The role of the psychiatric nurse practitioner

Policy, organizational management, and research roles have received little attention in this article because the focus has been on the practice role. It must be noted, however, that psychiatric nurse practitioners often assume these roles. Many psychiatric nurse practitioners have discovered that their expertise in communication and systems assessment prepares them well for policy and management positions. The influence of public and private policy on practice and the lives of mentally ill persons has led psychiatric nurse practitioners to become active in the public policy arena. Similarly, psychiatric nurse practitioners' grounding in practice and training in research allows for participation in planning and conducting studies that will inform policy makers as the mental health reform process continues. The psychiatric nurse practitioner title and role have evolved in response to regulatory desire for consistent titling of advanced practice nurses and community need for practitioners with the skills in assessment, psychotherapy, psychopharmacology, and care management. Nursing academic institutions are working to develop new programs to prepare the psychiatric nurse practitioners of the future in the wide range of skills needed for this role. Practice subspecialties and settings vary, but in all instances the psychiatric nurse practitioner offers a blend of nursing and psychiatric specialty care that, in many cases, is substitutive for that of a psychiatrist. In the current era of health-care reform, fiscal constraint, and burgeoning health-care technology, the practice, research, and policy roles available to and occupied by psychiatric nurse practitioners are many. The primary threat to full actualization of the psychiatric nurse practitioners' potential is that advanced practice nursing will choose to be wedded to anachronistic ideologies regarding nurse practitioners and clinical specialists.     

A collaborative program for advanced practice in trauma/critical care nursing

The students and faculty enrolled in the first TNP class have set a standard for future TNPs: a rigorous course of education with advanced practice and scholarship within an advanced practice collaborative model. Because of the increasingly number of trauma victims and the highly specialized care they require, nurses must come forward and provide quality care. The TNPs and their faculty must promote further recognition of the TNP role, become leaders in the field of acute care, and continue to develop and maintain collaborative relationship with physicians in support of advanced practice nursing in many areas of tertiary care. The first three graduates of the trauma/critical care practitioner class are now employed in advanced practice roles and are applying their education within trauma/critical care settings. Two of the students are trauma nurse practitioners in a community hospital, and one is a critical care nurse practitioner in a university hospital. Currently, there is an acute care nurse practitioner certification examination that is appropriate for nurses in the field of trauma/critical care. Co-sponsored by the AACN Certification Corporation and the American Nurses Credentialing Center, this examination is offered twice a year, in June and October. AACN is active in supporting and promoting the TNP role and, in conjunction with the American Nurses Association, has developed new standards of care and scope of practice to include this expanded role for the advanced practice nurse. The future for this exciting and demanding role looks bright for the advanced practice nurse interested in the care of the acutely ill patient. The time is right for this collaboration between nurses and physicians.     

Coping with transition: neonatal nurse practitioner education for the 21st century

As neonatal intensive care nurses face downsizing and/or cross-training, new opportunities are emerging for advanced practice nurses in follow-up care of neonatal intensive care unit graduates, case management, quality improvement, and community hospital care. This article identifies current issues in neonatal nurse practitioner (NNP) education as the model has shifted from hospital-based, certificate programs to graduate degree programs offered by colleges/universities of nursing. Opportunities for increasing NNP role flexibility and recommendations for bridging the transition to a 21st century education model for neonatal advanced practice nurses are also discussed. Despite the turmoil of change and uncertainty, the future for neonatal advanced practice nurses is positive. Successful nurses will master the skills of adaptability, flexibility, self-directed learning, leadership, and the provision of relationship centered care. Neonatal nursing educators must constantly monitor clinical practice and re-evaluate the curriculum to ensure the necessary knowledge and skills for successful practice can be achieved from the educational program. It is critical that faculty are cognizant of emerging trends and changing roles in the practice area. Additional learning opportunities may be required for graduates to successfully move into the next century.     

The self-concepts and motivational orientations of registered nurse master's degree students

The results of this investigation indicate that nurses enrolling in nursing master's degree programs are motivated to do so for reasons related to professional achievement and increasing their knowledge base. Many of the respondents indicated the desire to seek positions that reflect the more advanced practice roles in nursing, such as clinical nurse specialist, nurse practitioner, or nurse educator, upon completion of the degree. This is significant when considering that the investigation was conducted during a serious nursing shortage when much emphasis was placed on the recruitment and retention of staff nurses to work at the bedside (Fenner, 1987). The results of this investigation have implications for nursing educators and program administrators in master's degree programs. The seven motivational orientations underlying the reasons for returning to school should be considered when evaluating the ability of their programs to meet the needs and goals of their applicants. This might be accomplished by the exploration of the applicants' reasons for returning to school as well as their professional goals upon completion of the degree during the application process. An exit interview done on completion of the degree requirements could also be performed to determine if the program met the needs of the student.     

Concern, continuity, and choice: a health promotion formula for advanced practice nurses

Promoting health in a newly established nurse practitioner family practice was a major undertaking for one advanced practice nurse (APN) in a semi-rural community in southern California. The alignment of the resources necessary to begin such a practice opened many doors not previously traversed by nurses in this community. Likewise, the development of a formula and model for health promotion came about as a result of overcoming the obstacles to starting this private practice as well as the positive rewards of patient encounters over time. Episodes of concern for patients, continuous care, and choices in health care decisions come together to illustrate this formula. The research data supporting the practice further demonstrate the plausibility of the APN becoming a provider of health promotion in the primary care setting.     

Biochemical mechanisms of the toxic effect of oxalates

Australian nursing is undergoing major changes in practice, education and research in a climate of burgeoning health-care costs, and changing priorities and service directions. The government is searching for new ways to deliver services that are appropriate and equitable while focusing on containing costs. These are signs that it is an opportune time for nurses to test new roles, and one suggested way to provide extra cost-effective service is through the use of nurse practitioners. In order to improve the delivery of mental health services, the nurse practitioner specializing in mental health can provide a link between the community and the primary care provided by general practitioners. A proposed model for nurse practitioners in mental health is presented as a means of bridging this gap.     

Perioperative nurse practitioners

Perioperative nursing roles are evolving in response to health care reform, technological developments, and changing opportunities for advanced practice nursing. One response to these changes is the development of the perioperative nurse practitioner role. The perioperative base for this new advanced practice role is described in this article. The advanced practice role is effective in other specialty settings and can be developed readily in a variety of surgical settings. This role requires a master's degree in nursing to provide the academic and practice preparation for clinical decision making and patient management in the perioperative setting. Future opportunities for perioperative advanced practice nursing are discussed.     

RfaH and the ops element, components of a novel system controlling bacterial transcription elongation

PURPOSE/OBJECTIVES: To describe the foundational work and implementation of a nurse practitioner (NP) curriculum geared toward oncology nurses. The study is selective (not comprehensive) and reflective of one school's experience. DATA SOURCE: Journal articles, curriculum guidelines, anecdotal experience, and interviews. DATA SYNTHESIS: The NP is used more frequently in oncology, both as a clinician and for other aspects of advanced practice nursing. NPs must be prepared to fulfill graduate criteria as outlined by definitive sources for curriculum development. CONCLUSIONS: Schools must work with employers, graduates, and patients in conducting outcome evaluations to measure safety issues and role effectiveness of oncology NPs (ONPs), as well as fulfillment of all aspects of the advanced nursing practice role. IMPLICATIONS FOR NURSING PRACTICE: If healthcare employers continue to rely heavily on the use of ONPs, schools of nursing must be prepared to graduate safe clinicians, experts in oncology, and advanced practice nurses, all combined into one graduate. This difficult task requires evaluation of current practices.     

The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role

The purpose of this article is to provide an historical overview of the clinical nurse specialist and nurse practitioner roles in psychiatric nursing. This article is written as a follow-up to that of Dyer, Hammill, Regan-Kubinski, Yurick, & Kobert, (1997), Archives of Psychiatric Nursing, 11, 2-11, in which a new paradigm for delivering comprehensive mental and general health services is conceptualized, i.e., the psychiatric-primary care nurse practitioner role. In this article an alternative model is presented: the psychiatric clinical nurse specialist/nurse practitioner role. Similarities and differences in the two roles are discussed.     

Evaluation of a multidrug chemotherapy protocol (ACOPA II) in dogs with lymphoma

The introduction of market forces into health care delivery systems has had a number of important influences on the roles nurses perform. There have been increasing efforts to find alternative and more cost-effective ways of delivering care. One facet of this situation has been the examination of the roles and responsibilities of registered nurses (RNs) with the view of exploring different ways of using professional skills and determining if RN services are always required. One result of this has been the increased use of unlicensed personnel. The substitution of professional nursing staff by unlicensed personnel has become a major concern for practitioner, manager and client alike. This paper reviews some of the concepts of economic substitution as well as the assumptions advanced for the use of unlicensed personnel in clinical areas as a substitute for nursing services. While there has been increased use of unlicensed staff, the evaluation of clinical outcomes has been poor. This paper reviews primarily the hospital-based evidence about the impact of using unlicensed personnel in practice, and suggests there are methodological problems with the research published to date. Findings suggest that substitute service providers generally 'do no harm'. By contrast, evidence is presented indicating the major contributions nurses make to client care when adopting advanced practice roles (acting as a substitute for other professionals).     

Development of specialist and advanced practice in North America

North American literature provides interesting ideas about the nature of specialist and advanced practice which are useful in informing British thinking on these subjects. However, the two roles do not have the same meanings as their British counterparts. Clarification of the terminology used and the roles described are essential if we are to understand the concepts. This article presents an overview of the literature about clinical nurse specialist and advanced practitioner roles within North America and identifies differences and similarities between the two.     

CD4(+) T cells tolerized ex vivo to host alloantigen by anti-CD40 ligand (CD40L:CD154) antibody lose their graft-versus-host disease lethality capacity but retain nominal antigen responses

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.     

Advanced nursing practice in the USA: new directions for NPs

The demand for nurse practitioners (NPs) continues to increase in the USA and, as a result, the NP role is expanding. Originally, NPs were primarily based in the primary care arena; however, they are now filtering into secondary and tertiary healthcare settings, bringing with them advanced clinical skills. This has led to many clinical nurse specialists undertaking NP programmes. American nurses are now calling for a merger of these two roles and for changes in NP training programmes that will prepare practitioners for work in secondary and tertiary care environments as well as primary care settings. British nurses continue to examine the perimeters of advanced nursing practice; however, the realms of secondary and tertiary care should not be neglected, but rather incorporated into these developing roles and educational preparations.     

Advanced practice nursing certification: where do we go from here?

Certification requirements for advanced practice nurses (APNs) vary between APN specialties and the certification agencies. This variability perpetuates confusion for APNs, the health care system, and the public. Recommendations are made for the certification of APNs: (1) standardization of the certification process for APNs, (2) consistency in the requirement for graduate level education for all APNs, (3) regulation requiring certification for practice in all states, and (4) nurse practitioner (NP) program accreditation or preaccreditation for eligibility to take the certification examination. To support these recommendations, two questions are considered: Where are we now in certification? Where do we need to go?     

Advancing nursing practice: acute care nurse practitioners meet challenges at and beyond the health care horizon

Preparation of advanced practice nurses (APNs) with acute care skills relevant to today's health care environment is a challenge faced by nurse educators, care providers, professional organizations, and regulatory agencies. The acute care nurse practitioner (ACNP) is prepared to provide multidimensional, risk-appropriate management of medically vulnerable patients with serious illness in a variety of settings. ACNPs conduct comprehensive health assessments, order and interpret diagnostic tests, diagnose and manage health problems and disease-related symptoms, prescribe and evaluate drugs and treatments, and coordinate care during setting transitions. Working independently and collaboratively the ACNP enhances access to care and quality of care for patients and families through cost-effective, outcome-oriented practice. This article describes health care market factors fostering ACNP practice, ACNP practice domain, the University of Washington ACNP program, and collaborative contributions from educators, care providers, professional organizations, and regulatory groups needed to implement the role.     

Application of caring theory in primary care: a challenge for advanced practice

That caring is central to nursing is now axiomatic. But has this concept been transferred to advanced nursing practice in primary care? The following article will present reflections on the use of caring in advanced practice in primary care. It is suggested that the nurse practitioner's and other advanced practice nurses' (APNs') use of caring sets nursing's contributions to primary care apart from other providers' practice. A vision is discussed in which professional caring frames the delivery of primary care's nursing therapeutics. How-tos are suggested for delivering professional caring in today's hectic health care environment. Ways the APN can create strategies for renewing caring energy are presented.     

Informatics nurse specialist: roles in health care organizations

The cost of managing and processing health care information is a significant component of hospital operating budgets, yet health care lags far behind other industries in the effective use of information technology. As nurses are the largest group of users of health care information, improving nurses' information management capability could have a significant impact. Informatics nurse specialists understand the concepts and technology of nursing information management and can provide operational and strategic benefits to nursing organizations. In this article, educational preparation, certification, and roles of informatics nurse specialists are discussed along with functions of health care information technology and nursing informatics.     

Advanced practice nurses: how did we get here anyway?

Historical events leading to the evolution of the present-day advanced practice nurse (APN) are discussed, as is the development of specialty nurses, nurse anesthetists, nurse-midwives, clinicians, and nurse practitioners. A review of legislation, education, regulation, and events that influenced the role development of the APN is presented.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.