The development of advanced nursing practice is a complex and influential process in health care. It depends on the already offered innovations in the profession, as well as serves as the possibility for new achievements and conclusions being made in the field (Barton, Bevan, & Mooney, 2012). To understand the nature of changes in advanced nursing, it is important to recognize and compare the roles of different people in clinical practice, primary care, education, administration, and research.
Advanced Practice Roles in Nursing
Nursing is a profession in a health care sector that includes the necessity to take care of patients and their families, to communicate with clinicians and different medical workers, and to support the quality of life by providing appropriate services. There are concepts, theories, and strategies in this field, and their understanding is an integral step that has to be taken by any nurse. For example, many students confuse the terms “advanced nursing practice” (ANP) and “advanced practice nursing” (APN). It is wrong to think that these terms can be interchangeable because each of them has its own unique meaning. APN is a concept that may be applied to nurses whose roles may vary regarding the type of care or service they have to perform. Different APN roles may be offered to nurses with their abilities to expand their skills and follow certain regulation.
ANP is a process of integration and application of a range of theoretical knowledge as a part of nursing education, and ANP is a form of a nursing intervention that may influence the outcomes of health care offered to patients (Hamric, Hanson, Tracy, & O’Grady, 2013). ANP is where nurses have to develop their skills, abilities, and behaviors and incorporate their needs in leadership, education, and research. APN is where nurses choose their roles in regards to their skills and knowledge. In advanced nursing practice, there are many roles that have to be properly recognized and understood. In this paper, the roles of a nurse practitioner (clinical practice and primary care), a nurse educator (education), a nurse informaticist (health information), and a nurse administrator (administration) will be compared and contrasted.
A nurse practitioner (NP) is one of the most common types of APN roles, the importance of which may be compared to a clinical nurse specialist (CNS) (Bryant‐Lukosius et al., 2016). NPs are registered nurses with master’s degrees and special training in a certain area of nursing, including such fields as pediatrics, women’s health, or family practice. This role presupposes the possibility to deliver health care services and treatment to patients under a supervision of a physician or other doctors.
NPs have to be ready to work under different conditions, make fast decisions, and solve organizational or personal problems. In addition, these employees have to provide patients with a compassionate attitude and the ability to communicate with their doctors. The peculiar feature of this role is its possible growth and expansion. As soon as nurse practitioners get their MSN, they may diagnose or even treat patients with different infections and injuries, write prescriptions, and talk with patients about their progress or problems regarding available medical records and history (Barnes, 2015). Sometimes, NPs choose their tasks regarding their personal needs and interests or follow the guidelines given by other clinicians.
A nurse educator plays an important role in nursing because this profession combines clinical practice and education. This profession makes it possible to strengthen nursing practice and the workforce of any hospital (Hamric et al., 2013). The field of leadership in nursing undergoes considerable changes in case nurse educators are involved in it because they provide interesting and helpful models for evidence-based practice.
The roles of educators in nursing vary considerably, including the evaluation and implementation of special education programs and training courses for nurses and motivation of all nursing staff. As registered nurses, educators have to be ready to teach nurse learners and evaluate the worth of a learning process and document all processes and their outcomes. It is not enough for nurse educators to participate in certain learning activities. They have to engage other nurses in scholarly work and conferences.
The role of a nurse informaticist cannot be neglected in nursing practice as well due to a number of reasons. First, the field of nursing informatics continues developing and integrating nursing. Nurses have to store and exchange huge amounts of information and share their knowledge quickly. The goal nurse informaticists have to achieve is the empowerment of all caregivers in improving patient-centered care. A nurse informaticist is responsible for the development of communication and information technologies among practitioners, educators, researchers, and other medical workers.
Communication is an important part of the work of any nurse. If it is not properly developed and supported, the results of care and treatment may undergo some changes, and negative results may be observed. Informaticists should make sure that every piece of information is clearly introduced and understood by caregivers.
Finally, in advanced nursing practice, the role of a nurse administrator must be recognized and understood. This position is of a managerial type that includes a number of leadership duties and responsibilities (Hamric et al., 2013). As a rule, a nurse administrator should have a Master of Science degree in nursing in order to know how to administrate nurses and other medical staff in a hospital. In comparison to other types of nurses, administrators should not cooperate with patients frequently. Their main task is to guide nurses and report on their activities. In addition, nurse administrators have to ensure patients’ welfare through communicating and controlling all nursing activities and supervising different nurses.
Personal Philosophy in Nursing Practice
Taking into consideration the existing variety of roles in advanced nursing practice, every nurse has to make a final decision about a nursing philosophy that has to be followed, the goals that have to be achieved, and the expectations that should be developed. I believe in the power of a lifelong learning process. Nursing is the field that may be changed and improved regularly. It is impossible for a nurse to know everything. Therefore, I accept the philosophy in terms of which nurses have to improve their knowledge and be able to educate and support other people involved in care. It means that nurses have to be active learners, as well as support patients, their families, and other nurses in their intentions to know more. Education may have different forms, and nurses should benefit with its variety. The main peculiarity of this philosophy is that not only nurse educators have to be involved in a learning process. Nurse practitioners, informaticists, and administrators should enlarge their level of knowledge.
Selected Advanced Practice Role
In the United States, every nurse has to be aware of local regulatory and legal requirements for nurses. Due to the fact that rules and jurisdictions may change with time, it is important to investigate the chosen field and review if some significant changes take place. If a nurse violates a working nurse practice act, the board has to investigate a case and make a decision.
Regulatory and Legal Requirements
In Florida, nursing is a respected profession that is usually governed by state acts supported by the Florida Board of Nursing. There are two important regulations that have to be followed: the Florida Statutes (Chapters 456 and 464) and the Florida Administrative Code (Chapter 64B-9) (Robertson, 2017). The content of these regulations protects patients against the unsafe nursing practice and promotes the necessity for all nurses to have appropriate licenses and certificates.
My goal is to become a nurse administrator and be involved in numerous managerial activities through a whole hospital. During the last years, many health organizations focus on searching qualified people who are able to take a position of a nurse administrator and meet all necessary requirements. As a rule, it is often required for a nurse to have a Bachelor’s degree in nursing and usually required or recommended to have a Master’s degree. In addition, it is appreciated but not required to have a certification related to administrative activities. According to the Nurse Practice Act, any nurse has to understand the laws and rules that have to be followed at work, including professional assessment, administration of medications, supervision of other personnel, and making important for patient care decisions.
In Florida, there are many professional organizations that can be chosen by nurse practitioners and other registered nurses. The role of these organizations is to guide a nurse, offer a required portion of the professional support, and describe the opportunities available to nurses. For example, in Florida, there is a local Polk County Advanced Practice Nurses Association where registered nurses can find useful information about recent regulations and laws. There is also the Florida Association of Nurse Practitioners where nurses share their experience and knowledge to promote the development of their profession. There are also several state organizations (e.g., The American Association of Nurse Practitioners) which aim at helping and supporting American nurses regardless of their location.
Competencies for Nurse Administrators
The chosen profession of a nurse administrator requires the development of a number of personal skills. It is not enough for an administrator to be good at leading, managing, or nursing only. It is important to combine all these fields and introduce a solid portion of work regularly. A good nurse administrator has to be competent in written and oral communication with the medical staff, patients, and families and stay attentive to all details in a hospital. Rational judgment skills and critical thinking are required for a nurse administrator to succeed in different managerial activities, meetings, and strategies. I expect to earn such certifications as NE-BC (Nurse Executive – Board Certification) and CNML (Certified Nurse Management and Leader).
The choice of a hospital as a regular place of work is important for every nurse. If I am able to choose, I would like to work at a local general hospital where education and training programs are available to all medical workers. I believe that nurses who understand the importance of education always have enough space for personal and professional growth. As a nurse administrator, I can supervise nurses and support patients in their communication with nurses and doctors. It is normal to cooperate with about 100 regular employees, and the number of patients cannot be predicted. Therefore, I have to be ready for different conditions and expectations.
Leadership Attributes of the Advanced Practice Role
The test developed by Cherry and Gans (2016) shows that I have all chances and skills to succeed as a democratic leader. This style of leadership is also known as participative where leaders support their teams and involve all group members in decision-making processes, evaluations, and organizational development. The core aspect of this leadership style is the possibility to motivate and support employees and introduce effective decisions and solutions (Cherry & Gans, 2016). I believe that this style depicts my true nature and abilities. I realize that one person can hardly be an expert in all spheres. Nursing is a unique combination of different skills and knowledge. It is a real challenge to be a good nurse leader. However, in case a nurse administrator is able to cooperate with other medical workers, listen to different people, and promote group discussions and decisions, such leader has enough chances to be one of the best workers in an organization.
One of the main tasks democratic leaders have to complete is to understand where the line between leadership and cooperation is. It is wrong to put all responsibility on team members. At the same time, it is wrong for a democratic leader to make all decisions independently. Therefore, it is necessary to stay adequate and respect all team members, as well as guide people and identify their possible mistakes or wrong decisions. I am not confident if I am ready to identify this line and not to make a mistake. Therefore, I have to develop my critical thinking and judgment skills in order to understand how a good nurse administrator has to work in a team and not to lose a leading position. The examples of other nurse administrators, communication with working leaders, and the biographies of famous democratic leaders such as Donald Trump or Jack Stahl can be used as the tools to learn more about democratic leadership and the relationships that have to be developed.
Health Policy and the Advanced Practice Role
Value-based care is based on an idea that patients have a right to high-quality care and certain improvements in their treatment. The core aspect of such type of care is to identify and promote changes in order to improve the offered care and meet all patients’ needs and expectations. One of the representatives of the Robert Wood Johnson Foundation, Ganos (2016), says about the importance of doctor-patient cooperation and conversations with the help of which it is possible to develop better treatment plans and care. Some health care organizations are afraid of organizational improvements because they expect serious prices being established. The chosen foundation is in the list of the organizations that are ready to cover some financial aspects of health care and support cost-of-care conversations with approximately $1.9 million in funding (Ganos, 2016). Such organizational change is a responsibility of a nurse administrator or an executive because it touches upon the relationships people have to develop in a hospital.
Value-Based Care Policy
Value-based care is a complex issue, and it is necessary for all registered nurses to standardize health care processes, obtain all necessary information, identify available resources, and determine which activities and decisions can and cannot work. Nurses have to understand that wellness and prevention is also a part of value-based care that should be offered to patients. It is not enough to control all managerial activities. There are many financial issues that have to be discussed in terms of value-based purchasing programs (Hamric et al., 2013). The policy of value-based care consists of several important elements, including the empowerment of patients to make their own independent decisions and participate in hospital performance and improvement of clinician access to claims and quality care (Monica, 2017). This policy helps to recognize what people may want from health care organizations and what health care organizations may offer in return.
In many facilities, hospital workers are ready to cooperate with patients and follow their nurse administrators’ pieces of advice on how to communicate, how to record changes, and how to evaluate personal progress. However, not all people are ready to cooperate in the same way. Therefore, the policy of value-based care has to be properly evaluated and improvement under the control of a nurse administrator.
Change in Policy
Being a part of a nursing team and performing the functions of a nurse administrator, I realize the level of my responsibility and possible impact on other medical workers. I have to gather the opinions of different people about their readiness to accept and implement change. In addition, it is necessary to think about the details of an implementation process. I believe that cooperation and mutually made decisions have to facilitate a transition to value-based care. It is expected to improve communication between nurses and patients and make nurses take a leading role in this process. When patients address hospitals, they are not always ready to cooperate with the medical staff due to their poor awareness of medical terms, stress, and unwillingness to recognize their health problems. Nurses have to support all patients and provide them with the best care services possible. A nurse administrator has to check how nurses complete their functions and if patients are satisfied with the work done.
This change in nursing practice may be organized through short questionnaires offered to patients and their families. Waiting is a usual activity in hospitals. Families have to wait for the results of surgeries or treatment plans. Patients wait for their diagnoses and medications. Nurses wait for doctors’ directions. It is necessary to use this “waiting” period and ask to fill in simple questionnaires.
Effects and Expectations
To be a nurse administrator is not an easy job, and not all people are ready to complete all tasks and meet all the expectations. I understand the risks of possible challenges and the amounts of the work to be performed. I want to believe that my knowledge and plans should be enough to be confident in this decision and the ability to promote an organizational change in the chosen health care policy. As a nurse administrator, I should be responsible for the work of nurses and the feedbacks of patients. Any change may be a problem for an organization, and a good leader has to be ready to consider the opinions of all involved people and make sure that new policies and ideas do not contradict the regulations and the conditions under which nurses agree to work, and patients agree to be treated.
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