APRNs Unraveling the Myths: Role Development Issues and the APRN Experience
APRNs ROLE CONCEPTS AND ROLE DEVELOPMENT ISSUES
Role Conflict: A Central Issue in Role Development
Role conflict develops when role expectations are perceived to be contradictory or mutually exclusive. Advanced Practice Registered Nurses (APRNs) often experience role conflict due to the varying demands of their roles, leading to both intraprofessional and interprofessional conflicts. These conflicts significantly impact role concepts and role development in the field of nursing.
Intraprofessional Role Conflict
APRNs experience intraprofessional role conflict for several reasons. Historically, the development of APRN roles has been fraught with conflict and controversy within nursing education and organizations, especially for Certified Nurse-Midwives (CNMs), Nurse Practitioners (NPs), and Certified Registered Nurse Anesthetists (CRNAs). Although relationships among these APRN groups and the broader nursing discipline have improved over time, challenges remain.
Communication difficulties that contribute to intraprofessional role conflict occur in four major areas: organizational level, educational programs, literature, and direct clinical practice. For instance, each APRN role has specific organizations with different certification requirements, competencies, and curricula, creating communication barriers. In education, gaps occur when courses and textbooks are not shared among APRN programs, even within the same institution. Specialty-specific journals also contribute to these communication gaps, as APRNs may focus primarily on literature within their specialty, neglecting broader APRN issues.
Horizontal Violence: A Manifestation of Intraprofessional Conflict
During the 1980s and 1990s, confusion about the delineation of roles between Registered Nurses (RNs) and NPs often led to resistance from RNs towards NPs, manifesting as refusal to perform supportive tasks such as taking vital signs or obtaining blood samples. This behavior, suggestive of horizontal violence, is more prevalent during nursing shortages and can be categorized as oppressed group behavior. Horizontal violence among nurses, including APRNs, has decreased as the NP role has gained acceptance, but it still poses a challenge to role development.
Strategies to address intraprofessional role conflict include incorporating APRN role descriptions in staff nurse orientation programs and encouraging new APRNs and APRN students to build rapport with nursing staff to foster a positive atmosphere for collegiality and collaboration.
Interprofessional Role Conflict: Physicians vs. APRNs
Interprofessional conflict, particularly between physicians and APRNs, is another significant issue affecting role concepts and development. Major sources of conflict include perceived economic threats, limited clinical training resources, lack of experience working together, and historical professional hierarchies. Clarifying professional roles and fostering interprofessional collaboration can mitigate power struggles and facilitate the integration of new roles.
One way to promote positive interprofessional relationships is through education and practice experiences that include both APRN and medical students. Developing such interprofessional educational experiences can be challenging due to different professional standards and schedules, but successful examples demonstrate that these obstacles can be overcome.
The Complementary Nature of Advanced Practice Nursing
Some physicians view APRNs as physician extenders rather than recognizing the complementary nature of advanced practice nursing. This misunderstanding often leads to opposition to independent APRN roles. However, numerous studies have shown that APRN roles blend elements of nursing and medicine, offering a holistic approach to patient care that differs from the medical model.
To improve relationships between APRNs and physicians, both groups must redefine their roles and work together to enhance interprofessional collaboration. Competency in interprofessional collaboration is critical for APRNs, as it is central to their practice.
Research and Collaboration: The Path Forward
Research has shown that collaboration is both a philosophy and a practice for NPs, who cultivate collaborative relationships with clients, colleagues, and healthcare leaders to address role autonomy and clarity issues. This collaborative approach extends holistic, client-centered care and promotes innovation and system change.
Further research is needed to explore the outcomes of this integrated practice and to demonstrate the impact of the holistic nursing approach on patient outcomes. Nurse-midwives, in particular, have been successful in developing collaborative relationships with physicians, serving as a model for other APRN groups.
Addressing Role Development Issues
Addressing role development issues requires a multifaceted approach. Education, communication, and collaboration are key to overcoming role conflicts and fostering a positive environment for APRNs to thrive. By focusing on these areas, the nursing profession can move towards a more integrated and holistic approach to patient care, benefiting both healthcare providers and patients.
FAQ
Q1: What is role conflict in nursing? A1: Role conflict occurs when role expectations are contradictory or mutually exclusive, leading to challenges in fulfilling the demands of a particular role.
Q2: How does intraprofessional role conflict affect APRNs? A2: Intraprofessional role conflict affects APRNs by creating communication barriers and tensions within the nursing discipline, particularly among different APRN roles.
Q3: What is horizontal violence in nursing? A3: Horizontal violence refers to hostile behaviors among nurses, often manifesting as passive-aggressive actions, particularly during periods of nursing shortages.
Q4: How can interprofessional conflict between physicians and APRNs be addressed? A4: Interprofessional conflict can be addressed through clarifying professional roles, fostering collaboration, and providing joint education and practice experiences for both APRN and medical students.
Q5: Why is interprofessional collaboration important for APRNs? A5: Interprofessional collaboration is important for APRNs because it enhances teamwork, improves patient care, and is central to the practice of advanced nursing roles.
Q6: What strategies can be used to minimize intraprofessional role conflict? A6: Strategies include incorporating APRN role descriptions in orientation programs and encouraging APRNs to build rapport with nursing staff to foster collaboration.
Q7: What is the complementary nature of advanced practice nursing? A7: The complementary nature of advanced practice nursing refers to the holistic approach that APRNs bring to patient care, blending nursing and medical practices.
Q8: How can research contribute to addressing role development issues in nursing? A8: Research can demonstrate the impact of holistic nursing approaches on patient outcomes and provide evidence for the benefits of collaborative practice in nursing.
Q9: What role do nurse-midwives play in interprofessional collaboration? A9: Nurse-midwives have been successful in developing collaborative relationships with physicians, serving as a model for other APRN groups to improve communication and teamwork.
Q10: What are the key components of addressing role development issues in nursing? A10: Key components include education, communication, collaboration, and ongoing research to overcome role conflicts and enhance the development of advanced nursing roles.