Defining Advanced Practice Nursing

As noted, the concept of advanced practice nursing continues to be defined in various ways in the nursing literature. The Ovid Medline database defines the Medical Subject Heading of advanced practice nursing as:

Evidence-based nursing, midwifery, and healthcare grounded in research and scholarship. Practitioners include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives.

(US National Library of Medicine, 2021)

This description is vague and relies primarily on a delineation of roles.

The Four Pillars of Advanced Practice Nursing

Advanced practice nursing is often defined as a constellation of four roles: the Nurse Practitioner (NP), Clinical Nurse Specialist (CNS), Certified Nurse-Midwife (CNM), and Certified Registered Nurse Anesthetist (CRNA) (APRN Joint Dialogue Group, 2008; Stanley, 2011). The fourth edition of ANA’s Nursing: Scope and Standards of Practice provides a regulatory and role-based definition of APRNs:

A subset of graduate-level prepared registered nurses who have completed an accredited graduate-level education program preparing the nurse for special licensure recognition and practice for one of the four recognized APRN roles: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), or certified nurse practitioner (CNP). APRNs assume responsibility and accountability for health promotion and/or maintenance, as well as the assessment, diagnosis, and management of healthcare consumer problems, which includes the use and prescription of pharmacologic and non-pharmacologic interventions (APRN Joint Dialogue Group, 2008).

The Role-Based Definition: Benefits and Limitations

Historically, advanced practice nursing has been discussed in terms of specific roles such as the NP and CNS (Lindeke et al., 1997; Rasch & Frauman, 1996) or the NP role exclusively (Hickey et al., 2000; Mundinger, 1994). However, defining advanced practice nursing solely by these roles can be limiting. It does not consider that some nurses in these roles may not utilize the core competencies of advanced practice nursing in their daily practice. Additionally, this approach does not account for the evolution and emergence of new APRN roles. Therefore, while role-based definitions are practical for regulatory purposes, they fall short in fully capturing the essence of advanced practice nursing as a concept.

For further reading on advanced practice nursing, visit the American Nurses Association (ANA) website.

Conceptualizing Advanced Practice Nursing Beyond Roles

A broader definition of advanced practice nursing should consider the core competencies that transcend specific roles. These competencies include advanced clinical skills, leadership, evidence-based practice, and a commitment to lifelong learning. Advanced practice nurses (APNs) are expected to operate at the highest level of clinical practice, integrating complex clinical decision-making with expert knowledge to provide exceptional patient care.

The Evolution of Advanced Practice Nursing

Advanced practice nursing has evolved significantly over the years. Initially, the focus was on the expansion of clinical roles, particularly for NPs and CNSs. However, as the healthcare landscape has changed, so too has the scope of practice for APRNs. The inclusion of CRNAs and CNMs in the definition of advanced practice nursing reflects this evolution. These roles have expanded beyond their traditional confines, incorporating leadership, policy-making, and interprofessional collaboration as key components of their practice.

Challenges in Defining Advanced Practice Nursing

One of the main challenges in defining advanced practice nursing is the variability in how the roles are perceived and practiced across different regions and healthcare settings. For instance, the scope of practice for NPs can vary significantly between states in the U.S., with some states allowing full practice authority while others impose restrictions. This inconsistency makes it difficult to create a universal definition of advanced practice nursing that applies across the board.

The Impact of Advanced Practice Nursing on Healthcare

Advanced practice nursing plays a crucial role in improving healthcare outcomes. APNs are often at the forefront of patient care, particularly in underserved areas where access to healthcare providers is limited. Their ability to provide high-quality, cost-effective care has been well-documented, and they are increasingly recognized as vital contributors to the healthcare team.

Future Directions for Advanced Practice Nursing

The future of advanced practice nursing is likely to see further expansion of roles and responsibilities. With the ongoing emphasis on interprofessional collaboration and the growing complexity of patient care needs, APNs will continue to play a critical role in shaping the future of healthcare. There is also potential for the development of new APRN roles that address emerging healthcare challenges, further broadening the scope of advanced practice nursing.

FAQs

1. What is the primary difference between an RN and an APRN?
An APRN is a registered nurse (RN) who has completed advanced clinical education and training, allowing them to perform more complex patient care tasks, including prescribing medications and developing treatment plans.

2. What are the core competencies of advanced practice nursing?
The core competencies include advanced clinical skills, leadership, evidence-based practice, and a commitment to lifelong learning.

3. Can APRNs work independently?
In some states, APRNs can work independently, while in others, they may require a collaborative agreement with a physician.

4. What roles are included in advanced practice nursing?
The roles typically include Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse-Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs).

5. How does advanced practice nursing impact healthcare outcomes?
APNs improve healthcare outcomes by providing high-quality, cost-effective care, especially in underserved areas.

6. What is the educational requirement for becoming an APRN?
APNs must complete a graduate-level education program that is accredited and specific to their chosen role.

7. Is advanced practice nursing recognized globally?
Yes, advanced practice nursing is recognized in many countries, though the roles and scope of practice may vary.

8. What is the role of evidence-based practice in advanced practice nursing?
Evidence-based practice is central to advanced practice nursing, ensuring that patient care is based on the latest research and best practices.

9. Are there emerging roles in advanced practice nursing?
Yes, as healthcare evolves, new roles are emerging within advanced practice nursing to address specific healthcare needs.

10. What challenges do APRNs face in their practice?
Challenges include regulatory variability, limited scope of practice in some regions, and the need for ongoing professional development to keep up with advances in healthcare.