The shortage of physicians has opened up abundant opportunities for advanced practice nurses (APNs). As barriers continue to be broken for APNs, they will continue to magnify their role in providing both primary and specialized care to patients. The purpose of this paper is to explore defining concepts of the advanced practice nurse, such as the roles of scholarship, the APN consensus model and certification requirements, ways of knowing, and the empiricism paradigm. It will discuss personal interest in the role of psychiatric-mental health nurse practitioner and describe how these defining concepts contribute to refining patient care and the nursing profession. Role of Scholarship
The four components to scholarship that APNs have a significant role in are knowing, teaching, practice and service. Scholarship of knowing is utilized by applying previous or current research to their current practice, as well as aiding in the formation of new knowledge. Scholarship of teaching emphasizes the importance of preparing advanced nurses to become “life-long learners” (Riley, Beal, Levi, & McCausland, 2002). Teaching should incorporate the significance of evidence-based practice (EBP) in the innovation of nursing as a professional practice, as well as in the advancement of patient care. Accountability and establishing therapeutic nurse-patient relationships are an important aspect of nursing practice (Riley et al, 2002). Collaboration with physicians and other professionals in the health care setting is another way APNs engage in practice. Ways APNs engage in service include organizing community health screenings, providing health and wellness teaching, advocating for the wellbeing of vulnerable populations, and helping with the advancement of the nursing profession. APN Criteria for Certification
The American Association of Colleges of Nursing (AACN) and the National Organization of Nurse Practitioner Faculties (NONPF) established the consensus statement, which aims to standardize the role of APNs. Establishing a regulatory model for the role of APNs will be a gradual process, and the goal is to have all practicing APNs certified at the doctorate level by 2015. There are four roles in the APN regulatory model that advanced nurses can be educated. Within these four roles, there are 6 different focus areas in which the APN can practice (National Council of State boards of nursing, 2008). The area of interest I am pursuing is that of a Psychiatric-Mental Health Nurse Practitioner (PMHNP).
The American Nurses Credentialing Center (ANCC) is the professional organization that certifies PMHNPs. PMHNP certification requires that an applicant must currently hold a valid RN license; graduate from an accredited psychiatric-mental health nurse practitioner program; complete at least 500 clinical hours that are faculty supervised and completed in at least two different methods of psychotherapeutic treatment; and complete graduate level curriculums in advanced pathophysiology, pharmacology and health assessment (ANCC, 2014). The PMHNP certification requirements meet the requirements of the APN consensus model. Conceptual Models/Framework for Practice
Hamric’s model of advanced practice nursing outlines four defining features for APNs. The primary criteria for APNs are graduate level education, certification, and their clinical focus. The central competency of direct patient care should include six core competencies, which include leadership, collaboration, ethical decision making skills, guidance and coaching, consultation, and evidence-based practice. In order for advanced practice nurses to be successful, APNs need to be able to manage the environmental elements that affect their professional role; Examples include the business aspects of the practice, regulatory and credentialing requirements, payment mechanisms, and outcome evaluation and performance improvement (Hamric, Hanson, Tracy, & O’Grady, 2014, p. 44). The specific elements incorporated in Hamric’s model make it a great example for guiding practice for the advanced nursing role. Ways of Knowing
The four major elements in nursing’s patterns of knowing are empirics, aesthetics, ethics and experiential. Empirical knowing is the science of knowing (Chinn & Kramer, 2011, p. 11). It uses evidence-based practices to shape the current way nurses provide care to patients. PMHNPs decision to use long acting injectable antipsychotic medications over oral medications as a way of addressing medication compliance is a way empirical knowing is used. Chinn and Kramer (2011) identify aesthetic knowing as “the art of nursing that can be expressed through the actions, attitudes, and interactions” between nurses and others (p. 9). Engaging in therapeutic interactions with mental health patients on the unit is a way I currently utilize the element of aesthetic knowing. The moral element of nursing knowledge is ethics.
A nurse must know how to handle situations in an ethical manner. Psychiatric registered nurses must utilize ethical knowing in order to preserve the dignity of patients when using physical restraints. As a PMHNP, one has an ethical obligation to admit patients to a crisis stabilization unit when a patient verbalizes that they are a danger to themselves or others. Experiential knowing is the type of knowing that a nurse learns and gains through experience. This element of knowing is one that I have continued to build on during my two years of experience as a psychiatric nurse. I believe that my interaction with the practicing psychiatrists and nurse practitioners on our psychiatric unit will also help continue to expand my experiential knowing for my transition into the role of an APN. Preferred Paradigm
The Empiricism and Interpretative paradigms are both important in the nursing role. Chinn and Kramer (2011) state that “empiric concepts are ideas that are formed from direct observation” (p.160). Monti and Tingen (1999) elaborate on the idea that empiricism is based on the idea that one is able to validate what they know through their sense of observation (p. 66). The empirical view supports the fact that nursing practice is implemented from previous evidence-based practice. I feel that the empirical view currently defines me in my role as a psychiatric registered nurse. However, psychiatric nursing is very subjective. It is in my opinion that for a nurse to be therapeutic in their nursing role, the nurse should engage in more interpretative views. As I transition from the role of RN to APN, I hope to become more interpretative in my nursing views. Future Contributions and Conclusion
There are many ways in which the role of APNs will contribute to advancing patient care and the nursing profession. The roles of scholarship for APNs will advance patient care through the continuous utilization of evidence-based practice research, as well as providing education and services to the community. The different ways of knowing will also help continue to mold and advance the delivery of patient care. The APN consensus model will contribute to the advancement of the nursing profession by setting high standards for certification and licensure of advanced practicing nurses. The role of PMHNP will aid in providing mental health treatment to those that have been unable to find treatment due to the lack of practicing psychiatrists.
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