Advanced Practice Nurse Roles: How They’re Changing the Face of Modern Medicine

Continued Advanced Practice Nurse Role Evolution

CNMs, CRNAs, NPs, and CNSs have attained positive recognition and support in clinical positions in many settings in the United States. However, despite the increasing familiarity and popularity of these APRN roles, some healthcare settings have used few, if any, APRNs, and some staff members have had minimal experience working with APRNs. In some areas of the United States, physicians or physician assistants are preferred over APRNs. Even experienced APRNs can expect to encounter resistance to full implementation of their roles if they seek positions in institutions with no history of employing APRNs. Andrews and colleagues (1999) described their experiences introducing the NP role into a large academic teaching hospital. They delineated helpful strategies for marketing a new NP role to staff, patients, and the surrounding community, as well as ways to set up the necessary infrastructure to support the new role in the institution. They referred to this process as evolutionary.

The Meaning Behind the Evolution

The meaning of the evolution of established APRN roles varies according to the type of APRN role. The emphasis on cost containment in the healthcare delivery system led to the trend of having acute care NPs staff intensive care units to compensate for the shortage of house staff physicians (Rosenfeld, 2001). Then ACNP practice broadened from an intensive care unit focus to diverse settings, including specialty clinics and private practice groups (Kleinpell, 2005; Kleinpell-Nowell, 2001). New roles for APRNs will develop as telehealth continues to expand (Rincon et al., 2020). Evolution of APRN roles is also reflected in the expansion of practice to multiple areas or sites. Although responsibility for multiple areas in the same facility has been typical of many CNS roles for years, it is an evolutionary process for most other APRN roles.

Expansion of APRN Roles to Multiple Sites

Expansion of practice to multiple sites is one way in which advanced practice registered nurse (APRN) practice is evolving. For instance, a clinical nurse specialist’s role might evolve from the full range of clinical nurse specialist practice for several medical cardiac units at a tertiary care center to also include support primarily in education, consultation, and program development at additional hospitals. This expansion signifies a strategy for extending APRN resources and trying to use them more efficiently.

EXEMPLAR: Evolving APRN Roles in Multisite Practices

One example of this evolution is a clinical nurse specialist whose practice has evolved from a focused role within one facility to a multisite practice across different institutions. This shift presents numerous challenges, such as varying supervision and role requirements, inconsistencies in electronic health records, and differing onboarding processes at different institutions. These factors illustrate the complexity and the ongoing evolution of APRN roles in the healthcare system.

Barriers to Full APRN Practice

Barriers still exist preventing APRNs from practicing to the full extent of their education and training (Hain & Fleck, 2014). Twenty-eight states have granted full practice authority; however, 14 states still require physician oversight for a specific number of hours or years of practice. The US Department of Veterans Affairs (VA) has made significant strides by granting full practice authority to three APRN roles within their system, allowing them to practice to the full extent of their education, training, and certification, regardless of state restrictions.

The Role of Research in APRN Evolution

Continued research that demonstrates positive outcomes of APRN care is essential for APRN practice to make an impact on healthcare policy (Kapu & Kleinpell, 2012). Research activity and increasing involvement in the larger arena of health policy may also represent continuing role evolution for APRNs. Engaging in research as a coinvestigator or collaborator not only keeps APRNs engaged but also offers opportunities for interprofessional collaboration.

DNP Preparation: A New Era for APRNs

DNP preparation is another example of APRN role evolution. The DNP-prepared APRN brings an advanced skill set to healthcare with a deeper understanding of research and technology. These APRNs are educated to translate evidence into practice, promote collaboration, and lead change in healthcare policy to improve patient outcomes. This advanced education supports APRNs in assuming leadership roles within clinical and non-clinical settings, further driving the evolution of APRN roles.

EXEMPLAR: DNP: The Changing Face of Healthcare

The dual purpose of the doctorate of nursing practice (DNP) proposed by the American Association of Colleges of Nursing (AACN) was to provide advanced clinical care and leadership in clinical settings and to increase the numbers of clinical nursing faculty in academic settings. The decision by AACN to allow nonclinical practice programs along with clinical practice programs to offer the same DNP degree led to the development of diverse roles for DNP graduates, further illustrating the evolving nature of APRN roles.

Challenges and Opportunities in DNP Roles

Despite the advanced preparation that DNP programs provide, new DNP-prepared APRNs often encounter uncertainty and anxiety while seeking to demonstrate their advanced skills and knowledge. Acceptance of the DNP role is growing, but challenges such as physician resistance and role ambiguity still exist. Nonetheless, DNP-prepared APRNs are well-positioned to lead changes in healthcare, improve patient outcomes, and advance the profession through their unique skill sets.

FAQs

Q1: What is the significance of the evolution of APRN roles? A: The evolution of APRN roles reflects the changing needs of the healthcare system, including the expansion of responsibilities, the adoption of new technologies, and the adaptation to new settings and patient care models.

Q2: How does the DNP program contribute to the evolution of APRN roles? A: The DNP program provides APRNs with advanced clinical and leadership skills, enabling them to take on more complex roles, lead healthcare teams, and influence healthcare policy.

Q3: What are some challenges faced by APRNs in multisite practices? A: APRNs in multisite practices face challenges such as varying role requirements, inconsistent electronic health records, and differing onboarding processes across institutions.

Q4: How has telehealth influenced the evolution of APRN roles? A: Telehealth has expanded APRN roles by enabling them to provide care in diverse settings, including remote and underserved areas, thereby broadening their scope of practice.

Q5: What barriers still exist for APRNs seeking full practice authority? A: Despite progress, some states still require physician oversight for APRNs, limiting their ability to practice independently to the full extent of their education and training.

Q6: Why is research important for the continued evolution of APRN roles? A: Research that demonstrates the positive outcomes of APRN care is crucial for influencing healthcare policy and advancing the recognition and acceptance of APRN roles.

Q7: What opportunities do DNP-prepared APRNs have in non-clinical settings? A: DNP-prepared APRNs can pursue roles in leadership, education, administration, and informatics, contributing to the evolution of healthcare delivery and systems.

Q8: How do APRNs manage the challenges of working in multisite practices? A: APRNs manage these challenges by setting realistic expectations, maintaining professional boundaries, and continually adapting to new environments and requirements.

Q9: What role does interprofessional collaboration play in the evolution of APRN roles? A: Interprofessional collaboration is essential for APRNs as they work alongside other healthcare professionals to improve patient care, share expertise, and lead healthcare teams.

Q10: How can APRNs stay engaged and avoid burnout in their evolving roles? A: APRNs can stay engaged by pursuing continuous learning, participating in research, and seeking opportunities for professional growth and collaboration.