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This issue of Nursing Clinics, Guest Edited by Robin Dennison, DNP, MSN, CCNS, RN, will focus on Future of Advanced Nursing Practice with topics including: regulatory procedures for APNs; future of the NP role; future of CNS role; future of nurse midwife role; future of the nurse anesthetist role; impact of LACE in public health; merging roles of the psychiatric mental health CNS and NP; impact of DNP on AP roles; future of reimbursement for APNs; role of APN in EBP; genetics and APNs; APNs in medical home; and executive role of the APN.
Table of Contents
Preface Robin Donohoe Dennison xi
The Future of Nurse Practitioner Practice: A World of Opportunity Mollie E. Aleshire Kathy Wheeler Suzanne S. Prevost 181
Health care is transforming at a rapid pace. Nurses should be leading change and advancing health in this increasingly complex health system. The multiple systemic health care changes occurring secondary to the 2010 Patient Protection and Affordable Care Act make this an optimal time for full use of nurse practitioners (NPs). This article describes the evolution and future of the NP role, explores the practice in relation to regulation and policy; primary care; acute care; international, global, and cultural issues; and public image, and addresses how NPs must prepare for changing health care environments and consumer demands.
The Bright Future for Clinical Nurse Specialist Practice Stephen Patten Kelly A. Goudreau 193
This article discusses the past, present and future of Clinical Nurse Specialist (CNS) practice and education and identifies how 4 major shifts will impact CNS practice: 1) the APRN Consensus Paper, 2) the Affordable Care Act, 3) the Institute of Medicine's 'Future of Nursing' paper, and finally 4) the journey to Magnet status for many institutions. Each of these documents and/or themes has had, and will continue to have, a major impact on the future of CNS practice. The future is bright for CNSs as the role has an extremely important part to play in ensuring high quality patient outcomes.
Nurse-Midwifery: Art and Science Debora M. Dole Cynthia F. Nypaver 205
The gap in the health of the nations' people seems to be widening and reflects existing social inequalities affecting the ongoing health of individuals. From a historical and practical perspective, certified nurse-midwives (CNMs) are one group of advanced practice registered nurses uniquely situated to address existing disparities related to maternal-child health. This article provides an overview of the historical development, current status, and use of CNMs in the United States health care system; the impact of CNMs on maternal-child health outcomes; and future trends in the education of GNMs.
Nurse Anesthesia: A Past, Present, and Future Perspective Wanda O. Wilson 215
The US health system needs to make efficient use of resources and avoid duplication of effort. The United States needs to examine how to make best use of highly qualified advanced practice registered nurses to drive a more efficient and effective health care system. Certified registered nurse anesthetists will help manage this change by continuing to provide patient access to safe, cost-effective anesthesia care; knowing the direction in which health care is headed; being politically active at the state and federal levels; educating the public about the value of nurse anesthetists; and being involved at the local community and institutional levels.
The Doctorate in Nursing Practice: Moving Advanced Practice Nursing Even Closer to Excellence Robin Donohoe Dennison Camille Payne Kathleen Farrell 225
One of the most significant events to affect advanced practice nursing is the practice doctorate. The doctor of nursing practice (DNP) is firmly established as an educational alternative to the traditional academic research doctoral degree. This option empowers nurses to advance knowledge and skills in clinical practice. This article reviews the historical context that led to the introduction of the DNP and the proposal of the DNP as entry into practice for advanced practice nurses, DNP program parameters, and some of the evolving issues related to nursing's practice doctorate.
Impact of New Regulatory Standards on Advanced Practice Registered Nursing: The APRN Consensus Model and LACE Joan M. Stanley 241
Advanced practice registered nurses (APRNs) represent a crucial resource to meeting growing health care needs. Such resources must be used to the full extent and in the most effective way possible. Through the development of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education (LACE), nursing is assuming a leadership role within the health care system and participating as an equal partner in redesigning health care. When fully implemented, the Consensus Model will allow APRNs to practice to the full scope of their education and more easily move from one state to another, increasing access to quality health care for all populations.
The Movement to Improve Care: The Institute of Medicine Quality Reports and Implications for the Advanced Practice Registered Nurse Anita Finkelman 251
Since the late 1990s, there has been a movement in the United States to improve care. Nursing has been slow to embrace this movement. Nursing education was particularly slow in recognizing that the movement and the problem of health care quality related to nursing education, both undergraduate and graduate. To improve care requires efforts from practice and health care education perspectives. This article discusses the quality of care in the United States, the movement to improve, and some of the critical issues as they relate to advanced practice nursing.
The Role of the Nurse Executive in Fostering and Empowering the Advanced Practice Registered Nurse Tukea L. Talbert 261
The nurse executive plays a critical role in the design, oversight, and outcomes of the delivery of care and a key role in the success of the integration of advanced practice registered nurses (APRNs) into an organization. The critical areas that nurse executives must consider to foster and empower APRNs are: (1) knowledge and self preparation, especially of political initiatives that affect the role, (2) visionary leadership and development of clear role expectations and appropriate credentialing, (3) strategies to reduce disconnection between the APRN and their practice setting, and (4) appropriate education and marketing of the role to stakeholders.
The Role of the Advanced Practice Registered Nurse in Ensuring Evidence-Based Practice Marthe J. Moseley 269
The advanced practice registered nurse (APRN) is vital in role-modeling and ensuring evidence-based practice (EBP) engagement and application at the point of care. This article describes the formulation of national competencies for EBP, specific to the APRN level. The application of selected competencies is delineated and the creation of an APRN action plan to identify necessary EBP competencies is discussed. If EBP skills are lacking, the action plan is used for development of skills in the required areas.
The Impact of Interprofessional Collaboration on the Effectiveness, Significance, and Future of Advanced Practice Registered Nurses Dorothy Brooten JoAnne M. Youngblut Jean Hannan Frank Guido-Sanz 283
Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations.
The Future of the Psychiatric Mental Health Clinical Nurse Specialist: Evolution or Extinction Anita Dempsey Judy Ribak 295
The role of the psychiatric mental health clinical nurse specialist (PMHCNS) is now in a precarious position. At first glance, some may say it is on the verge of extinction. In this article, a brief history of the role of the PMHCNS is reviewed along with current education, practice, role, and American Nurses Credentialing Center certification of the PMHCNS. The future implications and considerations of the unique functions of the PMHCNS for an advanced practice registered nurse with a psychiatric mental health specialization are discussed.
The Future of the Population-Focused, Public Health Clinical Nurse Specialist Dawn Doutrich Jo Ann Walsh Dotson 305
This article addresses the need for continued certification of community and public health nurses at the advanced practice registered nurse level, and explores curricular avenues and policy recommendations with regard to certification and education of these nurses. The transformation of health care and burgeoning access to information has changed what the public expects and needs from health professionals. Nursing roles have expanded and transformed, in turn requiring that the education, licensure, certification, and accreditation of the professional likewise change.