Distinguishing Between Advanced Nursing Practice and Advanced Practice Nursing

The terms advanced nursing practice and advanced practice nursing have distinct definitions and cannot be seen as interchangeable. In particular, recent definitions of advanced nursing practice do not clarify the clinically focused nature of advanced practice nursing. For example, the third edition of Nursing’s Social Policy Statement defines advanced nursing practice as “characterized by the integration and application of a broad range of theoretical and evidence-based knowledge that occurs as part of graduate nursing education” (ANA, 2010, p. 9). This broad definition has evolved from the AACN’s Position Statement on the Practice Doctorate in Nursing (AACN, 2004), which recommended doctoral-level educational preparation for individuals at the most advanced level of nursing practice.

Advanced Nursing Practice vs. Advanced Practice Nursing: Understanding the Distinction

Advanced nursing practice, as described in various documents and position statements, encompasses a broad range of nursing interventions that influence healthcare outcomes for individuals or populations. These interventions include the direct care of individual patients, management of care for populations, administration of healthcare organizations, and the development and implementation of health policy. This broad approach includes specialties beyond clinical care, such as administration, informatics, and public health, thereby extending beyond what is typically understood as advanced practice nursing.

Table: Key Differences Between Advanced Nursing Practice and Advanced Practice Nursing

Source: American Association of Colleges of Nursing (AACN)

The Evolution of Advanced Nursing Practice and Advanced Practice Nursing

The development of these terms has a complex history. The American Association of Colleges of Nursing (AACN) advanced a broad definition of advanced nursing practice in their 2004 position statement. This definition includes any form of nursing intervention that influences healthcare outcomes, whether through direct patient care, management, or policy development. The goal was to ensure that the Doctor of Nursing Practice (DNP) degree would be accessible to nurses across varied specialties, not just those in advanced practice roles.

The Role of Education in Defining Practice

Education plays a critical role in distinguishing between advanced nursing practice and advanced practice nursing. The DNP degree, for instance, is not a role but a degree, much like the Master of Science in Nursing (MSN). DNP graduates can assume various roles depending on their specialty focus, with some roles not falling under the traditional APRN scope.

The AACN’s revised Essentials (2021) further complicates matters by using the term advanced nursing practice specialty instead of advanced nursing practice role, leading to confusion even among those within the profession. This revision has blurred the lines between advanced nursing practice and advanced practice nursing, particularly when discussing roles that require direct clinical care versus those that do not.

Why the Distinction Matters: Implications for Practice

The distinction between advanced nursing practice and advanced practice nursing is not just a matter of semantics; it has significant implications for nursing practice, regulation, and education. Advanced practice nursing specifically refers to roles that involve expanded clinical skills and require stringent regulation due to the direct patient care component. These roles include Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), Certified Nurse Midwives (CNMs), and Certified Registered Nurse Anesthetists (CRNAs).

In contrast, advanced nursing practice can include roles that do not involve direct patient care, such as nursing administration or policy development. This broader scope requires a different level of regulation and may not demand the same clinical competencies as advanced practice nursing roles.

Global Perspectives on Advanced Nursing Practice and Advanced Practice Nursing

The distinction between these terms also has global implications. While the United States has developed specific definitions and regulations for advanced practice nursing roles, other countries may use the term advanced nursing practice to refer to roles that are more aligned with the US’s understanding of APRN roles. The International Council of Nurses (ICN) has more recently started using the term advanced nursing practice to describe direct care roles, which can create confusion in the global context.

Frequently Asked Questions (FAQ)

Q: What is the primary difference between advanced nursing practice and advanced practice nursing?
A: The primary difference lies in the scope and focus. Advanced nursing practice is a broad term that includes both clinical and non-clinical roles, while advanced practice nursing specifically refers to clinical roles that involve direct patient care.

Q: Why is the distinction between these terms important?
A: The distinction is crucial because it affects how roles are regulated, the education required, and the competencies needed for practice. Advanced practice nursing roles require more stringent regulation due to their clinical nature.

Q: Can a DNP graduate work in a non-clinical role?
A: Yes, a DNP graduate can work in various roles, including non-clinical positions in administration, policy, or education, depending on their specialty focus.

Q: How do these terms impact global nursing practice?
A: Globally, the terms can be confusing as different countries may use them differently. The ICN has started using advanced nursing practice to describe roles similar to US APRN roles, but the terminology and definitions can vary widely.

Q: Is advanced practice nursing more regulated than advanced nursing practice?
A: Yes, advanced practice nursing is more regulated due to its focus on direct patient care, requiring specific licensing and certification.

Q: Does advanced nursing practice require a DNP degree?
A: Not necessarily. Advanced nursing practice roles can be filled by individuals with various levels of education, including master’s degrees. However, the DNP degree is often required for advanced practice nursing roles.

Q: Are APRN roles included in advanced nursing practice?
A: Yes, APRN roles are a subset of advanced nursing practice but are distinguished by their clinical focus and regulatory requirements.

Q: How does the AACN define advanced nursing practice?
A: The AACN defines advanced nursing practice as any nursing intervention that influences healthcare outcomes, including both clinical and non-clinical roles.

Q: Can advanced nursing practice roles involve direct patient care?
A: Yes, some advanced nursing practice roles involve direct patient care, but the term also includes roles that do not.

Q: What is the ICN’s stance on advanced nursing practice?
A: The ICN has started using the term advanced nursing practice to refer to direct care roles, aligning more closely with the US definition of APRN roles.