Introduction
The profession of a nurse requires constant growth and development. The completion of a master’s degree in nursing implicates that a specialist may choose an advanced practice nursing role for the further development of his or her career. Currently, there are four roles in advanced practice – the Certified Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, and Certified Nurse Midwife.
The change of practice often implies the process of transition that may be stressful for a substantial number of nursing practitioners. This essay examines four roles in advanced practice nursing and the transition from the practice of a registered nurse to advanced nurse practice. It provides a personal insight into the significance of the NP role and the strategies for a successful transition as well. The purpose of this paper is to demonstrate that all roles in advanced practice are immeasurably significant and offer high-quality health care to patients.
Four APN Roles
Certified Nurse Practitioner
A substantial number of patients currently choose certified nurse practitioners (CNP) as their permanent health care providers. According to the American Association of Nurse Practitioners (n.d.), CNPs specialize in the delivery of “primary, acute and specialty health care to patients” regardless of their age (para. 1). They traditionally focus on disease prevention, health promotion, and health education. NPs have a highly positive impact on patient safety and welfare as they enhance the quality of health distribution and team-working as well (McDonnell et al., 2015). Nurse practitioners establish a good relationship with patients, assess them, order diagnostic tests, interpret the tests’ results, and frame treatment plans that may include the prescription of medications.
Moreover, nurse practitioners perform observations and physical examinations, record the patients’ medical histories, diagnose and treat chronic conditions, educate patients on disease prevention, and offer recommendations. Due to permanent work with long-standing patients, CNPs detect all emergent changes in their health to change treatment on time. They frequently collaborate with other medical specialists to specify diagnoses on an as-needed basis and monitor medical equipment as well.
To become certified nurse practitioners, registered nurses should inevitably obtain a master’s degree in nursing. Doctoral degrees and a post-master’s certification are optional though preferable as well. In addition, nursing students should consider several courses, such as leadership, clinical ethics, practicum, clinical research, advanced pathophysiology and pharmacology, health care informatics, and advance physical assessment.
The environments where CNPs may work include hospitals, the settings of acute or ambulatory care, nursing homes, long-term care facilities, palliative care services, and hospice. They may execute nursing practice in private homes, community health agencies, governmental settings, private practice, universities, and research centers as well. Moreover, CNPs may specialize on pediatric, family, adult-gerontology, neonatal, trauma, women’s health, emergency, and psychiatric care.
Clinical Nurse Specialist
Clinical nurse specialists are certified registered nurses who specialize on an advanced level of health care in hospitals, medical centers, and other locations. They focus on evidence-based practice both at the individual and system levels. According to the National Association of Clinical Nurse Specialists (n.d.), this profession is currently “widely accepted in the health care system as a standardized, licensed, and fully regulated health care occupation” (para. 2).
CNSs provide system innovations in clinics, hospitals, and various outpatient, long-term, and community care settings, leadership in practice, and clinical expertise. There are several definitions of CNSs according to population (geriatrics, pediatrics), disease (cancer, diabetes), type of problem (stress, pain, wounds), setting (emergency or admission room), and type of care (rehabilitation, psychiatric). In general, nurse specialists are responsible for health promotion, the maintaining of patient records, disease management, diagnosis and treatment, risk reduction, the development and maintenance of departmental policies and health care standards, and medication prescription.
Similar to any advanced practice, the receiving of the CNS’s certification requires a master’s degree from registered nurses. In addition, they should complete coursework in the area of specialization, such as pharmacology, epidemiology, pathophysiology, practicum, health care policy, research, nursing informatics, or physical health assessment. Clinical nurse specialists work in hospitals, community and outpatient health care centers, physicians’ offices, laboratories, colleges and universities, and other offices and facilities.
Certified Registered Nurse Anesthetist
Certified registered nurse anesthetists (CRNA) are advanced-practice registered nursing specialists responsible for anesthesia during surgery and other medications. In the United States, this profession appeared during the Civil War when nurses began to give anesthesia to severely injured soldiers (American Association of Nurse Anesthetists, n.d.). Certified registered nurse anesthetists are currently considered to be the highly valuable members of the medical assistance team.
They monitor the state of patients who received anesthesia and their later recovering as well. CRNAs provide patients and their families with all necessary knowledge about anesthesia, recovery, and potential side effects as well. CRNAs work in hospitals, plastic and outpatient surgery centers, pain management centers, dental offices, and public health centers. Moreover, they may start their practice as a private anesthesia provider in underserved and rural communities to provide competent and high-quality health care for local residents. Concerning educational preparation, nurse anesthetists begin their careers as registered nurses. They should obtain a master’s degree in nursing, complete clinical training, and pass an exam to receive certification as well.
Certified Nurse Midwife
A certified nurse midwife (CNM) is an advanced-practice registered specialist with a master’s degree in nursing who specializes in childbirth and women’s reproductive health. They are responsible for the provision of medical aid to women during pregnancy, childbearing, and the postpartum period, and preventive women’s health care as well. CNMs offer prenatal visits, initial and continuous consultations to women, and postpartum care both for mothers and children. The nurse midwife’s other areas of competence are gynecological care, family planning, and contraceptive control.
Nurse midwives play an immeasurably significant role in the health care system due to their holistic view of patient care. They focus not only on the patients’ physical needs but their psychological needs and emotional state as well. According to the American College of Nurse-Midwives (n.d.), the assistance of CNMs has a variety of substantial advantages, such as the lower rates of labor augmentation and cesarean births, and the higher rates of breastfeeding.
Moreover, the presence of a certified nurse midwife during childbirth encourages the significant reduction of the women’s third and fourth-degree perineal tears and limits the use of conduction anesthesia (American College of Nurse-Midwives, n.d.). With the help of CNMs, women receive appropriate prenatal education and less medical invasive and technological interventions in the future.
To become CNMs, registered nurses should obtain a master’s degree in nursing through the completion of a bachelor’s degree in nursing and an accredited nursing program. The completion of a master’s degree takes two years in case if a registered nurse has a bachelor’s degree in nursing. A specialist may obtain a degree in any convenient way as both classroom, and online programs are available. In addition, nurse midwives have an option to choose their formal specialties or clinical focus areas, such as birth centers, community health centers, hospitals, educational centers, or primary care clinics.
Nurse midwifery typically includes close interaction with patients and their families and the development of a strong emotional involvement with women. CNMs are required emotional stability for effective performance under pressure in occasionally stressful situations. Nurses should constantly consider safety as their practice implicates potential occupational hazards, such as infectious diseases, bloodborne pathogens, and other potential contaminants. Moreover, CNMs should work according to the latest updated guidelines and standards of nursing in order to avoid any medical error that may lead to unacceptable health risks.
Rationale for Choosing CNP Role
My choice of advanced nursing practice in the capacity of a certified nurse practitioner is determined by several significant reasons. First of all, as a CNP, I will have the widest range of medical facilities appropriate for practice – from large medical centers and hospitals to private homes. Moreover, there are more options and areas of specialization for a CNP in comparison with other roles, especially with CRNA that is constrained by the area of anesthesia and medications. In addition, CNP may work in close contact with patients as their permanent health care provider to build strong trust-based relationships between each other that will positively influence the specialist’s constant occupancy and income.
Plans for Clinical Practice
It goes without saying that the completion of a master’s degree in nursing is obligatory for advanced clinical practice. In addition, I would like to focus on several specific courses, such as practicum, leadership, clinical ethics, and pharmacology, to upgrade my qualifications. Moreover, I would like to specialize in family, pediatric, and gerontology care to have an opportunity to work as a personal health care provider.
I will consider the completion of a doctoral degree in the future as well. The research of the roles in advanced nursing practice was immeasurably useful for me as it has simultaneously provided insight into its significances, responsibilities, educational preparation, and work environments. After this investigation, I started to understand the importance of all advanced specialists and became convinced in my choice of the CNP role.
Role Transition
The role of transition from the RN role to the NP role should not be underestimated as it may implicate substantial stress due to new requirements and experience. The first factor that has a highly significant impact on transition is the previous experience in the position of a registered nurse (Barnes, 2015). It will inevitably result in a more comfortable clinical rotation even if the experience of RN differs from the NP’s experience. The second essential factor is the understanding of the process of transition. Registered nurses frequently feel established in a defined role as a nurse and may experience instability, increased anxiety, and a lack of confidence in the new role of a nurse practitioner. The understanding of the transition process and its impermanence encourage a smoother rotation as well.
Personally, I will decrease potential anxiety with the help of understanding that the period of transition is non-durable. After several months of NP practice, I will feel more comfortable in a new position and excited with new responsibilities and broadened perspectives. I will apply my previous experience of any transition in my life to this following challenge. Moreover, I will continue to communicate and cooperate with other graduated NPs and specialists as the support from my colleagues may help to smooth my transition.
Conclusion
All four roles in advanced practice nursing specialize in providing patients with high-quality health care in various areas of specializations in medical settings such as hospitals, medical centers, private homes, and other facilities. The roles require a master’s degree in nursing and additional courses to upgrade the specialist’s qualification. Despite potential anxiety and stress during the period of transition, from the RN role to the NP role, advanced nursing specialists are immeasurably significant members of the health care system.
References
American Association of Nurse Anesthetists. (n.d.). Who we are. Web.
American Association of Nurse Practitioners. (n.d.). About NPs and AANP. Web.
American College of Nurse-Midwives. (n.d.). About midwives. Web.
Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transaction. The Journal for Nurse Practitioners, 11(2), 178-183. Web.
McDonnell, A., Goodwin, E., Kennedy, F., Hawley, K., Gerrish, K., & Smith, C. (2015). An evaluation of the implementation of Advanced Nurse Practitioner (ANP) roles in an acute hospital setting. Journal of Advanced Nursing, 71(4), 789-799. Web.
National Association of Clinical Nurse Specialists. (n.d.). What is a CNS? Web.