Nursing, as a field, is an ever-evolving career that continues to push boundaries as healthcare continues to change and expand. Within the past 175 years, nurses began taking new responsibilities never before seen with the guidance of more experienced personnel. With this new wave of education, advanced practice nursing began to form. One of the more recent and fastest growing nursing professions is the role of the nurse practitioner (Denisco, 2016). With a new profession on the spectrum, the board of nursing must have appropriate standards, licensure, and regulations to adhere to policies that change state-by-state.
Advanced practice registered nursing (APRN) can be separated into four different specialties: certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). All of these require a minimum of a masters’ education within the scope of one of these groups: family/individual across the life span, adult–gerontology, pediatrics, neonatal, women’s health/gender-related, and psych/mental health (Johnson, 2008).
Within the advanced practice roles, each APRN has a very specific role. CRNAs practice anesthesia alongside Anesthesiologists in surgery centers and operating rooms nationwide. Certified nursing midwives’ specialize with the obstetric population along with woman’s health and throughout the birthing process. Certified nurse specialists are more in tune with the pathway of diseases and can be found alongside Hospitalists in acute care setting such as rounding on patients in a hospital. Nurse practitioners are similar to CNSs with the exception that NPs may prescribe medications in all 50 states.
They not only take care of the six general populations mentioned earlier, but began in aiding physicians who began leaving primary care to subspecialize (Denisco, 2016).
According to the National Council of State Boards of Nursing (NCSBN), there are over 267,000 APRNs within the United States (About the APRN, 2019) and approximately 192,000 of those APRNs are classified as nurse practitioners (Denisco, 2016).
In the state of Tennessee, APRNs are more properly known as Advanced Practice Nurses (APNs). According to the Tennessee APN Certification Requirements (2019), APNs must begin by holding a bachelor’s degree in nursing and then advance to a masters’ level or higher, for example, Masters of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Nurse practitioners must attend and successfully graduate from an accredited program and must pass a licensure exam that will enable NPs to practice within the state of Tennessee.
The role of the nurse practitioner recently turned 50 years old and with such a young and booming advanced practice position, many professional organizations have begun appearing geared toward the NP. There are many organizations ranging from the national level to the state level and even separated by location. A large organization, the American Association of Nurse Practitioners (AANP) strives to make the voices of those NPs heard. Because there is strength in numbers, it is beneficial to support these types of membership-based establishments. Along the state level and smaller, like the Middle Tennessee Advanced Practice Nurses and the Tennessee Nurses Association, there is a focus on issues affecting those who practice right “at home” where it matters.
Within the advanced education, specifically for nurse practitioners, the classes of Advanced Pharmacology, Advanced Health Assessment, and Advanced Pathophysiology/disease prevention must be taken and successfully completed (Johnson, 2008). Proper clinical sites and hours must also be completed and correctly documented. The certification must be within one of the six population focus groups, for example, a CRNA would not become certified in women’s health alone. Unlike becoming an RN where your NCLEX was your standard licensure exam, there are two widely accepted licensure exams a student may take. The American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) are accepted licensure exams approved to become a certified nurse practitioner.
There are multiple subspecialties within the nurse practitioner realm. If an NP chose to work in a clinic setting in the state of Tennessee, they must be under the supervision of an MD. With this, they collaborate with physicians within their clinic to help bounce ideas off of each other. Clinics can be a host of pediatrics, adult/family, throughout the lifespan, or even geriatrics. If an NP wanted to specialize in psychiatric nursing, not only would they brush shoulders with psychologists, but also social workers, counselors, and psychiatrists to name a few. Nurse practitioners in hospital settings also deal with all sorts of age ranges and also work with nurses, medical assistance, and certified nurse assistants.
As a nurse practitioner, you may be considered a “mid-level practitioner” or an “advanced practice professional” because you respond to someone higher than yourself, for example, a doctor at your clinic site. Because you are an advanced practice professional, your education is more advanced and specialized than your ancillary staff such as registered nurses, licensed practical nurses, medical assistants, and patient care technicians. Knowing this, you hold some leadership authority when your nurses and assistants ask for your medical opinion on a particular case or patient. You play an important role by not only being able to answer questions but also ask for opinions from someone higher up than yourself. When you take input from unequal levels and evaluate them, you might be known as a democratic leader or a participative leader. To accomplish this type of leadership successfully one must utilize listening skills and weigh out the options presented to you. Not only are you actively asking your peers but those affected.
To ensure you become the best leader possible, it is essential to value the opinions of all staff equally. If your doctor, someone higher up than yourself could benefit from one decision but it ruins the rest of your staff, voting and discussions may need to take place for everyone involved. At times it may be difficult to value everyone’s opinion but being neutral may also help and benefit your decision making or even the way you participate with input.
Physicians have been leaving primary care since the mid-1900’s and that left a gap of people underserved, specifically pediatrics. This is how the nurse practitioner career began. In today’s world, we struggle to provide primary care in rural communities far away from the big city, higher salaries. This advanced practice nurse role can fill the void that is felt among outlying towns and country life. In the state of Tennessee, practitioners must be supervised by physicians but how can that be if physicians are choosing to stay away from the areas outside of their comfortable traveling zone? A paper was written by the University of Memphis detailing why nurse practitioners should have expanded roles within the workplace, specifically in Tennessee. These major points were directed towards legislators to emphasize the inequality of compensation, scope of practice, and to fully utilize the role of a nurse practitioner. In this entry, Chang, Zhan, Mirvis, and Fleming (2015) highlight lack of care in rural areas, recommend fully implementing the APRN consensus model and fill the vacant positions nurse practitioners can relieve.
Nurse practitioners have more resources at their fingertips than ever before because of the easy access to the internet, but how do they know their information is accurate? Organizations such as the American Association of Nurse Practitioners (AANP) provide their members with access to The Journal of the American Association of Nurse Practitioners (JAANP) and The Journal for Nurse Practitioners (JNP) that are peer-reviewed journals that are relevant and original articles that can expand knowledge on subject matter that is unfamiliar to an NP at any given time. Along with journals, the AANP provides digital clinical resource tools. If you do not belong to an organization, there are many apps that can assist with drug interactions and uses, essentially a medication card in your pocket.
Deciding to become a nurse practitioner may seem discouraging to some with certain states limiting the scope of practice. Those who continue down a fulfilling path always place patient care first and never lose sight of their first mission – to be a patient advocate.