An advanced practice nurse (APN) can fulfill a variety of roles related to clinical practice as well as research, education, and management, all of which contribute to the improvement of care. In particular, one of the key clinical practice roles is that of a nurse practitioner, which, among other things, presupposes being involved in providing high-quality primary care (Wolff, 2016, p. 62). Another role that is fulfilled by an APN in clinical settings is that of a nurse administrator. However, this role is not clinical per se; instead, it refers to administrative activities that are aimed at the coordination of service to improve the quality of care, safety of patients, and efficiency and cost-effectiveness of the service (White, 2015, p. 72).
Another non-clinical position that an APN can take is the role of a nurse educator that is predominantly related to nursing training and education, which has a direct impact on the quality of service. Apart from that, the role is closely connected to the research. Here, it should be pointed out that any APN role can and is welcome to be involved in nursing research, but the role of a nurse educator presupposes this involvement (White, 2015, p. 69, 71-72). The role of a nurse informaticist is similarly related to research, but it is concerned specifically with the investigation that is related to nursing informatics. In turn, nursing informatics is linked to the application of information technologies to nursing knowledge management (White, 2015, p. 91). As a result, White (2015) insists that the role of a nurse informaticist presupposes managing the meaningful use of technology in clinical settings while also being engaged in research and the education of the staff. Thus, the multiple roles of APN differ in the specifics of related activities, but they seem to be similar in their aim, which consists of the improvement of the quality of service in various domains of healthcare.
Health Policy and the Advanced Practice Role
The present paper considers a policy issue, which is identified by the Robert Wood Johnson Foundation [RWJF] (2016) as the need for cost transparency, the lack of which appears to be harmful to patients. On the other hand, price transparency can have several outcomes that are beneficial for customers and, indirectly, for the quality of care. In particular, RWJF (2016) mentions the educational and cost-lowering functions of the policy. The latter is the result of an increase in competition, which tends to positively affect the quality of services and products, including those related to healthcare (Wu, Sylwestrzak, Shah, & DeVries, 2014). RWJF (2016) and Reinhardt (2013) also point out that the decrease in costs increases efficiency, which is a valuable outcome for healthcare companies and the economy of a country.
The first state-level programs aimed at the improvement of healthcare price transparency started to appear during the previous decade; for instance, New Hampshire launched such a program in 2007 and was one of the pioneer states (Wu et al., 2014, p. 1392). However, the problem of price transparency remains a national issue: in 2016, RWJF (2016) stated that 45 of the states of the US appear to have unnecessarily complicated healthcare pricing, even though the Foundation does report some positive dynamics. As a result, almost every person in the country can be regarded as a stakeholder concerning this issue, while healthcare organizations and specialists can be the key players. Apart from that, politicians should be engaged in the process of change as powerful players. The parties of interest include patients, which can potentially imply any person in the country, and the providers of healthcare, insurance, and healthcare equipment. It should be pointed out that the latter might have a mixed attitude towards the change (Reinhardt, 2013), but from the nursing perspective, the change is positive due to its effect on the quality of care.
The pervasiveness of the issue also defines the level of the change. In general, it appears that state and, possibly, federal policies may need careful consideration and planned enhancement. The change process can be affected by the advocacy of healthcare and other organizations, including RWJF (2016), but it can only be set in motion by political figures. On the other hand, the pervasiveness of the problem does not imply that no local changes are needed. Local institutions (and individual practitioners) can review and improve their policies, thus gaining a competitive advantage and enhancing the quality of their care. Local changes are particularly relevant for nurses as change agents.
Nurses are trained and expected to be change leaders (White, 2015), and, as a result, a nurse practitioner can contribute to the change at every level. While federal, state, or municipal policies are of importance (and can be advanced by promoting relevant agendas through nursing organizations), the change at the local level may be of particular relevance to a practicing nurse. Indeed, a generic policy is constrained by the lack of knowledge of the particular issues and resources of a specific institution. On the other hand, the development of local policies can and should be customized, which is supposed to have a positive impact on the outcomes. Thus, nurse practitioners can promote, advocate for, and facilitate the development and implementation of their healthcare organizations. As for the outcomes, the development and improvement of a local cost transparency policy can improve the quality of care (as mentioned above) and introduce competition into the regional healthcare market, prompting other institutions to introduce similar changes. While it is a small contribution to a national problem, it can still be valuable, especially for the local community.
Reinhardt, U. (2013). JAMA, 310(18), 1927. Web.
Robert Wood Johnson Foundation. (2016). Web.
White, K. (2015). Emerging roles for the DNP nurse educator. In S. DeNisco & A. Barker (Eds.), Advanced practice nursing (pp. 69-108). Burlington, MA: Jones & Bartlett Publishers.
Wolff, D. (2016). Advancing your nursing degree. New York, NY: Springer Publishing Company.
Wu, S., Sylwestrzak, G., Shah, C., & DeVries, A. (2014). Health Affairs, 33(8), 1391-1398. Web.