Professional Roles for the Advanced Practice nurse

1 PA R T 1. Professional Roles for the Advanced Practice nurse The chapters in Part 1 of this book consider nursing that reflects current thinking. As the role of the Advanced Practice nurse you read this chapter, keep in mind this from historical, present-day, and future expanded definition and appreciate the perspectives. This content is intended to development of the Advanced clinical Roles serve as a general introduction to select for nursing Practice . This discussion lays issues in Professional role development for the foundation for a deeper understand- the Advanced Practice of nursing.

2 As stu- ing of the historical development, current dents progress in the educational process Practice , and future opportunities for and develop greater knowledge and exper- Advanced Practice in nursing. tise, role issues and role transition should In Chapter 2, Stewart discusses the tip- be integrated into the entire educational ping point for nurse practitioners as we program. enter the age of healthcare reform and the In Chapter 1, the editors define role nurse practitioners will play in provid- Advanced Practice nursing from a tradi- ing cost-effective, quality primary care to tional perspective and trace the history a demographically changing population.

3 Of the role. Traditionally, Advanced prac- Stewart's quantitative and qualitative tice has been limited to clinical Roles that research resulted in the Stewart Model include the clinical nurse specialist, nurse of nurse Practitionering that reflects key practitioner, certified nurse -midwife, and attributes that make nurse practitioners certified registered nurse anesthetist; unique. Much has transpired related to the to Practice , the last three Roles require a role and education of nurses for Advanced license beyond the basic registered nurse Practice .

4 Most revolutionary is the man- (RN) license. This book, however, uses an date to have by 2015 the clinical doctorate expanded definition of Advanced Practice be the required degree for Advanced clinical 1. 1 27/10/14 5:44 PM. 2 n Part 1 Professional Roles for the Advanced Practice nurse Practice nursing (American Association of Col- For other Advanced Practice Roles , includ- leges of Nursing, 2004). With this change, many ing those of the clinical nurse leader, nurse master's programs for Advanced Practice nurses educator, and nurse researcher, a different set will transition to the doctoral level.

5 The ratio- of educational requirements exists. The clini- nale for this position by the American Associa- cal nurse leader as a generalist remains a mas- tion of Colleges of Nursing (AACN) is based on ter's-level program. For nurse educators, the several factors: position of AACN although not universally The reality that current master's degree accepted within the profession (as demon- programs often require credit loads equiva- strated by the existence of master's programs lent to doctoral degrees in other healthcare in nursing education) is that didactic knowl- professions edge and practical experience in pedagogy are additive to Advanced clinical knowledge.

6 The changing complexity of the healthcare nurse researchers will continue to be prepared environment in PhD programs. Thus, there will be only two The need for the highest level of scientific doctoral programs in nursing, the DNP and knowledge and Practice expertise to ensure the PhD. It is important for readers to keep high-quality patient outcomes abreast of this movement as the profession fur- In an effort to clarify the standards, titling, ther develops and debates these issues because and outcomes of clinical doctorates, the Com- the outcomes have implications for their own mission on Collegiate Nursing Education Practice and Professional development within (CCNE) the accreditation arm of AACN has their own specialty.

7 The best resource for this decided that only Practice doctoral degrees is the AACN website and the websites of spe- awarding a Doctor of Nursing Practice (DNP) cialty organizations. will be eligible for accreditation. In addition, The next three chapters in Part 1 discuss the the AACN has published the Essentials of Doc- future of Advanced Practice nursing and the toral Education for Advanced Nursing Practice , evolution of doctoral education in particular, which sets forth the standards for the develop- the Practice doctorate.

8 Within today's rapidly ment, implementation, and program outcomes changing and complex healthcare environment, of DNP programs. members of the nursing profession are challeng- Needless to say, this recommendation ing themselves to expand the role of Advanced has not been fully supported by the entire Practice nursing to include highly skilled prac- profession. For instance, the American Orga- titioners, leaders, educators, researchers, and nization of nurse Executives (AONE, 2007) policymakers. does not support requiring a doctorate for In Chapter 3, Chism defines the DNP degree managerial or executive Practice on the basis of and compares and contrasts the research doc- expense, time commitment, and cost benefit torate and the Practice doctorate.

9 The focus of of the degree. It also suggests that nurses may the DNP degree is expertise in clinical Practice . migrate toward a master's degree in business, Additional foci include the Essentials of Doctoral social sciences, and public health in lieu of a Education for Advanced Nursing Practice as outlined master's degree in nursing. Further, AONE sug- by the AACN (2004), which include leadership, gests there is a lack of evidence to support the health policy and advocacy, and information need for doctoral education across all aspects of technology.

10 Role transitions for Advanced prac- the care continuum. In contrast, doctoral and tice nurses prepared at the doctoral level call for master's-level education for nurse managers an integration of Roles focused on the provision and executives is encouraged. of high-quality, patient-centered care. 2 27/10/14 5:44 PM. References n 3. In Chapter 4, White discusses emerging both barriers to successful collaborative teams Roles of DNP graduates as nurse educators, and factors for successful team development. nurse executives, and nurse entrepreneurs and Advanced Practice nurse leaders educated Advanced Practice nurses' increased involve- at both the master's and doctoral levels are ment in public health programming and inte- uniquely positioned to overcome the workforce grative and complementary health modalities.