Introduction
The global economy, changing demographics, and soaring long-term sicknesses are driving major shifts in health care. In this unpredictable and dynamic climate, healthcare workers must display strong professionalism. Registered nurses in advanced practice nursing (APN) possess postgraduate training, professional expertise, multitasking abilities, and clinical competencies to expand their practice in their respective contexts.
This paper aims to describe and investigate the APN’s role within the context of professional guidelines, theory, and research. It also discusses APN practices in job descriptions, leadership, roles within the U.S. healthcare sector, and the Affordable Care Act (ACA). These features highlight the APN role’s complex nature, stressing its importance in the United States healthcare system and the influences of healthcare policy changes.
Ideal Versus Observed APN Roles
The ideal and observed APN roles are remarkably similar in theory, professional guidelines, research, and literature. In particular, literature and research serve as the base and source of information for patient care. Cleveland et al. (2019) indicate that research has shown that APN-led efforts, such as chronic illness management programs, preventive care initiatives, and patient education, are beneficial. Staying up to date on the latest and best practices helps advance the role and provides the information necessary to make well-informed choices and deliver exceptional patient care.
APNs should have extensive clinical knowledge and skills to provide comprehensive, holistic care to patients across various settings. Professional guidelines stress the value of evidence-based practice (EBP), patient advocacy, and collaboration with interdisciplinary teams. Continuous education, research, and professional growth help to retain competency and improve practice outcomes.
Theories, including Jean Watson’s Theory of Human Caring, emphasize the importance of ongoing education and professional development in the APN role. However, the observed APN role may differ from the ideal in some cases. Scope-of-practice limitations, legislative impediments, healthcare system dynamics, resource constraints, and organizational structures pose key challenges that limit APNs’ ability to use their skills and competencies fully.
Job Description and APN Practices
The APN is an indispensable part of the healthcare team, delivering advanced clinical care to improve patient outcomes. In this role, the APN must act autonomously, collaborate with other healthcare providers, and provide teaching, training, and expert guidance as needed. The role also involves conducting research to generate new and innovative concepts, models, techniques, and strategies (Wheeler et al., 2022).
The APN’s primary duties and responsibilities span four major domains. In clinical practice, the APN is tasked with conducting comprehensive health assessments, such as physical examinations, diagnostic testing, and medical histories, to develop tailored treatment regimens. The APN must demonstrate clinical independence and responsibility within the scope of practice and apply advanced diagnostic skills to develop appropriate diagnoses and treatment recommendations.
The APN is anticipated to work in an interdisciplinary team to manage patient care, smooth care transitions, and maintain service continuity. This is intended to align with APN practices of effective multidisciplinary communication and collaborative decision-making to improve patient care outcomes. The APN must lead by supporting nursing excellence, quality improvement initiatives, and patient-centered care.
As an advocate, the APN should address persistent obstacles to healthcare access and equity and work to eliminate disparities to improve health outcomes for all groups. In the literature and research, the APN must participate in scholarly endeavors and incorporate findings and EBPs into clinical decision-making, quality improvement programs, and policy development to enhance the quality and efficacy of healthcare services.
APN Leadership Functions
Leadership is a set of abilities and attributes that every registered nurse should possess. The profession involves administrative and managerial tasks, with APNs serving as informal clinical leaders. APN leadership has two main themes: patient-focused and organization- or system-focused. Patient-focused leadership aims to benefit patients and their loved ones directly.
The program focuses on four key leadership competencies: patient-centered care management, advocacy, coaching and education, and effective communication (Peters & Roodbol, 2020). Organizational and system-focused leadership aims to directly impact nurses, healthcare professionals, and the overall healthcare system. It comprises seven leadership capability areas: being an expert clinician; enhancing the quality of care; coaching and mentoring; developing professional nursing practice; effective communication; providing leadership on internal and external committees; and fostering collaboration.
Each of these competency domains requires specific leadership capabilities. For example, in providing patient-centered care, APNs must demonstrate clinical competence in a particular area to meet the needs of the patient population. Peters and Roodbol (2020) state that to improve the quality of care, the APN should be able to identify gaps and incorporate information about the patient population, team, and system to develop remedies while keeping the big picture in mind.
U.S. Healthcare Structure, APN Role, and County Comparison
The U.S. Healthcare System is considered the most complex, as it integrates public and private organizations that provide healthcare services to the American population. It is unique in its structure, funding, and operation compared to other healthcare systems worldwide. The U.S. Healthcare System operates on a few core principles.
Voluntary health insurance covers most American adults, with employer-sponsored plans accounting for the majority. Government programs, such as Medicaid and Medicare, cover certain demographics, including children, older adults, and low-income individuals (Wheeler et al., 2022). Out-of-pocket payments are amounts patients must pay before insurance coverage kicks in, such as co-payments and deductibles.
Nurses working today in the U.S. healthcare sector comprise the backbone of the industry and are the largest single profession. The close to 3 million individuals are consistently ranked as the most trusted profession in America each year as they play an increasingly large role as frontline caregivers attending directly to patients’ needs (Wheeler et al., 2022). APNs act as patient advocates, serving as intermediaries between patients and the embedded structures of the healthcare system. They use their skills and education to guide patients in maintaining their health and preventing disease. They also hold managerial roles, helping administer healthcare services.
The APN responsibilities differ by title and description between the U.S. and Canada, although they share a common border. The nature of the role in both countries has essential commonalities while also displaying significant differences due to variations in healthcare systems, regulatory frameworks, and professional standards. Both countries value APNs’ extensive clinical skills, their ability to provide autonomous care while collaborating with other healthcare providers, and their emphasis on EBPs.
However, there are differences in the scope of practice, educational qualifications, and regulatory landscape. APNs in the U.S. typically include certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), certified nurse midwives (CNMs), and certified registered nurse anesthetists (CRNAs), each with a different scope of practice and regulatory oversight, depending on the state.
In Canada, the APN role principally comprises nurse practitioners and clinical nurse specialists with a primary care focus and varying duties across different regions. Both countries value inter-professional teamwork and patient-centered treatment (Wheeler et al., 2022). The Canadian healthcare system incorporates APNs more closely into direct care teams, with the U.S. approach focusing mainly on more autonomous practice. The training pathways for APNs in the U.S. also differ: some U.S. institutions offer specialized courses for specific CNP populations, whereas in Canada, nursing education is more standardized.
Affordable Care Act (ACA) Impacts on the APN Role
Nurses have always responded to changes in healthcare regulation and financing through innovation and professional accountability. The ACA tackled the most recent policy-driven requirements for healthcare in the U.S. by focusing on three key goals: lowering healthcare costs, improving care quality, and improving access for all Americans. Nurses play a unique role in shaping healthcare through their collaborative approach, proximity to the bedside, and awareness of patient care in both the medical setting and the community.
The ACA emphasizes nurses’ interests while exposing the country’s disconnected healthcare delivery system. This new paradigm has hastened the growth of APNs and the extension of nursing education while improving administrative and policy abilities in nursing courses and practice (Cleveland et al., 2019). As a result, leadership positions have expanded across health organizations and insurance firms. APNs can serve on the boards of health-related and non-health-related corporations, healthcare systems, community programs, and government roles. This has given APNs an expanded role in shaping health policy and finding options within a more stringent regulatory environment.
Conclusion
APNs play a critical role in the healthcare system, and the ideal expectations influenced by professional guidelines, theory, and literature set a high standard. However, the observed role is impacted by inherent challenges and complexities that may affect the observed practice. Despite these challenges, APNs continue to play a crucial role in improving patient care, advancing healthcare delivery, and shaping the future of nursing practice by advocating for an expanded scope of practice, fostering interdisciplinary collaboration, and staying abreast of emerging EBPs.
The APNs also have to exercise leadership at a patient-focused and organization/system-focused level. The healthcare system’s unique structure, funding, and operations result in differences in APN roles across jurisdictions. The APN role in the U.S. has been impacted by healthcare regulations and financing, such as the ACA, which has expanded its scope of practice.
References
Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing, 24(2).
Peters, J. W. B., & Roodbol, P. F. (2020). Leadership in maintaining standards for the APN role. Advanced Practice Nursing Leadership: A Global Perspective, 167–183.
Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced practice nursing roles, regulation, education, and practice: A global study. Annals of Global Health, 88(1).