1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 24 Advanced Nursing Education and Practice

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 24.1 Discuss education for advanced nursing roles. 24.2 Identify graduate-level nursing roles. 24.3 Describe the historical development of advanced practice nursing. 27.4 Discuss certification and regulation of advanced practice roles. 24.5 Compare graduate education programs in nursing. 24.6 Identify international perspectives on advanced nursing practice roles. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities Advanced practice nursing has proliferated in response to healthcare changes Traditional ways of educating nurses and of practicing nursing have changed Demands for change provide opportunities to redefine nursing role and practice

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.1 Discuss education for advanced nursing roles.

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Historically, nurses educated to be a nurse generalist Specialization came after basic education Knowledge and skill previously limited to the physician have crossed over into nursing As nurses’ role expands they become more specialized

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Need for more formalized programs of study Preparation for advanced nursing practice –Specialty education at the master’s level evolved during 1940s–1950s –Funds provided by GI benefits and National Mental Health Act

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Preparation for advanced nursing practice –NLN agreed that  Baccalaureate was the generalist  Master’s was the specialist –Early graduate degrees focused on functional roles  Educator  Administrator –First clinical master’s developed in 1954

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Preparation for advanced nursing practice –Clinical nurse specialist (CNS)  Improves client care and nursing practice  Serves as an expert in the practice setting  CNS role not clearly defined –Healthcare personnel shortage due to Vietnam conflict –Maldistribution of primary-care physicians

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Preparation for advanced nursing practice –First nurse practitioner program established in 1965 –Short-term certificate programs for advanced nurse practitioners (ANP) emerged –Currently most ANP education is at the graduate level

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.2 Identify graduate-level nursing roles.

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Graduate programs –Advanced nursing practice requires a graduate degree –Roles can include  Educator  Researcher  Clinician  Informatics specialist

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Graduate programs –Roles can include  Consultant  Author  Advanced practice registered nurse (APRN)  Administrator  Attorney  Multiple others

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Graduate programs –Limit doctoral preparation in nursing to research- focused doctorate (PhD) or practice doctorate (DNP) –Master’s degree programs focus on education and leadership

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.3 Describe the historical development of advanced practice nursing.

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Practice APN –APN is an umbrella term for registered nurses who have met advanced education and clinical practice requirements –Newly preferred term is APRN  Four principal types of advanced practice Certified nurse midwives (CNM) Clinical nurse specialists (CNS) Certified registered nurse anesthetists (CRNA) Nurse practitioners (NP)

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Practice Clinical nurse specialist (CNS) –Professional advancement for nurses who remain in clinical practice at the bedside –Integrates subroles of  Expert nurse clinician  Consultant  Educator  Researcher

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Practice Nurse practitioner (NP) –Wide scope of practice with more autonomous role –Legal authority to order diagnostic tests and prescribe medicines –Treats many common and complex health problems that historically required physician’s care

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Practice Certified nurse midwife (CNM) –Began in the 1920s –Advanced education in  Prenatal care  Management of labor and delivery  Postpartum care of mother and infant  Family planning  Gynecological care for well women –Role is practiced worldwide

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Practice Certified registered nurse anesthetist (CRNA) –Earliest type of advanced practice role in the United States –Began as early as 1889 –Advanced education in the delivery of anesthesia –Cares for patient’s anesthesia needs before, during, and after surgery –Practice in variety of settings

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.4 Discuss certification and regulation of advanced practice roles.

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Regulation of Advanced Practice Varies from state to state –Each state has jurisdiction to determine requirements for licensure –Most states require certification examinations –Various legal titles are conferred by the states to designate the APRN

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Regulation of Advanced Practice Certification –Voluntary process by which agency or association grants recognition to a person who has met specified qualifications –Intended to protect the public by identifying competent people –Certified nurses are in the greatest demand and earn more than noncertified nurses

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Regulation of Advanced Practice Legal challenges for advanced practice nurses –Reimbursement for services –Prescriptive rights

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.5 Compare graduate education programs in nursing.

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Research doctorate (PhD) –Emphasizes research that builds science for nursing practice and prepares researcher to communicate that knowledge –Graduates of doctoral programs in nursing are prepared for  Research  Education  Practice in advanced careers

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Practice doctorate (DNP) –Focus on application of research to practice and preparation of graduate to provide direct and indirect care service  Affects accreditation programs, not licensure

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Practice doctorate (DNP) –Rationale for DNP movement  Nursing is a discipline seeking higher knowledge  Nursing is a practice requiring skill refinement and use of evidence –Concern about growing curriculum content for master’s programs in nursing, which exceeds other academic disciplines

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Master’s degree in nursing, focus on education –Prepares nurses for  Faculty roles in community colleges  Non-tenure-track positions in four-year programs –Certification as a nurse educator (CNE) requires two years’ full-time teaching within last five years of master’s or doctoral degree in nursing

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Advanced Nursing Education Master’s degree in nursing –Clinical nurse leader (CNL)  Care provider  Conceived of as advanced generalist  New role in nursing

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 24.6 Identify international perspectives on advanced nursing practice roles.

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The International Perspective International Council of Nurses (ICN) –Established International Nurse Practitioner/Advanced Practice Nursing Network –Released a position paper –Plans to develop worldwide standards –70 countries have advanced practice nursing roles

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The International Perspective Canada –Advanced nursing practice (ANP)  Umbrella term describing advanced level of nursing practice  Domain of practice is usually direct care  May include education, research, or administration  Minimum level or preparation is a baccalaureate degree in nursing

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The International Perspective Canada –Advanced nursing practice (ANP)  CNS is a registered nurse with master’s or doctoral degree in nursing; five domains Practice Consultation Education Research Leadership  Canadian Nurses Association offers certification

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The International Perspective Australia –The Nursing and Midwifery Board of Australia (NMBA) sets competency standards for nurse practitioners and midwives –Nurse practitioner is a registered nurse educated and authorized to function autonomously and collaboratively in an advanced role –Midwives must graduate from midwifery program and be licensed or registered to practice

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Future of Advanced Practice Nursing APRNs fulfill a need for quality primary-care services at an affordable cost Access to affordable care has been driving force in number of APRNs Nursing positioned to be major player in policy development for the future Nurses need to educate the public, politicians, and legislators about their role

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Future of Advanced Practice Nursing Need for further expansion of scope of practice Professional organizations need to ensure a high standard for certification There will be more standardization of the role, scope of practice, and standards internationally

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selecting a Graduate Program Factors to be considered –Professional career goals  Identify graduate program that best meets professionals goals

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selecting a Graduate Program Factors to be considered –Personal and family factors  Length of commute  Relocation  Work  Family  Part-time study

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selecting a Graduate Program Factors to be considered –Program characteristics  Programs of study offered  Program requirements  Convenience of program offering  School’s philosophy of nursing and education  Accreditation status  National standing

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Selecting a Graduate Program Factors to be considered –Characteristics of the proposed program  Admission requirements  Faculty qualifications  Institutional climate  Resources  Clinical facilities  Assistantships and other financial support