1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 39 The Advanced Practice Nurse in the Community

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Briefly discuss the historical development of the roles of the advanced public health nurse and the nurse practitioner. 2. Describe the educational requirements for population-focused advanced practice nurses (APNs). 3. Discuss credentialing mechanisms in nursing as they relate to the role of the APN. 4. Compare and contrast the various role functions of population-focused APNs.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 5. Identify potential arenas of practice. 6. Explore current issues and concerns related to practice. 7. Identify five stressors that may affect nurses in expanded roles.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Definitions  Advanced public health nurse (APHN)  Public health clinical nurse specialist (CNS)  Nurse practitioner (NP)  Clinical nurse leader (CNL)

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Perspective  Shift from institution-based health care to population-focused health care  CNS role began in early 1960s  NP movement began in 1965 at the University of Colorado  Physician assistant (PA) role initiated in 1965 at Duke University  Extending the Scope of Nursing Practice (1971)  Nurse Training Act of 1971

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Competencies  Quad Council of Public Health Nursing Organizations developed a set of national public health competencies specific for public health nursing practice (2003)  Based on the Core Competencies for Public Health Professionals (2001)  Updated in 2009  Scope and Standards for Public Health Nursing Practice (ANA, 2007)

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Educational Preparation  Minimum of a master’s degree  Synthesis of current knowledge and research in nursing, public health, and other scientific disciplines  ACHNE recommendations for graduate nursing education

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Credentialing  Certificate examinations for APNs offered by the American Nurses Credentialing Center (ANCC)  NP certifications  CNS certifications, including for public/community health nursing  Valid for 5 years Submit documentation of current RN licensure and meet practice and continuing education requirements.

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Advanced Practice Roles Clinician Educator Administrator Consultant Researcher

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Clinician  APHN:  Conducting community assessments  Identifying needs of populations at risk  Planning, implementing, and evaluating population-focused programs to achieve health goals, including health promotion and disease prevention activities  NP  Assess, diagnose, and treat individuals and families  Use of protocols

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Educator  Increase wellness; contribute to maintaining and promoting health by teaching the importance of good nutrition, physical exercise, stress management, and a healthy lifestyle.  Provide education about disease processes and the importance of following treatment regimens.  Provide anticipatory guidance and educate patients on the use of medications, diet, birth control methods, and other therapeutic procedures.

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Administrator  May be responsible for and have direct or indirect authority and supervision over the organization’s staff and patient care  Serve as decision makers and problem solvers  May also be involved in other business and management aspects, such as:  Supporting and managing personnel  Budgeting  Establishing quality control mechanisms  Program planning and influencing policies  Public relations  Marketing

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Consultant  Involves problem solving with an individual, family, or community to improve health care delivery  Steps of the consultation process:  Assessing the problem  Determining the availability and feasibility of resources  Proposing solutions  Assisting with implementing a solution, if appropriate

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Researcher  Conduct own investigations and collaborate with doctorate-prepared nurses, answering questions related to nursing practice and primary health care

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Arenas for Practice  Primary care  Independent practice  Third-party reimbursement  Nursing centers  Faith Community Nursing/Parish Nursing  Institutional settings  Ambulatory/outpatient clinics  Emergency departments  Long-term care facilities  Industry/Occupational health

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Arenas for Practice, Cont’d  Government  Armed Services  Public Health Departments  Schools  Other Arenas  Home Health Agencies  Correctional Institutions

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Issues and Concerns  Legal status  Prescriptive authority  Reimbursement  Institutional privileges  Employment and role negotiation  Portfolios

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Role Stress  Professional isolation  Liability  Interprofessional collaborative practice  Conflicting expectations  Professional responsibilities

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Trends in APN  Increasing number of NPs and decreasing number of CNSs  Loss of CNS positions in hospitals