tuned knowledge base and clinical skill, and the desire to provide quality health care aren't enough. Learn how to negotiate the winding road of rules and regulations, strategize for its pitfalls and detours, and ultimately know the rewards of delivering health care your way.

27 THE LAW, THE COURTS, AND THE ADVANCED PRACTICE NURSE

Virginia Trotter Betts, David Keepnews, and Kammie Monarch

612

(27)

A summary of the legal principles shaping and affecting advanced practice nursing. The authors present a discussion of selected legal issues and court cases involving APNs.

28 ETHICS AND THE ADVANCED PRACTICE NURSE

Gladys L. Husted and James H. Husted

639

(26)

The authors will consider the ethical decision-making competencies of the APN, and the barriers that exist to ethical practice. This will be accomplished through a context-based model that concentrates on the professional agreement that exists between nurse and patient. A context-based model actualizes the concept of treating persons as individuals and therefore selecting interactions based on that unique patient's needs and circumstances. Each patient entering the health care system hopes to derive some benefit. He hopes to regain his competence to perform his normal functions and to live his life as he chooses. At the very least, he expects to come out better able to live than when he went into that health care system. Emphasis will be given to the rights of nurse and patient deriving from their implicit commitments and expectations. Case examples will be used in the presentation.

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Advanced Practice Nursing: Essentials for Role Development

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