Nurse practitioners meet the needs of underserved communities or those who lack access to care by joining primary care medical services with advanced practice nursing skills. The nurse practitioner (NP) profession began in response to a lack of primary care providers in urban and rural areas in the United States. The first NP program was founded in the 1960s by Loretta Ford and Henry Silver, MD, at the University of Colorado. “The goal of this program was to bridge the gap between the health-care needs of children and his family’s ability to access and afford primary health care (Joel, 2017, p. 11).
The introduction of the nurse practitioner role set the stage for an exploration of the profession’s boundaries. “In the early 1970s, Health, Education and Welfare Secretary Elliott Richardson established the Committee to Study Extended Roles for Nurses” (Keeling, 2015, para. 19). The committee pressed the establishment of new curricular designs in health science centers and better financial support for nursing education. The committee also pushed for standardizing nursing licensure and national certification.
The most common barriers for nurses seeking a masters education include the cost of tuition, decreased time from work, and the possibility of not recovering lost income or progressing up the career ladder. A disadvantage to the master’s nurse practitioner track is that “the typical MSN curriculum for APNs has become highly focused on the specialty area of practice, leaving minimal opportunity for students to select elective areas of study“ (Joel, 2017, p. 45). Another disadvantage to the master’s nurse practitioner track is the transition phase. During this period, many nurse practitioners may find it challenging to make the transition from that of an experienced RN to a novice NP. “The adjustment in professional identity can impact self-confidence, impair development of the new role, and influence decisions to remain in the job and the profession within the first year of clinical practice for new NPs” (Twine, 2018, p. 56).
An advantage to choosing a career in the APN field is that there is a concern about the plummeting number of physicians choosing primary care careers. With that, there could be insufficient providers to replace those retiring. “It is plausible that practices will increase the use of providers other than physicians, such as nurse practitioners” (Rosenberg, 2018, para. 3). According to U.S. News & World Report (2019) by 2026, the Bureau of Labor Statistics projects 36.1 percent employment growth. In that period, an estimated 56,100 jobs should open up. This growth rate is more than double the national average for other occupations, making job security for nurse practitioners outstanding (U.S. News & World Report, 2019).
The American Association of Colleges of Nursing (2015) explained that the current education model in advanced practice registered nurse (APRN) programs is fundamentally unchanged from 45 years ago when student numbers were much smaller (p. 1). As health care grows in complexity, expectations are that APRNs will have competence in many expanding areas. Coursework and clinical experience demands are increasing to keep pace with these changes. Nurse practitioner requirements include a master’s or doctoral degree. Joel (2017) explained that education for nurse practitioners has moved to a university-based graduate program from previous educational programs offering certifications (p. 23).
Graduate candidates typically hold a Bachelor of Science in nursing (BSN). Master’s level nurse practitioner track includes core courses in pathophysiology, health assessment, and advanced pharmacology. According to Joel (2017), “Content and competencies core to all APRNs and those specific to a particular role must be provided in all APRN educational programs” (p.18). APRNs serve as NPs, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists. To attain certification in one of these advanced practice areas, nurses must take focused courses in addition to a basic curriculum. “Upon completion of required coursework and clinical hours, students must take a certification exam that is administered by a credentialing organization relevant to the specific specialization” (Institute of Medicine, 2011, p. 196).
In conclusion, Advanced Practice Registered Nurses are highly certified clinicians with graduate-level nursing degrees, who are taught to provide a wider range of services with the expertise and knowledge acquired within their specialty. Leadership, teamwork, direct clinical practice, research, instructing and mentoring, and ethical decision making are all mechanisms of a successful APRN.
References
- American Association of Colleges of Nursing. (2015). White Paper: Re-envisioning the Clinical Education of Advanced Practice Registered Nurses. Retrieved from American Association of Colleges of Nursing website: https://www.aacnnursing.org/Portals/42/News/White-Papers/APRN-Clinical-Education.pdf
- Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press. http://dx.doi.org/10.17226/12956
- Joel, L. (2017). Advanced practice nursing: Essentials for role development (4th ed.). Washington, DC: F.A. Davis.
- Keeling, A. W. (2015). Historical perspectives expanded role nursing. The Online Journal of Issues in Nursing. Advance online publication. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/Historical-Perspectives-Expanded-Role-Nursing.html
- Rosenberg, J. (2018). Nurse practitioners play an increasing role in primary care. The American Journal of Managed Care. Advance online publication. Retrieved from https://www.ajmc.com/focus-of-the-week/nurse-practitioners-play-an-increasing-role-in-primary-car
- Twine, N. (2018). The first year as a nurse practitioner: An integrative literature review of the transition experience. Journal of Nursing Education and Practice, 8(5), 54–62. Retrieved from http://jnep.sciedupress.com
- U.S. News & World Report. (2019). Nurse Practitioner. Retrieved from http://money.usnews.com/careers/best-jobs/nurse-practitioner
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