Running head: NURSE PRACTITIONER. A BRIEF REVIEW.

Nurse Practitioner. A brief review.

Eduardo Bernal.

Role of the Advanced Practice Nurse.

Faculty: Dr Song.

South University.
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Abstract

Despite proven benefits, full compliance with the Nurse Practitioner (NP) as part of health

systems has been slow in many places and met some resistance among both, health professionals

and in some areas of the population. Briefly reviewed three papers, two research and one expert

opinion on the first steps, design and development of NP as specialty within nursing scope, their

roles, responsibilities, economic issues, difficulties and obstacles in its implementation, and

possible solutions to these problems. Paper is focused in NP work in the Emergency Department

and in primary care and what the public needs to know about this specialty.
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Nurse Practitioner. A brief review.

There is widespread consensus that there are four Advanced Practice Registered Nurse

(ARPN) roles: certified nurse-midwife (CNM), certified registered nurse anesthetist (CRNA),

clinical nurse specialist (CNS),and nurse practitioner (NP)( Hamric, Ann. B., Hanson, Charlene.

M., Tracy, Mary Fran, O’Grady, Eileen. T., 2014, p.67; APRN Joint Dialogue Group Report,

2008, p.7). We are studying NP which is a clinical role that provides health care in direct contact

with the patient and ensures security following the recommendations of National Patient Safety

Goals (NPSG)( The Joint Commission, 2015,pp.1-17).

The National Patient Safety Goals lists a number of measures that must be met to ensure the

protection of the patient. The NP is an important part for the implementation of these measures

in any health care facility because of its close relationship with sick patients and with those who

are receiving preventive care. Many measures were mentioned in The Joint Commission,

2015,pp.1-17, point out some:

• Improve the accuracy of patient identification.

• Improve the effectiveness of communication among caregivers.

• Improve the safety of using medications.

• Reduce the risk of health care–associated infections.

These measures, if are applied correctly without doubt are very effective in protecting the

patient. The NP must constantly make sure that is on the right patient for this must use at least

two patient identification, not guided by room number or physical location. The NP must

maintain constant communication with relevant caregivers to ensure that the results of tests and

other procedures are immediately informed in order for action (if necessary) as soon as possible

avoiding delays that may be harmful to the patient(The Joint Commission, 2015,pp.1-2).
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The safe handling and administration of medication is a vital part of the work of NP which

must be at least twice sure that it is correct what will be administer, must maintain strict control

of storage and labeled medications. Also is their task to educate about the drugs patient is taking,

dose, route of administration, indications, possible side effects and risks of use such as

anticoagulant therapy(The Joint Commission, 2015,pp.3-6).

The extreme care to prevent the spread of infection is another of the most important tasks. It

should be zealous in carrying out measures designed to prevent sepsis in invasive and surgical

procedures; the NPSG makes greater emphasis on hygiene hands saying: "Either the Comply

with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the

current World Health Organization (WHO) hand hygiene guidelines"( The Joint Commission,

2015,pp.8-12).

Correspond to NP meet these and other measures of NPSG, perhaps more than other health

professionals due to the nature of their work. Compliance will depend largely the success of its

task.

Since the early twentieth century has been using the idea of the term "specialist in nursing"

and it was not until 1960-1970 that the NP role was introduced and expanded. The term "advance

practice" arises in the 80 'with which gains more strength and growth specialty (Hamric et

all,2014,p.2). Today ARNP represents about 8% of the nursing workforce in United States and

70-80% of those are working in primary care (Naylor, M. D., & Kurtzman, E. T. ,2010, p.893).

In this paper we will focus on reviewing two articles of research and one expert opinion about

Nurse Practitioner which is the specialty we are studying at South University.

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The work of the NP can be applied in different fields of health care, so we've chosen a

research about its impact in the Emergency Department (ED)( Li, J., Westbrook, J., Callen, J.,

Georgiou, A., Braithwaite, J.,2013,p.1) and other on its role in primary care(Naylor, M. D., &

Kurtzman, E. T.,2010,p.893). The article of an expert opinion comments on what needs to know

the public about NP (Ulrich.,2010,p.14).

Despite proven benefits, full compliance with the NP as part of health systems has been slow

in many places and met some resistance among both, health professionals and in some areas of

the population as was found in Australia( Li et all,2013,p.1). People have the right to choose who

treats and many residents prefer to be cared for by doctors instead of NP (Ulrich,2010,p.14), and

the impact of the role of MP in the ED for example is seen differently by health personnel such

as directives, doctors, nurses, and even the own NP (Li et all, 2013,p.6) . Moreover Naylor &

Kurtzman, (2010, p.894) found that there are still many bureaucratic obstacles that prevent the

proper formation of NP despite existing needs.

As we have seen there are many obstacles that hinder and frustrate the work of the NP.

Historically the image of the white coat is the one that connects people with medical care

(Ulrich, 2010, p.14). The traditional belief that the doctor is the gold standard in decision-making

in health care is perhaps the main obstacle to the full development of the work of NP and there

are criteria for health managers who advocate the importance of adherence to established scopes

of practice to recognize that the NP is an independent practitioner (Li et all, 2013,p.5-6). But

since 1974 a study in Canada showed that patient outcomes including mortality, satisfaction, and

physical, emotional, and social functioning among patients seeing NP were equivalents to those

seeing by physicians (Naylor & Kurtzman, 2010,p.894).

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In the three articles we reviewed there is consensus based on their studies that there is no

substantial difference in the quality of care provided and the results between NP and physicians

despite the scope of the work of both differs. Recall that the work of NP adheres to the principles

of nursing and by these is governed.

The NP as a specialty has come to stay and to meet the growing needs of the health system

due to population growth, chronic diseases, disabling diseases and the decreasing number of new

residents in medicine that forces them to seek new ways to ensure these needs. The impact of the

role of MP in different areas of the national health system is undeniable and this is applicable to

other countries despite differences of opinions and views. The NP has proved be efficient in both

ED and primary care.

Another important aspect to consider is the cost-benefit estimates for care provided by the

NP. Several studies based on insurance claims have demonstrated the lower cost associated with

the care of NP compared to physicians that can reach 20-35% less (Naylor & Kurtzman, 2010,p.

895). In favor of the above Ulrich (2010, p.14) suggests that NPs are licensed practitioners who

are trained to provide services similar to physicians but at lower costs.

As we know NP is a relatively new specialty and like almost everything new it will have to

force his way to demonstrate the need for full implementation on the scene of the Health System.

There is resistance to this. Phillips’s study (as cited in Ulrich,2010, p.15) states: “Far too often,

nurse practitioner and physician professional organizations do not work together but rather

expend considerable effort jousting in policy arenas. Turf battles interfere with joint advocacy

for needed health system change and delay development of interdisciplinary teams that could

help patients”. That is, they work together for a statement that is established and must be

fulfilled instead of doing interdisciplinary work in favor of the patient.

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It is recommended that should create Innovative interdisciplinary care models and

respectful dialogue between the different types of health care providers to guide toward better

cost-benefit and results in health care(Ulrich, 2010,p.15).

Trying to find solutions, Naylor & Kurtzman,2010,p.896-898 proposes to promote more

effective use of the work of NP, that must be implemented various measures to ensure

consistency with professional standards, strengthen collaboration and professional provider's

accountability, and better access to primary care high quality. These measures are: Remove

unwarranted restrictions, Equalize payments, Increase nurse’s accountability, Expand nurse-

managed centers, Address professional tensions, Fund pipeline expansions, and Pursue further

study.

The educational aspect to the population must be taken into account. The NP has a big

challenge ahead to expand the role of providers of alternative care, but to achieve this has to

break down the barriers that have been imposed by communicating its capabilities and benefits

of their services (Ulrich, 2010, p .15). This task is not only of the NP, should be shared by all

workers in the health system including in first place the leaders.

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References:

APRN Joint Dialogue Group Report, (2008) Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification & Education. Retrieved from:
http://www.aacn.nche.edu/education-resources/APRNReport.pdf.

Hamric, Ann. B., Hanson, Charlene. M., Tracy, Mary Fran, O’Grady, Eileen. T. (2014)
Advanced practice nursing: an integrative approach. [Vital Source Bookshelf]pp 2-111.
Retrieved from: www.myecampusonline.edu.

Li, J., Westbrook, J., Callen, J., Georgiou, A., Braithwaite, J.(2013) The impact of nurse
practitioners on care delivery in the emergency department: a multiple perspectives
qualitative study. BMC Health Services Research, 13(356),1-8. doi:10.1186/1472-6963-
13-356.

Naylor, M. D., & Kurtzman, E. T. (2010). The role of nurse practitioners in reinventing primary
care. Health Affairs, 29(5), 893-9. Retrieved from
http://search.proquest.com.southuniversity.libproxy.edmc.edu/docview/304562994?pq-
origsite=summon.

The Joint Commission (2015). National Patient Safety Goals Effective.pp.1-17. Retrieved from:
http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf.

Ulrich, C. (2010). Nurse Practitioners: What Does the Public Need to Know?. American Journal
Of Bioethics, 10(8), 14-15. doi:10.1080/15265161.2010.494221.