Advanced Nursing Role: Family Nurse Practitioner

Introduction

Advanced practice nursing encompasses many different kinds of roles in nursing. At the master’s level of education in nursing, a few roles include nurse practitioner, nurse informatics, nurse educator, and nurse administrator. It is essential to have knowledge and understanding of these advanced practice nursing roles and how they are different and similar. This final written assignment we are going to discuss what I discovered about the different advanced practice roles and scope of practice found in the master nursing curriculum I am pursuing the advanced practice nursing role of the family nurse practitioner. My involvement in future leadership roles and participation in professional organizations will also be discussed.

Advanced Practice roles in Nursing

Advanced Practice Nursing is a function of educational and practice preparation and a constellation of primary criteria and core competencies. Direct clinical practice is the central competency of any APN role and informs all the other competencies. The advanced role means that the traditional nursing role is advanced into new territory through a graduate-level education that prepares the nurse for one of four APRN roles: nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), or a clinical nurse specialist (CNS). All APRNs are educated and prepared to provide a range of services across the health wellness-illness continuum, but each role varies in the emphasis and implementation of these services (NCBSN, 2008, p. 8). Advanced nursing practice should not be confused with advanced practice nursing (APN), which includes all other nurses with a master’s degree who in some form, practice advanced nursing practice, but do not fall in any of the four roles of APRNs.

Clinical Practice

As far as clinical practice goes, the roles between the nurse practitioner, nurse educator, nurse administrator, and nurse informaticist are very different. The nurse practitioner is responsible for direct patient care, seeing patients every day and diagnosing and treating their health care concerns. The nurse educator in a clinical practice setting such as a hospital is typically in a role where they evaluate, suggest, create, and incorporate programs to improve medical practices for patient’s safety. The nurse administrator, in a clinical practice setting, is responsible for a large group of departments or units within the health care facility. They are expected to monitor and address issues with staffing and patient satisfaction. The nurse informaticist, in a clinical practice setting, is responsible for the development and evaluation of applications, tools, and processes that assist nurses with the management of data when providing care to patients.

Primary Care

The nurse practitioner can act as a primary care provider as a family nurse practitioner in an outpatient setting providing direct care to patients to manage their health care plan. The nurse educator can work in the primary care setting by educating patients in their homes or at the doctor’s office in regards to general health care issues or specializations such as lactation and diabetic education. The nurse administrator in a primary care setting could include managing the nurses providing care to a community of home health care patients. The nurse informatics is still essential and needed in a primary care setting which would serve the same job description as the clinical practice just on a smaller scale so instead of a hospital, it would be more like an outpatient doctor’s office.

Education

The nurse practitioner works every day to educate their patients they see in order to promote the patient’s health care plan and meet their goals. The nurse educator’s whole job is based on the education of nurses, patients, and staff working together to promote patient safety and prevent health deterioration. The nurse administrator also plays a huge role in education as they are responsible for providing written and oral materials and presentations to diverse audiences on nursing, health care topics, and organizational issues (American Organization of Nurse Executives, 2015). The nurse informaticist educates nurses providing direct patient care on better ways to utilize computer technology and the charting of collected patient data.

Administration and Research

When it pertains to administration, the nurse practitioner, educator and informaticist do not play a significant role in this area. The nurse administrator works directly in and with the administration in their place of work and is responsible for a large group of staff and patients and must have a working knowledge of policies, procedures, budgeting, business, and legal issues. As far as research goes, the nurse practitioner, educator, administrator, and informaticist are all responsible for basing their practice off of evidence-based practice through research in order to ensure that they are practicing in the safest most effective way.

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They are several advanced nursing practices, Family Nurse Practitioner is the one that I enrolled at South University. Family Nurse Practitioner is an advanced practice registered nurse who works autonomously or in collaboration with other healthcare professionals to deliver family care. Family Nurse Practitioner offers healthcare services that involve a family unit, from health promotion and disease prevention to direct care and counseling across life. Who influenced me to choose FNP was the emergency room department, where I currently have three years of experience. I have seen many people died because they do not know how to take care of their condition. I am aware of the lack of education that our patients have, and I will like to take care of my patients, help them believe in them, educate them and lead them to a healthy life. My nursing philosophy is that I am a faithful believer that God always works for good that is why my goal for the patient is always to keep the faith and confront the situation been favorable. I believe in bringing empathy to patients and always carry a smile for them. I always keep in mind one quote of an unknown patient “Remember, I’m not usually this needy or scared. I am here because I trust you, helping me stay confident.”

Advanced Practice Role: Family Nurse Practitioner

I interview Evelyn Reyes that is an FNP that currently work in the Emergency Department about eight months ago, but she also has experience working as FNP in an outpatient clinic. She works under multiple Doctors in the ED. The emergency department that she worked offer services to all ages. Evelyn has always loved the medical field, but she decides to pick a career where she was able to treat and diagnose patients but not to go to school for that long. She states that the most challenging part of being a Family Nurse Practitioner would be the lack of full autonomy. She chooses this specialty because she thinks it is a good starting point that helps you build a good foundation.

Regulatory and Legal Requirements

A family nurse practitioner scope of practice represents the full range of practice privileges allowed by certification and licensure. However, all NPs must complete al that master’s program. The American Nurses Association defines the scopes of practice as the ‘’who, what, where, when, why and how of nursing practice’’ There are five primary practice standards for patient care: assessment, diagnosis, development of treatment plans, plan implementation and plan evaluation. In Florida, the advanced registered nurse practitioner may perform acts of nursing diagnosis and nursing treatment of alterations of health status. They may also perform acts of medical diagnosis and treatment, prescription and operation defined by the Board of Nursing. Nurse practitioners do not perform complex surgical procedures; they can perform some invasive treatment procedures. They are going to need a Registered Nurse License and be nationally certified and state licensed to practice as NP. For Accreditation, they will need                Accreditation Board for specialty nursing certification, The National Commission for Certifying Agencies, Commission on Collegiate Nursing Education (CCNE) and National League for Nursing Accrediting Commission (NLNAC). Family Nurse Practitioners need to be certified; the certification is called F family Nurse Practitioner-Board Certified. 

Professional Organizations

For the family nurse practitioner, numerous professional organizations can be joined. The American Association of Nurse Practitioners (AANP), Doctors of Nursing Practice, contributing to the political action committee (PAC), Alliance of Nurses for Healthy Environments (ANHE), American Academy of Nurse Practitioners (AANP), American Association for the History of Nursing (AAHN), American College of Nurse Practitioners (ACNP), National Nursing Centers Consortium (NNCC), and National Organization of Nurse Practitioner Faculties (NONFP). Becoming a member of a professional organization is vital for connecting with professionals within your field, networking, job opportunities, and continuing education. Many of these organizations hold annual conferences.

Required Competencies

As a family nurse practitioner (FNP), you are prepared to care for families and the individuals that make up those families, across the lifespan (National Organization of Nurse Practitioner Faculties (NONPF), 2013). The role of an FNP includes patient assessment, diagnosis, and treatment of acute and chronic illness, and preventative healthcare for families and individuals (NONPF, 2013). The commitment is to family-centered care by understanding the relevance of the community in order to deliver family-centered care. The National Organization of Nurse Practitioner Faculties identifies the following core competency areas of a family nurse practitioner; scientific foundation, leadership, quality, practice injury, technology, and information literacy, policy, health delivery system, ethics, and independent practice (NONPF, 2013).

Future Workplace

Once a become a Family Nurse Practitioner, I am thinking I want to work in an outpatient clinic or working with a specialist doctor. The colleagues I would be working with will more than likely also nurses, FNP and doctors. 

Leadership Attributes of the Advanced Practice Role

A democratic leader is a type of leadership in which members of the group take a more participatory role in the decision-making process. This type of leadership likes to allow everybody participates, ideas are exchanged freely, and discussion is encouraged. This is the type of leadership that I am.

Democratic leaders possess honesty, intelligence, courage, creativity, competence, and fairness. These are specific traits that I always use at my job. I like to inspire trust and respect among followers. I used to be a charge nurse in a Medical Surgical Unit, and my team tends to feel inspired to take action and contribute to the group because good leaders also tend to seek diverse opinions and do not try to silence voices.

Transformational Leadership

“Transformational leadership is, in essence, a relationship of mutual stimulation and elevation that raises the level of human conduct as well as the aspirations of both the leader and those led, and thereby has a transforming effect on both” Burns (1978) A collaborative approach is the essence of transformational leadership and under this leadership style, change is the result of a collective conscience nurtured by a self-aware leader. This leadership style is most appealing to this author as the author values rapport, empathy, transparency, honesty, communication, and fairness.

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Transformational strategies in this author’s leadership practice are to establish productive, interprofessional communication, to advocate for improved quality and cost-effective healthcare, to practice sufficient conflict resolution by listening and valuing the opinions of others, and to collaborate on the development and execution of advanced practice initiatives. This author’s strengths are focused on organization, effective communication, team-building, clinical skills, relationship-building, and advocacy. Advocacy will be an underlying current in this author’s approach towards change at the individual, community, organizational and policy level. As an FNP, transformational leadership will guide my practice through the implementation of these strengths, with quality patient outcomes always being the highest priority. Advocacy for the APRN profession will also be a priority, as the scope of practice restrictions “have undermined the nursing profession’s ability to provide and improve both general and advanced care” (IOM, 2011). Scope of practice advocacy is therefore essential to useful leadership competencies.    

Health Policy and the Advanced Practice Role

Value-based care is a contractual model of paying providers that compels greater alignment and collaboration between health plans, providers and, in many cases, employers to focus more holistically on patients and populations as well as the healthcare system that serves them. The proliferation of value-based care means we need to focus not only on patients’ clinical needs but also their life outside the physician’s office and its impact on their health outcomes, and increasingly to anticipate patients’ future health events and intervene to mitigate them.

Value-based care offers the possibility of increasing quality time with patients and ultimately helping to restore the joy of medicine; the physician may increase at organizations during the transition. Value-based care we have a fighting chance, the best chance to improve costs, quality, and outcomes for individual patients and populations as a whole.

The state of Florida is one of the most restricted states, requiring physician supervision or delegation, instead of collaboration, for NP’s to provide care.  Florida is one of only two states that do not allow NPs to prescribe controlled substances.

For effective change, the APRN must be knowledgeable and lead by example by actively taking part in the change process. Talking about the APRN role, contacting state legislators, and becoming a member of supportive associations are all ways the APRN can actively participate in support of the trend toward higher practice authority for APRNs. The impact of the APRNs attempts in transforming the current healthcare system can only be realized through strong leadership and consistent effort. 

Conclusion

Advanced Practice Registered Nurses are highly qualified clinicians with graduate-level nursing degrees, who are taught to provide a broad range of services in relation to the expertise and knowledge acquired within their specialty.  The APRN must be a leader, a collaborator, an innovator, and a policy-changer. The framework for this role is reflected in the advanced educational requirements, the expected core competencies of the advanced practice nurse, and the legal requirements and scope of practice set forth by each state’s practice act. It is up to the APRN, individually, to decide the leadership style that fits best and then to practice in a manner that is consistently aligned with quality patient outcomes. 

References

• Hamric, A. B. (2014). Advanced practice nursing an integrative approach.(5^th ed). Saunders. ISBN 9781455739806
• American Organization of Nurse Executives. (2015). AONE Nurse Executive Competencies. Retrieved from http://www.aone.org/resources/nec.pdf
• Page, A. (Ed.). (2004). Transformational leadership and evidenced-based management. In Page.
• Editor. (Ed.), Keeping Patients Safe: Transforming the Work Environment of Nurses. (pp. 108-161). Retrieved from file:///C:/Users/Computer_one/Downloads/108-161.pdf
• Burns, J. (1978). Leadership. New York, NY: Harper and Row.
• Cherry, K. (2016). What’s Your Leadership Style? Learn more about your strengths and weaknesses as a leader. Retrieved from https://www.verywell.com/whats-your-leadership-style-3866929