VIJAYA COLLEGE OF NURSING

COURSE : I ST YEAR MSC NURSING

SUBJECT : advanced nursing practice

UNIT : x

TOPIC : INDEPENDENT NURSE PRACTITIONER

HOURS : 2hrs

NAME OF THE STUDENT : SOUMYA.R

NAME OF THE HOD : PROF. RAJI RAJU

NAME OF THE EVALUATOR : PROF. RAJI RAJU

SUBMITTED TO : PROF. RAJI RAJU

SUBMITTED ON : 02-06-2020
 INDEX
1. INTRODUCTION
2. DEFINITION OF INP
3. PURPOSES OF INP

4. TYPES OF INP

5. SCOPE OF INP
6. VARIOUS AREAS OF INDEPENDENT NURSE

PRACTICE.
7. ISSUES REGARDING INP
8. QUALIFICATION REQUIRED BY AN INP
9. BARRIERS OF INP
10. ROLE OF A NURSE PRACTITIONER
11. SUMMARY
12. CONCLUSION
13. BIBLIOGRAPHY
 I. Introduction:
An independent Nurse Practitioner (INP) is a registered
nurse who has completed specific advanced nursing
education (generally a master's degree or doctoral degree,
B.sc. or GNM) and training in the diagnosis and management
of common as well as complex medical conditions. Nurse
Practitioners provide a broad range of health care services.
& independent nurse practitioners function independently
without physician involvement.

ii. Definition:
INDEPENDENT NURSE PRACTITIONER (INP) is a primary
health care provider who cared of and provide curative or
rehabilitative service to community groups in an
autonomous ways. - ( ANA)

iii. Purpose:
 To provide primary, acute, and specialty healthcare
services to diverse populations.
 With their advanced clinical training, NPs are
authorized to diagnose illnesses, treat conditions, and
 provide evidence-based health education to their
patients.
 NPs assess their patients by examining medical
histories; performing physical evaluations; and
ordering (or performing) diagnostic tests.
 It helps to develop the professional autonomy.

iV. Types:
1) Generalized Nurse Practitioner:
In Hospital & Community, both rural & urban, she/he will
give promotive, curative or rehabilitative health care
services.
2) Specialized Nurse Practitioner:
She / he provides package of promotive, therapeutic or
rehabilitative services to a defined group. The Society will
also receive special services from the specialized group in
the form of voluntary health services, charity and
missionaries etc.

V. Scope of INDEPENDENT NURSE

practice
 Diagnosing, treating, evaluating and managing acute
and chronic illness and disease (e.g. diabetes, high blood
pressure).
 Obtaining medical histories and conducting physical
examinations
 Ordering, performing, and interpreting diagnostic
studies (e.g., routine lab tests, bone x -rays, ECGs.
 Prescribing physical therapy and other rehabilitation
treatments.
 Prescribing pharmacologic treatments and therapies for
acute and chronic illness (extent of prescriptive
authority varies by state regulations).
 Providing prenatal care and family planning services.
 Providing well-child care, including screening and
immunizations.
 Providing primary and specialty care services, health-
maintenance care for adults, including annual physical
check up.
 Providing care for patients in acute and critical care
settings.
 Performing minor surgeries and procedures (with
additional training and usually under supervision) (e.g.,
dermatological biopsies, suturing, casting).
 Counseling and educating patients on health behaviors,
self-care skills, and treatment options.
VI.

ADULT NURSE PRACTITIONER

Adult nurse practitioners (ANPs) focus on providing primary
health care to adults, although the definition of this broad
patient population focus includes patients from age twelve
through the senior years. As such, the role of an ANP may
overlap with the roles of family NPs, pediatric NPs, or
gerontological NPs. Adult nurse practitioners evaluate,
diagnose, and manage common, acute, and chronic health
problems among adolescents, adults, and the elderly, and
also educate their patients on wellness strategies and
disease prevention. Adult nurse practitioners can choose to
further specialize in areas of practice ranging from women’s
health, to cardiovascular or cardiopulmonary care, to mental
health care, depending on their experience and the needs of
the communities in which they work.
FAMILY NURSE PRACTITIONER
Family nurse practitioners (FNP) are advanced practice
registered nurses who work autonomously or in
collaboration with other healthcare professionals to deliver
family-focused care. Given the rather broad nature of the
“family” patient population focus, FNPs offer a wide range of
healthcare services that revolve around the family unit; from
health promotion and disease prevention to direct care and
counseling across the lifespan.
FNPs may work in a variety of settings, including
conventional doctor’s offices, clinics, private homes, schools,
or hospitals. Family nurse practitioners place a strong
emphasis on wellness and prevention, but also provide
treatment for everything from mild ailments to serious
conditions affecting any member of the family, from children
to grandparents. An FNP can be expected to perform duties
that include:
 Developing treatment plans for acute and chronic
diseases
 Educating and guiding patients on disease prevention
and healthy lifestyle habits
 Understanding the changes in health promotion
throughout the aging process
 Conducting exams
 Performing diagnostic tests and screening evaluations
 Managing overall patient care regarding lifestyle and
development issues
 Emphasizing preventative care and disease
management
 Prescribing medication
PAEDIATRIC NURSE PRACTITIONER
pro




Pediatric nurse practitioners (PNPs) have been serving
patients and communities across the country for more than
40 years. According to the National Association of Pediatric
Nurse Practitioners (NAPNAP), they reach million of patients
annually and spend one-on-one time with patients, treating
common illnesses and listening to descriptions of symptoms,
just as pediatric physicians might do. In fact, the NAPNAP
reports that 51 percent of its members spend anywhere
from 16 to 20 minutes with a patient during a typical
appointment.
Pediatric Nurse Practitioner

According to Vanderbilt University’s School of Nursing,

pediatric nurse practitioners provide compassionate and
high quality care to children of all ages, ranging from birth
up to the age of 21.

They work in a variety of settings, including health care

clinics and physician offices, and help prevent disease,
promote health, and educate family members on plans of
care. Specific services they may provide include:

 Childhood immunizations
 Developmental screenings
 Medication prescriptions in some states, depending
upon law
 School physicals
 Treatment of common illnesses
ACUTE CARE NURSE PRACTITIONER

An acute care nurse practitioner (ACNP) is an advanced-

practice registered nurse (APRN) who specializes in the care
of acutely ill or injured patients. They work primarily in
hospitals and urgent care centers. They diagnose medical
problems and order treatments and medications to help
patients recover from sudden illness/injury or exacerbated
chronic conditions.

Acute care nurse practitioners (ACNPs) are also involved in

the assessment, stabilization, and management of patients
recovering from surgery, typically within an inpatient
setting. When caring for both pre- and post-operative
patients, acute care nurse practitioners often perform
therapeutic and pharmacotherapeutic interventions in
collaboration with specialists. In addition to postoperative
in-patient settings, ACNPs are also found in the following
settings:

 Emergency Departments
 Intensive Care Units
 Neonatal Intensive Care Units
 Ambulatory Surgery Centers
 Operating Rooms
 Specialty Labs
 Acute and Sub-Acute Care Wards
 Long-Term Care Facilities
 Home Healthcare Settings
  Well-child exams
GERIATRIC NURSE PRACTITIONER
Geriatric nurse practitioners (GNPs) provide medical
services for older patients. They share skills common among
all advanced nurse practitioners. Senior care institutions
rely on GNPs to provide comprehensive healthcare services
for aging patients. Geriatric nursing practitioners conduct
physicals, evaluate well-being and prepare care plans
specifically for these individuals. GNPs educate senior clients
and their caregivers on matters regarding geriatric well-
being and also consult with senior patients and their
caregivers.

PSYCHIATRIC AND MENTAL HEALTH NURSE

PRACTITIONER
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONERS
(PMHNPS) FOCUS ON HELPING THEIR PATIENTS COPE WITH
DIFFERENT PSYCHIATRIC DISORDERS AND ILLNESSES, INCLUDING
MOOD DISORDERS, SUBSTANCE ABUSE, ANXIETY, AND
DEPRESSION.

These professionals track their patient's progress before and

during care to provide holistic, high-quality care. According
to the American Psychiatric Nurses Association (APNA),
PMHNPs provide assessment, diagnoses, and treatment to
individuals or families with psychiatric disorders while also
identifying risk factors for such.
MIDWIFERY OR WOMENS HEALTH PRACTITIONER
A Women's Health Care Nurse Practitioner (WHCNP) is an
advanced practice nurse that specializes in continuing and
comprehensive health care for women throughout their
lives. WHCNPs provide well-woman care, reproductive and
gynecological care, and prenatal and postpartum care.
Additionally, WHCNPs focus on health promotion, disease
prevention, health education, and helping patients make
smart lifestyle choices
As a Women’s Health Nurse Practitioner, she can serve in a
variety of practice settings, such as:
 Adult/Internal Medicine
 Ambulatory OB-GYN Clinics
 Family Planning Clinics
 Home Health/Assisted Living/Nursing Homes
 Planned Parenthood
 Prenatal Clinics
 Private Practices
 Infertility Clinics/Practices
 Uro-gynecology Practices.
 Women’s Health Clinics.
 Women’s Prisons
SCHOOL HEALTH NURSE PRACTITIONER
School nurses work at every level of education, from
preschool through high school and college. One of the
primary duties of a school nurse is to treat students who
became sick or injured during the school day. Additionally,
school nurses administer medication to students with
ongoing health conditions such as juvenile diabetes, anemia
and seizure disorders and implements care plans for
students with physical and emotional disabilities. Federal
law mandates that all schools make accommodations for
students with such challenges, and a school nurse helps
schools meet that responsibility.

VII. Issues Regarding INP)

1. Legal Status:

The regulation for direct care role performed by nurses is

not well defined such as:
a) Prescribing medication
b) Ordering certain lab tests, X-ray & USG exam?

2. Nursing & Feminism:

a) Feminism can be defined as a world view that values

women & confronts systematic injustice based on gender.
 b) Most of the professionalist view nursing as a traditional
female occupation. The society is made dominant & not
allowing independent nursing.

3. Nurse is the resistant to change.

Nurses are the first enemies for nurses because the

traditional nurse does not want to change her views
regarding practice. In generally, the nurses are relict the
change.

4. Physician & nurse relationship.

Most of the physician does not like the nurse who are like to
do INP because of honesty, doubt and the nurses ability to
cope with Problem. They are threatened with the expansion
of nursing Care.

5. Role Stressors It directly affect the nurses in

nursing practice.

In addition to legal issues, there are many issues (family and

social) need to face by the nurse during their professional
period.

6. Liability:

All the nurses including general nurses are liable for this
action in appearing judicial system / laws concerning
independent practice.
7. Experience & Skill:

If the nurse have adequate skill but don’t have adequate

experience will difficult them in their professional life.

VIII. QUALIFICATI0N REQUIRED BY AN

INP
EARN A BACHELOR OF SCIENCE IN NURSING (BSN)
DEGREE

Nursing credentials typically call for a nursing degree. While

an associate may fulfill registered nurse (RN) requirements
in some areas, individuals should still consider earning a
BSN if they intend to pursue NP credentials. Bachelor's
programs typically take four years to complete and include
elective, general education, and nursing courses, along with
practices and internships. Nursing classes and fieldwork
may reflect nursing specializations, so students should select
programs that relate to their career goals

OBTAIN LICENSURE AS A REGISTERED NURSE

Applicants must earn RN licenses before earning their NP

credentials. The RN license calls for a nursing degree and
passing scores on the National Council for Licensure
Examination (NCLEX). Most states also require an
application fee and a criminal background check prior to
being admitted in clinical training as well as before a license
is issued.

 PURSUE SPECIALIZATIONS WHILE WORKING AS AN RN

NPs can specialize in areas like mental health, pediatrics,

gerontology, neonatal, emergency, and family care. Each
focus requires unique knowledge and skills the mental
health specialization deals with psychological concepts
more than emergency care, and pediatric and
gerontological areas address different life periods.
Candidates can pursue national certifications in many
specializations by completing exams and fieldwork
related to the focus area. Many states require national
certifications to earn NP credentials. Individuals should
also choose a master's program and fieldwork that
emphasize their specializations.

 GAIN ADMISSION TO AN ACCREDITED MASTER OF

SCIENCE IN NURSING (MSN) OR DOCTOR OF NURSING
PRACTICE (DNP) PROGRAM
Candidates for NP credentials must decide whether they
want to pursue a master's or a doctorate. States may
only require a master's, but a doctorate indicates more
in-depth knowledge and can help individuals who are
 competing for NP jobs. A doctor of nursing practice
(DNP), in particular, may qualify graduates for nursing
leadership positions in areas of management and
policy-building. .
Barriers;
1. Lack of understanding of the
nurse practitioner role:
The registered nurse itself doesn’t know regarding
the wide range of independent role that she can
perform.

2. Endorsement:

Lack of getting acceptance from society.

3. Conflict of interest:
It is occur due to the work overload and insufficient
salary.
4. Public perception:

Negative attitude of traditional society towards nursing

x. THE ROLE OF NURSE

PRACTITIONER)
Nurse practitioners (NP) are registered nurses who have
graduate level nursing preparations as a nurse practitioner
at the masters or doctoral level and perform comprehensive
assessments and promote health and the prevention of
illness and injury”
 The role of Advanced Nurse Practitioner is invaluable.
 It provides opportunity for patients to receive timely
care and negate unnecessarily delay in receiving
treatment, especially with the growing shortage of GPs
in primary care.
 ANPs in the community and primary care are able to
develop close, long-term relationships with their
patients and work in partnership with them to achieve
optimum health.
 Advanced Nurse Practitioners are autonomous in
making decisions based on assessment, diagnosis and
interpretation of test results.
 ANPs are able to independently prescribe appropriate
medication, evaluate or refer to other specialists if
necessary.
 Coping with a complex and evolving environment like
the NHS demands expertise in evidence-based practice,
service transformation, and implementation of new
strategies in managing patient care and healthcare
workforce through traditional and non-traditional
ways.
 They should have advanced nursing practices,
leadership and management skills.
 Nurse practitioner (NP’s) manages acute and chronic
medical conditions, both physical and mental, through
history and physical examination and ordering of
diagnostic tests and medical treatments.
 NP’s are qualified to diagnose medical problems, order
treatments, perform advanced procedures, prescribes
medicines and make referrals for wide range of acute
and chronic medical conditions within their scope of
practice.
 In addition to building upon and expanding their
nursing knowledge and skills, the nurse practitioner
also learns medicine and uses medical diagnoses and
medical treatments in their practice
 The INP can work in hospitals, in healthcare
institutions, public health settings, and research and
government services.
 NP’s provide high quality, cost effective care.
 They are specifically trained to educate and support
individuals and families, helping them change behaviors
and make informed, individuals choices about their
health and their healthcare.
 NP’s provide patient centered care.
 They take the “whole person” into account, not just the
immediate ailment.
 NP’s combine nursing education and experience for
their specialty care.
  NP’s are uniquely focused on “caring” as opposed
“curing”.
 NP’s practice in collaboration with physician.
The registered nurse itself doesn’t know regarding
the wide range of independent role that she can
perform.

xi. Summary
Independent nurse practitioners are those registered nurses
that they can perform various roles in society without
medical supervision. Till we discussed about introduction,
definition, purposes, different areas, scope, barriers and role
of an independent nurse practitioners.

xii. Conclusion
Establishing an independent nursing practice is an
opportunity to obtain greater autonomy in nursing practice
and to focus on a particular population on healthcare venue.
Leadership challenge helps to work independently. and
current clinical special supervision & services. Independent
nursing practice is a step towards liberation & insuring
dignity to the profession of nursing. It will ensure financial
autonomy and uplift the profession of nursing. Nursing
practice