What is the Role? Christy Holshouser University of Alabama at Birmingham School of Nursing
NFH 601 Dr. Anne Williams 3-18-09
What is the Role? Introduction My journey to pursue the role of Nurse Practitioner (NP) had its inception approximately two to three years ago when I was in Uganda, Africa traveling with Operation Renewed Hope (ORH) and conducting medical clinics in local villages. I had worked in a pediatric intensive care unit for eight years at this time and had traveled with ORH for two years primarily serving as head nurse. On this particular trip, I was asked to work with the physicians and to care for the children. This experience sparked a fire that pushed me to consider an advanced practice nursing role. My expectations of this role are to increase my knowledge, assessment, and diagnostic skills in the medical care of children and families to be able to function as a practitioner for the children on these medical mission trips. The role of a nurse practitioner is an advanced practice role as evidenced by meeting the advanced practice criteria of expanded knowledge and specialization, certification, and a clinical focus on patient care. The National Organization of Nurse Practitioner Faculties (NONPF) indicates the NP competencies as follows: consultation, research skills, clinical and professional leadership, collaboration, ethical decision-making skills, and expert coaching and guidance (NONPF, 2002). Direct clinical practice is identified as the core competency of the advanced practice nurse (APN). Hamric, Spross and Hanson state that “what distinguishes APN practice is the expectation that these competencies are visible in the practice…” (Hamric, Spross & Hanson, 2005, p. 96) Comparison Table The following table lists a comparison of three professional roles. These roles include Nurse Practitioner, Clinical Nurse Specialist, and Social Worker.
Comparisons Specific functions
Independent versus collaborative role Education Licensure Certification
Nurse Practitioner 1. Direct clinical practice: a. Assessment b. Diagnosis c. Management of care d. Prescriptive treatments 2. Consultation 3. Research skills 4. Clinical and professional leadership 5. Collaboration 6. Ethical decision-making skills (NONPF, 2002) Collaborative role
Role comparison table Clinical Nurse Specialist 1. Consultation 2. Professional expert 3. Case manager 4. Educator 5. Director of patient care 6. Research skills
Social Worker 1. Research skills 2. Advocacy 3. Case manager 4. Supervisor 5. Legislative practice 6. System design
Master’s degree Doctorate degree
Bachelor’s degree Master’s degree
Licensure standards vary by state 1. Examination required for certification 2. Obtained through American Nurses Credentialing Center or American Academy of Nurse Practitioners
Licensure standards vary by state 1. Examination required for certification 2. Certification in specialty areas are currently being developed 3. Obtained through American Nurses Credentialing Center and other specialty organizations
Bachelor’s degree Master’s degree Doctorate degree Licensure standards vary by state 1. Dependent on at least Master’s degree level of education 2. Based on professional experience
The Role Scope of practice
Provide primary care to patients including: 1. Obtaining health history and performing physical assessment 2. Manage acute and chronic illness 3. Educate patients in health management and disease prevention 4. Manage prescriptive therapies 5. Identify patients in need of referral services Initiated in response to a physician shortage
Work with patients, nursing personnel and organizational systems to provide expertise in education, consultation and research that will provide quality outcomes
Work with individuals, children and families to aid in coping with issues, relationships and activities of daily living including: 1. Finances 2. Domestic and marital dysfunction 3. Unemployment 4. Abuse and neglect
1. Not usually involved in direct patient care 2. Developed to improve the quality of nursing care 3. Work with a specific population
Work with a specific population
Summary The comparison table above delineates the separate characteristics of each identified role and helps to show the similarities and differences between each role. The three roles compared focus on aspects of patient/client care although that care may or may not be direct care of the person. All three roles require a higher level of education and licensure to practice, and they may be complemented with certifications specific to patient populations. Consultation, research, collaboration, and education are also key components to each of these roles. In summary, to be able to effectively function in a desired role, a professional must first be able to differentiate that role from the role of other professionals. Role development and definition is a dynamic function that is crucial in providing quality care to the population being served.
References Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 200809 Edition, Social Workers, on the Internet at http://www.bls.gov/oco/ocos060.htm (visited March 18, 2009). Christian, S., Dower, C., & O'Neil, E. (2007). Overview of nurse practitioner scopes of practice in the United States-discussion [Electronic version]. University of California, The Center for the Health Professions.. Hamric, A. B., Spross, J. A., & Hanson, C. M. (2005). Advanced practice nursing: An integrative approach. St. Louis, Missouri: Elsevier Saunders. National Organization of Nurse Practitioner Faculties. (2002, April 1). Nurse practitioner primary care competencies in specialty areas: adult, family, gerontological, pediatric, and women's health. . Teicher, S., Crawford, K., Williams, B., Nelson, B., & Andrews, C. (2001, August 1). Emerging role of the pediatric nurse practitioner in acute care. Pediatric Nursing, 27(No. 4), 387.