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Advanced Practice Registered Nursing (APRN)

A Lecture Presentation for Theoretical Foundations of Nursing, a post-graduate course at St. Paul University Iloilo

Aaron Bjorn Godfrey Ong

on 6 October 2012

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Transcript of Advanced Practice Registered Nursing (APRN)

Advance Practice Registered Nursing (APRN) The Frontier of Nursing Practice What is APRN? Nursing Specialty Roles Practice Credentials Approval to Practice Licensure Certification Certified Nurse Practitioner (NP) The Master of the Nursing Process Certified Nurse Midwife (CNM) The Pillar of Maternal and Child Health Nursing Certified Clinical Nurse Specialist (CNS) The Clinical Consultant of the Health Care Team Certified Registered Nurse Anesthetist (CRNA) The Goldmine of Advanced Practice Registered Nursing "Registered Nurses with Master or Doctor's Degree with specialization in an area of advanced Nursing; they have had 'supervised practice during the graduate education, and have had ongoing clinical experiences'." (ANA, 1996) Expansion Commitment for ongoing learning and acquisition of new knowledge, skills and competencies (ANA, 1996). Specialization Concentration of one of the four APRN specialty areas: CRNA, CNM, CNS, NP (ANA, 1996). American Nurses Association (ANA) Both specialization and expansion which results in a new integration of theory, skills and competencies to respond to the needs of patients, families, and an evolving health care system (ANA, 1996). Advancement CRNA provides anesthesia and anesthesia-related care, including performance of the Following; pre-anesthetic preparation and evaluation, and anesthesia induction, maintenance, and emergence including administration of appropriate drugs and techniques and local, regional, and general anesthesia. In addition, the role of CRNA includes establishment of invasive monitoring, post-anesthesia care, accurate and chronic pain management, and associated clinical support function such as respiratory care and emergency resuscitation (American Association of Nurse Anesthetists, 1996). Definition A Lecture Presentation
Theoretical Foundations of Nursing
(N 201)

Submitted to:
Associate Dean, College of Nursing

Prepared by:
AARON BJORN GODFREY S. ONG, B.S.N., R.N. St. Paul University Iloilo
Graduate School - Nursing Program
Master of Arts in Nursing Pre-requisites A minimum GPA as an undergraduate.
An satisfactory score at GRE.
Completion of course work related to the specialty role.
License to practice nursing.
At least one (1) year experience on a clinical area. CNM is a clinical nurse expert who has the advanced knowledge, skills, competencies, and clinical reasoning for the management of care for women and newborns. The focus of practice is providing ante-partum, intra-partum, and post-partum care; neonatal care, family planning, well-women gynecologic (American College of Nurse-Midwives, 1993). Definition The CNS has a unique APRN role to integrate care across the continuum and through three spheres of influence: patient, nurse, and system. The three spheres are interrelated but are each distinct and the key of CNS practice is the creation of an environment through mentoring and system changes that empower nurses to develop caring, evidence-based practices to alleviate client distress, facilitate ethical decision-making, and respond to diversity. The main goal is continuous improvement of patient outcomes and nursing care (Advanced Practice Registered Nursing Model of regulation 2008). Definition CNP is an expert nurse clinician who conducts comprehensive health assessments, makes a diagnosis, prescribes pharmacologic and non-pharmacologic interventions, and evaluates outcomes of direct management of individual patients with acute and chronic illness and disease in a variety of settings, through working independently or collaboratively (Hickey, 2000). Definition Direct Clinical Practice
Expert Coaching
Clinical and Professional Leadership
Ethical Decision-Making Core Competencies (Sparacino, 2005) Privileging Signifies qualifications, responsibilities, and rules to the public concerned which is essential for understanding in order that informed decisions and choices can be made (Hickey, 2000).

Approval to practice
Privileging Definition PURPOSE: protection of public health, safety and welfare.

It is mandated by the following: regulatory criteria- entry level minimum requirements

legal regulation- joint responsibility of state legislators and the Board of Nursing

institutional approval/ 'privileging' - individual facility National Council of States Board of Nursing (NCSBN)
-"Position Paper and Model Legislation in the Licensure of Advanced Practice"
- called for a SECOND licensure examination for APRN's PURPOSE: protect the public by ensuring a minimum level of professional competence

Government grants permission to individuals accountable of the profession and prohibits others from legally doing so (Committee for the Study of Credentialing Nursing, 1979). PURPOSE: determined and set by the specialty with the profession

Non-governmental agency or association grants recognition to individual who has met certain predetermined qualifications specified by the agency or association. BENEFITS (Hickey, 2000):
Entry into practice
Validation of competence
Recognition of excellence
For regulation QUALIFICATIONS (CSCN, 1979):
Graduation from accredited program
Acceptable performance on qualifying examination
Completion of a given amount of work experience American Nurses Credentialing Center (ANCC) -reflect practice in a particular nursing specialty recognized by the American Nurses Association (ANA) Congress of Nursing Practice, which defines specialties in established criteria. PURPOSE: verify a practitioner's preparation and competence to perform medical activities in hospitals and other medical

Used by facilities or employing organization to monitor the clinical activities a provider is authorized to perform within the facility.

Commensurate to the credentials of the professional (Rustia and Barteck, 1997) Established a mechanism to monitor privileges along with charging the hospital to establish a criteria for clinical privileging and the process to ensure that competent individuals are providing patient care (Quigley, Hixon and Janzen, 1991). Joint Commission for Accreditation of Hospitals and Organizations (JCAHO) Review credentials of provider, to determine criteria for granting certain privilege and to evaluate continued competence of provider overtime (Hickey, 2000). Peer Review Board Evidence of graduation
Evidence of advanced education/ degree of specialty
Specialized training/ experience not evident in education preparation
Specialty Certification and history
Licensure information
Drug Enforcement Administration (DEA) license number
Evidence of continuing education
Professional organizations
Professional liability insurance data
Any liability history, judgments, settlements, disciplinary actions
Others: physical, mental health, or chemical dependence problems Proposed Components of the Nurse Credentialing File (Hickey, 2000) Books:

American Association of Nurse Anesthetists. (1996). Professional practice manual for the certified registered nurse anesthetist. Park Ridge, Illinois: Author

American College of Nurse-Midwives. (1993). Standards for the practice of nurse-midwifery. Washington, D.C.: Author

American Nurses Association. (1996). Scope and standards of advanced practice registered nursing. Washington, D.C.: Author

Benner, P. (1984). From novice to expert. Mendo Park, CA: Addison-Werley. pp. 292-233

Hickey, J.V. et. al. (2000). Advance practice nursing: changing roles and clinical applications (2nd Ed.). Philadelphia, PA: Lippincott, Williams and Wilkins

Sparacino, P. S. A. (2005). The clinical nurse specialist. In A. B. Hamric, J. A. Spross & C. M. Hanson (Eds.), Advanced practice nursing: An integrative approach (3rd ed., pp. 415–446). St. Louis: Elsevier


“Best Practice”. (1998). AACN News 15, 7:5

Byers, J.F. and Brussels, M.L. (1998). Demonstrating the value of the advanced practice nurse: an evaluation model. AACN Clinical Issues 9(2), 296-305

Committee for Study of Credentialing in Nursing. (1979). The committee report, Vol I of the credentialing in nursing. Kansas City, MO: American Nurses Association

Cook, D.J. and Levy, M.M. (1998). Evidence-based medicine. Critical Care Clinic 14(3), 353-358

Quigley, P.H. et. al. (1991). Promoting autonomy and professional practice: A program of clinical privileging. Journal of Nursing Quality Assurance 5(3), 27-32

Rarch, R. and Frauman, A. (1996). Advanced practice nursing: Conceptual issues. Journal of Professional Nursing 12(3). 140-146

Rustia, J.G. and Bartech, J.K. (1997). Managed care credentialing of advanced practice nurses. The Nurse Practitioner 22(9), 90-103

Styler, M.M. (1991). Bridging the gap between competency and excellence. ANNA Journal 18(4), 353-360

Internet Sources:

http://www.slideshare.net/saspencer/evolution-of-apn-1812411 Retrieved 07 September 2012, 6:00 pm

http://dynamicnursingeducation.com/class.php?class_id=86&pid=18 Retrieved 07 September 2012, 6:00 pm

APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee (7 July 2008). "Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education". APRN Joint Dialogue Group Report. Retrieved 07 September 2012, 6:00 pm References “The world is put back by the death of every one who has to sacrifice the development of his or her peculiar gifts to conventionality.” -Florence Nightingale Thank You For Listening!!!
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