Christopher Manacci, MSN, ACNP The National Flight Nurse Academy Frances Payne Bolton School of Nursing Case Western Reserve University Advanced Nurse Practitioner Education in the USA;Past, Present and Future

 Discuss the definition and educational requirements for becoming a Nurse Practitioner  Understand the differences between Nurse Practitioners and other providers.  Discuss the Acute Care Nurse Practitioner scope of practice

 Late 1950’s-Ingles/ Stead  1960-CNS  Mid 1960’s-NP’s  1990 ACNP

1970-Neonatal NP 1997-Balanced Budget Act Early 1990’s-NP required have master’s degree urban settings 2000-CTP passed 1994-ACNP scope of practice 2002-Prescriptive Authority fully implemented Historical Perspective

 Clinical Nurse Specialist  Certified Nurse Midwife  Certified Registered Nurse Anesthetist  Certified Nurse Practitioner

 Registered nurses who: ◦ Are master’s or doctoral prepared ◦ Has become an expert clinician in a specialty area. ◦ National certification is optional.  The functions of the CNS include clinician, leader, educator, and change agent to improve quality of care. Ohio Association of Advanced Practice Nurses, 2001

 Registered nurses who: ◦ Have advanced training in Women’s health and midwifery. ◦ Have a master’s degree and ◦ Are nationally certified  The functions of the CNM include labor and delivery, prenatal, postpartum, newborn and routine gynecological care Ohio Association of Advanced Practice Nurses, 2001

 Registered nurses who: ◦ Have critical care training ◦ Have a master’s degree in the delivery of anesthesia ◦ Is nationally certified  CRNA functions include: administration of anesthetic agents/drugs for surgical, diagnostic procedures, and acute and chronic pain control Ohio Association of Advanced Practice Nurses, 2001

 Registered nurses who: ◦ Have a master’s degree or doctorate ◦ Are nationally certified ◦ Have advanced training and education in a specialized area of health care  CNP functions include: management of acute and chronic illnesses and disease prevention to a variety of age ranges in a variety of care settings Ohio Association of Advanced Practice Nurses, 2001

 Neonatal nurse practitioner  Family nurse practitioner  Adult nurse practitioner  Acute Care Nurse Practitioner

Collaboration vs. Supervision  Nurse Practitioner ◦ CNP works under his/her license ◦ Responsibility rests on competence of individual ◦ In collaborative arrangement, parties interact under mutual respect and authority.

 Written guideline which defines responsibilities, accountabilities, and obligations of the specific CNP practice.  Limited by: ◦ State legislation ◦ Standard Care Agreement ◦ Credentialing institution ◦ Collaborating Physician Scope of Practice

 Physician licensed to practice medicine in Ohio who agrees to work with the Advanced Practice Nurse in order to mutually establish a procedure for patient care Ohio State Board of Nursing, 2001

 Systematic formal guide for planning and evaluating health care. State of Ohio Board of Nursing, 2001  Written agreement between CNP and collaborating physician regarding guidelines of care and scope of practice.

 Rounds  H&P’s/discharges  Physical exams  Evaluation/initiation of plan of care ◦ diagnostics ◦ pharmacotherapy ◦ multidisciplinary collaboration

 Intubation  Line placement: central, Swan, arterial  Tube Thoracostomy  Wound Closure  Lumbar drain  Subdural drain removal  CSF specimens  C-spine clearance  Laceration repair  VP shunt reprogram

 Identify research opportunities  Collaborate to develop research study/design  Incorporate evidenced based practice  Identify quality/performance issues  Communicate specialty knowledge through professional publications

 Prioritize patient/family learning needs  Conduct formal/informal teaching  Provide teaching to other health care disciplines or community agencies as requested

 Clinical resource and continuity  Quality assurance involvement  Multidisciplinary contact to assist with patient flow/resource utilization

Formulary ACNPFamily/Adult Approved for intravenous: Approval for oral/ may not prescribe IV: Inotropes Nitrates Antiarrhythmics Vasodilators Beta blockers Antihypertensives Vasopressors

ACNP Formulary  Blood  Plasma Expanders  Parenteral vitamins  Parenteral electrolytes  Systemic alkalinizers  Anticoagulants  IV-Aminoglycosides  NSAIDS-prescription

Key elements of the acute care nurse practitioner : Advanced clinical expertise Development of differential diagnoses Use of medical diagnostic reasoning to formulate the plan of care Order and prescription of pharmacologic and non- pharmacologic therapy

Key elements of the acute care nurse practitioner : Planning and management of patient care across the acute care continuum Utilization and performance of invasive and non invasive interventions and procedures to promote physiologic stability or obtain diagnostic information Surveillance of care Accountability and authority for patient care outcomes across settings and boundaries

Key elements of the acute care nurse practitioner: Evidence-and research-based clinical practice. Monitor, evaluate and refine care in a continuous fashion Accountability and authority for patient outcomes across settings Clinical leadership Managing and negotiating health care delivery systems, Prevention and promotion of health Provide care for awareness of the uniqueness of the individual.

Diagnostic reasoning Advanced pharmacology Invasive interventions In keeping with the standards of the nursing profession Introducing graduate level academic preparation for research and practice. Formal Preparation

Provide the highest level of care to those most in need. Provide the highest level of care to those most in need. Create a mechanism for the distribution of research into clinical practice. Create a mechanism for the distribution of research into clinical practice. Advance science and Nursing. Advance science and Nursing. Reduce cost by early intervention. Reduce cost by early intervention. Educate those already trained and meet today’s societal needs. Educate those already trained and meet today’s societal needs.

Advanced Practice Model

The Case Western Reserve University Frances Payne Bolton School of Nursing, in collaboration with our clinical partners: The First University Degree Program with Subspecialty in Flight Nursing Louis Stokes Cleveland VA Medical Center

Plan of Study; Full-time study 48 semester hours

Headquartered at the Frances Payne Bolton School, the Flight Nurse Academy features environmental and human simulators for in-flight training. Synthetic Natural Environment

Summer Camp

Synthetic Natural Environments

Human Simulation

Summer Camp

“Taking critical care from the bedside to the roadside”