Advanced Practice Nurses: Family Nurse Practitioner

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14.04.2022
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Advanced nurse practitioners (APNs) play a critical role in the provision of high-quality healthcare services due to their irrevocably high competencies attributed to the acquisition of advanced education and practicing experience. According to Campo et al. (2016), nurse practitioners demonstrate high competency levels in their workplaces by serving communities and individuals. As such, they have attracted much attention from most the healthcare stakeholders, especially after the appearance of the Affordable Care Act, which called for a significant increase in the number of clinicians to provide high-quality care for millions of Americans expected to become eligible for different forms of health insurance (Barnes, 2015). Currently, the United States (US) experiences a severe shortage of physicians; as a result, APNs are viewed as the solution to this shortage since they can fill the void by providing services similar to those of their physician colleagues (Barnes, 2015). Therefore, it is of critical significance to gain a deep understanding of these clinicians, including their professional role, actual and potential barriers to practice, and appropriate ways of overcoming them to foster the delivery of quality care.

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Advanced Practice Roles in Nursing

Similarities

Although advanced nurse practitioners have varied roles depending on their settings and the subsequent responsibilities, they share a variety of similarities. For instance, all APNs have a minimum education requirement of a master’s degree in the area of specialization; the acquisition of this requirement is mandatory before receiving a practicing license (Parker & Hill, 2017). Additionally, they have similar leadership competencies to aid in the communication of practical knowledge, address different educational and care needs of their clients, boost healthcare system changes, and promote innovation, among other reasons (World Health Organization [WHO], 2016). Notably, Jogerst et al. (2015) explain that nurses have information, policy, and technological literacy skills to aid in the discharge of nursing services. Furthermore, all these professionals have adequate nursing research skills in their area of specialization, which are utilized for generating new solutions to existing problems and accumulating knowledge. Therefore, the nurse practitioners have many similarities, ranging from their minimum education requirements to the competencies and skills required to effectively execute their professional responsibilities.

Differences

APNs differ from each other depending on the specialty and area of practice, as well as on the scope of practice, among others reasons. Nurse educators are supposed to provide their services in institutions of nursing education and clinical areas where teaching is required. As such, the help in developing a healthy environment for communities not only in the US but also in other parts of the planet by preparing new nurses to join the healthcare industry after meeting the professional training requirements (WHO, 2016). In their line of duty, nurse educators design, implement, monitor, and evaluate educational programs and the entire nursing curriculum to train students who assume different nursing roles as practitioners, administrators or managers, educators, and informaticists, among others. According to WHO (2016), their functions are different from those of nurse practitioners, who provide primary care services to communities, families, and individuals requiring care. As such, they interact and collaborate with their patients and other clinicians, such as nutritionists and physicians, in order to enhance the delivery of quality services. Some of the services provided by nurse practitioners include not only the examination and assessment of patient needs, but also the treatment of acute and chronic illnesses (Iglehart, 2013). Essentially, they are the primary providers of care to the patients after assessing and diagnosing their health problems before sufficing the identified needs.

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Conversely, nurse administrators differ from their practitioner colleagues since they do not provide direct primary care; fundamentally, their role is to manage both human and physical resources in institutions of care and training. Stanley (2011) states that in addition to the delegation of authority to their subordinates in their area of practice, these administrators plan, coordinate, monitor, evaluate, and supervise the delivery of high-quality care to have a positive impact on the patients’ health outcomes. Tanioka, Kataoka, Yasuhara, Miyagawa, and Ueta (2011) reiterate that nurse managers and administrators evaluate nurses’ clinical competencies before assigning duties and responsibilities. Apart from that, they work in multidisciplinary teams that comprise the physicians and other clinicians to foster the provision of high-quality care (Tanioka et al., 2011). Contrarily, nurse informaticists are professionals who utilize different forms of technology to facilitate the delivery of care services by not only storing and retrieving patient information, but also by utilizing it (Stanley, 2011). These informaticists work together with their colleagues, such as nurse practitioners and other clinicians in primary care settings, in order to process patient data with the aim of enhancing both quality and safety care. Therefore, nurse practitioners provide direct primary care to their patients and communities compared to administrators who manage physical and human resources to facilitate the provision of care; contrarily, educators are concerned with the training of nurses while informaticists’ role is to use technology to affect the quality of care.

Significance of Comparing and Contrasting APN Specialty Roles

Since nurses play an essential role in the healthcare system, it is essential to understand their roles and the way different specialties resemble or differ from each other. Additionally many nurses and students look forward to advancing their careers in this profession by acquiring specialty education and putting it into use in relevant areas of practice. For instance, the Institute of Medicine found that despite more nurses seeking to advance their education, it is of great significance to increase the number of nurses with both masters and doctoral degrees by 2020 and beyond (Parker & Hill, 2017). These nurses need to understand the similarities and differences among the nursing specialties before becoming advanced practice nurses. Moreover, health professionals and the general public need to know much about APNs due to the political and media amplification of high practicing standards (Restrepo, 2012). One of the ways of creating awareness is through the detailed clarification of the profession and its members, including the specialties that distinguish one cadre of these practitioners from others.

Family Nurse Practitioner Role

Regulatory and Legal Requirements in Florida

All American states have an immense control over the health functions, including the formulation of legal regulations that govern the nursing profession. The Florida Nurse Practice Act has provisions that regulate the duties of family nurse practitioners as well as of other nurse cadres. The policy compels all nurses to discharge their mandates by handling medical problems through the assessment of patients and diagnosis of health conditions before treating them by using different treatment modalities, monitoring patients who suffer from both acute and chronic diseases, and providing health promotion and disease prevention services among others (Florida Board of Nursing, 2007). Legally, these practitioners have the mandate to manage acute and chronic illnesses, conduct various functions that lead to disease diagnosis, physical examinations, and other diagnostic tests (Florida Board of Nursing, 2007). Principally, family nurse practitioners have the legal mandate to provide primary care services to communities, families, and individuals.

Additionally, these nursing professionals carry various responsibilities, including undertaking child, prenatal, and adult check-ups, diagnosing and managing minor traumas, and facilitating the awareness of disease prevention and health promotion activities in patients and their families. The practitioners do not only treat and diagnose conditions, but they also prescribe medications in line with the provision of the legal requirements of the Florida Nurse Practice Act (Florida Board of Nursing, 2007). Unfortunately, this law denies APNs the full authority to practice to the full extent of both their knowledge and experience due to legal limitations put to their scope of practice. The Florida Board of Nursing (2007) asserts that APNs in the state are obliged only to perform some duties stipulated by law under the supervision of physicians. To make it worse, these nurses are not entitled to prescribing controlled substances despite operating under the physicians’ watch. Primarily, just like other Floridian APNs, family nurse practitioners are legally obliged to carry their responsibilities by providing quality care in and out of primary care settings; however, the law infringes on their autonomy to fully practice in line with their knowledge and experience.

Moreover, both the Nurse Practice Act and the Board of Nursing in this state provide the legal regulations that guide both the roles and responsibilities of family nurse practitioners. Chapter 64F-6.004 of the law provides the qualifications as well as the delegation of functions and responsibilities of these specialty nurses — apart from that, the legislation obliges them to work in multidisciplinary teams (Florida Board of Nursing, 2007). The Nurse Practice Act provides a range of guidelines that support these nurses in handling situations and events that warrant ethical dilemmas (Florida Board of Nursing, 2007). Primarily, the functions and responsibilities of nurse practitioners in the state of Florida are guided by the Nurse Practice Act and the scope of practice — unfortunately, family nurse practitioners lack the full authority to practice independently.

Available Professional Organizations

Family nurse practitioners and other advanced practice nurses have professional organizations that they can choose to be members of in order to meet their career goals. For instance, the Florida Nurses Association is the most appropriate one for these nurses as it caters to all nurses in the state without considering their specialties. Additionally, the organization provides access to its nurse members to utilize recent studies, as well as other scholarly material, with the intention of having a positive impact on their practice (Florida Nursing Association, 2017). Information from these sources has a positive impact on the entire profession since it facilitates the provision of high-quality nursing services. The Floridian association is an earnest advocate for the welfare of these practitioners in addition to helping them access a variety of job opportunities not only in the state, but also in the country and beyond. The organization asserts that its members are entitled to the protection of their welfare needs; besides, by offering research and other benefits to nurses, information from scholarly sources is aimed at benefiting the community as well (Florida Nursing Association, 2017). Moreover, the Floridian association is endowed with the primary responsibility to protect and support both the rights and needs of its nurse members, helping them acquire the most appropriate knowledge that can bolster their primary care practices. Additionally, it positively transforms the lives of Floridians.

Furthermore, the Florida Association of Nurse Executives is another important organization for family nurse practitioners in the state, among many others. The association permits nurse members to develop their skills of leadership through the creation of mentorship opportunities, which can benefit nurse practitioners to a great extent. As such, the Floridian nursing organization promotes leadership excellence in their members to facilitate the delivery of high-quality care and transform education and policy requirements that affect the entire profession (Florida Association of Nurse Executives, 2017). Just like many other organizations, this professional association advances research and the subsequent evidence-based practice. Apart from the American Nurses Association, these clinicians have a huge opportunity to join the respectable American Association of Nurse Practitioners, which gives room to all nurse practitioners in the country. These two provide an avenue for accessing scholarly materials to their members, increase opportunities for networking, and most importantly, advocate for their welfare needs. Therefore, Floridian family nurse practitioners have the chance of joining state professional organizations as well as those from the national level.

Competencies and Certifications

As advanced practice nurses, family nurse practitioners have competencies and certification that may or may not apply to other specialties in the profession. Jogerst et al. (2015) explain that these practitioners should not only develop, but also sustain competencies to fulfill the health needs of their patients and communities. Principally, these nurses have acquired different academic certifications from the bachelor’s degree in nursing, which enables them to work as registered nurses, to master’s degree and above, to facilitate their specialization requirements. Through experience and advanced education, they demonstrate competency in respecting the beliefs and values of their patients; moreover, they actively participate in critical communication and decision-making processes that affect the process of providing care (Jogerst et al., 2015). Given that these nurses work in multidisciplinary teams in addition to utilizing technology to execute their professional responsibilities, they also have high competency levels.

Additional competencies for these nurses are also required. According to WHO (2016), clinicians should independently integrate fundamental competencies with educational requirements of the profession; they include practice inquiry, technology, leadership, quality, and scientific foundation, among others. Apart from the competencies in health delivery and ethics, family nurse practitioners should be competent in order to autonomously practice and make decisions that minimize health risks and improve treatment outcomes. Additionally, they should apply ethical principles in their work (WHO, 2016). On the other hand, apart from the academic certifications, family nurse practitioners receive licenses for their practice after completing a master’s degree education in the relevant field, and in this case, they obtain licensure from the state of Florida. Basically, these professionals have advanced educational levels with appropriate certifications to demonstrate their competencies.

Organization and Setting, Population, and Colleagues

The primary goal of any nurse professional is to gain skills that will help in acquiring the most appropriate job in a specific environment. In this case, I intend to work in a college-based healthcare organization by offering medical services to both students and other members of the institution such as teachers, subordinate staffs, and so forth. My services will enhance the health outcomes of teachers, students, their parents, college staff, and the entire community affiliated with the school; as such, challenges such as absenteeism will significantly reduce. Additionally, I will strictly work with all college stakeholders, including parents, students, instructors, and subordinate staff. Also, working with social workers, school counselors, other primary care nurses, laboratory and radiology staff, and pharmacists among other professionals will be the norm. Therefore, I will deliver diverse, patient-centered care in multidisciplinary teams.

Importance of Preparing for a Post-Graduate APN Role Opportunity

Preparing for the family nurse practitioner’s role is essential since it involves some challenges that should be premeditated. Morgan, Barry, and Barnes (2012) explain that since transitioning to the APN role is coupled with immense challenges, adequate planning is essential since a registered nurse will repeat the novice-to-expert process. This process is associated with insecurities and self-doubt that most of the family nurse practitioners and other APNs experience. As such, without sufficient planning, feelings of inadequacy and frustrations are likely to overwhelm the transitioning nurses (Morgan et al., 2012). Therefore, planning should be a mandatory requirement for nurses who wish to specialize in family nursing.

Leadership Attributes of the Advanced Practice Role

Democratic leadership is my style of choice due to the features I would be able to demonstrate to different groups when assuming a leadership role. Amanchukwu, Stanley, and Ololube (2015) assert that in most cases, this style of leadership entails the seeking and acquisition of input from team members to affect the decision-making process. This leadership style fosters creativity, commitment, and high levels of job satisfaction due to the involvement of employees in the process of decision-making. Aligning with my beliefs and professional requirements, this type of leadership is appropriate since it makes care provision a responsibility of teams with no profession or individual gaining monopoly over others.

Leadership Attributes

Among the leadership attributes to aid in the discharge of family nurse practitioner role there are effective communication, social awareness, and self-awareness. The attribute of social awareness has assisted in the acknowledgment of what others encounter by understanding their emotions. Being cognizant of their expressed feelings, I usually listen to my followers before addressing their needs and concerns. Also, the attribute of communication entails using personal skills in listening to followers before launching appropriate responses, resulting in healthy relationships between leaders and their followers (Amanchukwu et al., 2015). As such, high-quality care becomes a feasible aspect. Attributes that require immediate development are conflict and time management. In a democracy, the constant sharing of information and opinions can result in severe disagreements, which should be solved amicably; however, the lack of effective conflict management skills can deteriorate employee relationships, hence the required high-quality care. Also, democracy requires enormous amounts of time for allowing all parties to participate in decision-making processes. As such, learning how to manage time, as well as reduce time wastage, is a key to successful leadership. Basically, I plan to assess time management skills by comparing the time taken to make decisions compared to the previous occurrences, as well as by examining the progress of resolution of conflicts with time.

Health Policy and APN Role

Potential Policy Change: Florida Nurse Practice Act

Full practicing authority provided by the nurses’ laws is one of the major policies affecting nurses in the state of Florida and other states across the US. Vleet and Paradise (2015) explain that a minimum of 127,000 nurse practitioners in Florida offer primary care services, with more numbers expected in the future. Unfortunately, their scope of practice is restricted by the state policy, which limits the autonomy to practice in accordance with their education and experience (Altman, Butler, & Shern, 2016). As such, family nurse practitioners are supposed to discharge some of their responsibilities under the watch of physicians. Consequently, these practitioners are struggling to fulfill their duties due to the presence of this policy barrier, which can only be solved by amending the Florida Nurse Practice Act to give them the full authority to practice with doctors’ supervision. Already, 20American states have given these nurses the authority to practice with any restriction (Vleet & Paradise, 2015). As such, Florida has to follow their example by adhering to the recommendations of the Institution of Medicine, which advocates for full practicing authority in nurse practitioners (Altman et al., 2016). Therefore, Florida is obliged to eliminate this practice barrier by amending the Florida Nurse Practice Act.

Process and Effort to Influence Policy Changes

The process of making policy changes starts from demonstrating the need for the required amendments, especially the need for granting nurse practitioners the right to practice independently and in accordance with their education and experience. The evidence should be gathered and demonstrated by all stakeholders in the health sector, including nurses, administrators, and other organizations, such as the Institute of Medicine. Already, these stakeholders have gathered adequate evidence by comparing what other states have done, the importance of giving the nurses the autonomy to practice, and most importantly, the benefits associated with policy amendments. From this stage, legislators should be persuaded to see the need for change before amendments can be achieved. As an individual, my role in influencing this change entails researching and displaying evidence of why the Florida Nurse Practice Act should be reconsidered to allow nurse practitioners to practice without policy barriers. Fundamentally, the evidence will entail how these clinicians can reduce care costs and improve community health outcomes, which are crucial for the state.

Potential Impact of Policy Change on the Quality of Care

Most of the benefits coupled with the amendment of the Florida Nurse Practice Act are attributed to better health outcomes as a result of the input of family nurse practitioners to high-quality care delivery. Iglehart (2013) explains that giving full authority to nurses equates to giving them an opportunity to deliver limitless high-quality care aimed to improve health outcomes for patients and communities that they serve. Apart from using structured protocols, nurse practitioners are known for utilizing both pharmacological and non-pharmacological modalities to administer care, giving them an advantage over their colleagues, including the physicians (Mart?nez-Gonz?lez, Tandjung, Djalali, & Rosemann, 2015). Therefore, making changes to this policy by giving these nurses the autonomy to practice will improve the quality and safety of care and the subsequent health outcomes among Floridian communities.

Conclusion

The profession of nursing comprises members with specialty education who constitute the group of APNs, such as administrators, informaticists, practitioners, and educators. Despite having a sizeable number of similarities, such as a master’s degree education to qualify as APNs, these professional cadres are dissimilar in many aspects due to their areas of specialization and the type of services they offer to affect the delivery of primary care. Serving in college-based health facilities and armed with adequate democratic leadership skills, attributes, and competencies, these practitioners deliver high-quality care. Unfortunately, nurse practitioners in Florida are restricted by the law, which denies them practicing autonomy. By amending this policy, they can regain the opportunity to practice to the full extent of their experience and education. Since Floridians will benefit from the legislative amendments, the change process should be initiated before the legislation of the law happens.

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