Conceptualizations of Advanced Nurse Practitioner: Problems and Imperatives

Introduction

Despite the usefulness and benefits of conceptual models, conceptual confusion and uncertainty remain regarding advanced nurse practitioner roles. One noted issue is the lack of a well-defined and consistently applied core stable vocabulary used for model building. Despite progress, this challenge remains.

Vocabulary Variations

Different Terms in Different Regions

• In the United States, “advanced practice nursing” is the term used, but the ICN and CNA use “advanced nursing practice.”
• Variations in definitions exist between Australia, Canada, New Zealand, the United States, Canada, and the United Kingdom.

Role Confusion

• The term “advanced practitioner” is used to describe non-APRN experts in the United Kingdom and internationally.
• Different states in the U.S. use various terms for APRNs:
  • Iowa: Advanced Registered Nurse Practitioner
  • Virginia: Licensed Nurse Practitioner

The APRN Consensus Model

The APRN Consensus Model (APRN Joint Dialogue Group, 2008) represents a major step forward in promulgating a uniform definition of advanced practice in the United States for the purpose of regulation. However, the lack of a core vocabulary continues to make comparisons difficult because the conceptual meanings vary.

Competencies and Concepts

• Competencies are more commonly used to describe APRN practice concepts.
• Reflection on and discussion of terms such as roles, hallmarks, functions, activities, skills, and abilities continue, contributing to the urgent need for a common language.

Addressing Nursing’s Metaparadigm

Few models of APRN practice comprehensively address nursing’s metaparadigm (person, health, environment, nursing). Comparing, refining, or developing models is challenging because concepts are often used without universal meaning or consensus, and sometimes with inconsistent definitions.

Evolution and Clarity in APRN Practice

• The evolution of advanced nurse practitioner roles will be enhanced if scholars and practitioners agree on fundamental concepts of APRN practice.
• A clear differentiation of APRN practice from registered nurses (RNs) is necessary.

International and Global Models

Current Status

• Few conceptual models describe the practice and outcomes of APRNs.
• The United Arab Emirates is emerging in APRN roles but lacks a formal model.

Need for Diverse Models

• Models addressing diverse health and cultural needs worldwide are required.

Distinguishing APRNs from Physicians

Role Clarity

• Clarifying differences in practice between APRNs and physicians is crucial.
• Lack of conceptual clarity in job advertisements can lead to confusion.

Barriers to Practice

• Organized medicine attempts to limit or discredit APRNs.
• Lack of conceptual clarity can hinder APRNs from practicing to the full extent of their education and training.

Interprofessional Education and Practice

Interprofessional education and practice are central to high-quality care. Graduate education of APRNs alongside other health professionals is beginning to take place, enhancing collaborative care.

Example: University of Michigan

• An interprofessional clinical decision-making course includes students from nursing (APRN students), pharmacy, dentistry, medicine, and social work.

Development of Interprofessional Competencies

• High-functioning interprofessional teams are critical for maximizing patient outcomes.
• Conceptual models for APRN practice on interprofessional teams are needed.

Imperatives for Conceptual Consensus

Among many imperatives for reaching a conceptual consensus on advanced nurse practitioner roles, the interrelated areas of policymaking, licensing, credentialing, and practice are most important.

Policymaking

• Not all APRNs are eligible for reimbursement by insurers.
• The APRN Consensus Model and other reforms call for changes to enable APRNs to work within their full scope of practice.

Continued Dialogue

• Ongoing dialogue and activity are essential for clarifying advanced nurse practitioner roles and concepts.

Box 2.1: Clarification and Consensus on Conceptualization of Advanced Nurse Practitioner Roles

1. Clear differentiation of advanced nurse practitioner roles from other levels of clinical nursing practice.
2. Clear differentiation between advanced nurse practitioner roles and the clinical practice of physicians and other non-nurse providers.
3. Clear understanding of APRNs’ roles and contributions on interprofessional teams.
4. Clear delineation of similarities and differences among APRN roles.
5. Regulation and credentialing of APRNs that protect the public.
6. Clear articulation of health policies that:
   1. Recognize APRNs’ contributions to quality, cost-effective healthcare.
   2. Ensure public access to APRN care.
   3. Ensure appropriate billing and payment mechanisms for APRN care.
7. Maximizing social contributions by APRNs in healthcare.
8. Enabling APRNs to reach their full potential personally and professionally.

By addressing these issues, the conceptualization of advanced nurse practitioner roles can be clarified, enhancing the understanding and practice of APRNs globally.