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Health Care Industry

The evolving role of advanced practice nurses in surgery

AORN Journal, May, 1998 by Denise M. Hodson

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SIGNIFICANCE OF ADVANCED NURSING PRACTICE

Social, political, and professional factors in the 1950s and 1960s created an enabling environment for the introduction of new ideas. Medicare, Medicaid, technologic advances, and increased physician specialization offered opportunities for nurses to succeed in advanced practice, especially in underserved areas of primary care.(22) The turbulence of today's health care environment again is creating paradigm shifts that now focus on prevention and health maintenance in an effort to control health care costs--costs that account for approximately 14% of the US gross national product.(23) Institutions once again are amenable to change, and opportunities for APNs have escalated.(24)

More Articles of Interest: National Nursing Stakeholders' Meeting On Advanced Practice Nurses; Can Advanced Practice Nurses Succeed in the Primary Care Market?; acute care nurse practitioner: An evolving role in Kansas, The; Demonstrating APN value in a capitated market; Reimbursement Issues in Advanced Practice Nursing: An Overview

A goal in managing the federal budget has been to reduce Medicare payments and medical education funding for many teaching facilities. This can cause a decrease in the number of medical schools and hospitals used as clinical sites for residents, a decrease in the number of specialty resident positions, and an elimination of non-US citizens in residency positions.(25) The effects of managed care are creating a new care model in which

* providers collaborate,

* patients serve as partners in their own care, and

* patients are restored to their highest functional health status.(26)

The nursing profession continually has adapted to society's needs with the explicit mission of APNs to provide expert, quality, and comprehensive nursing care to clients.(27) Advanced practice nursing describes nurses who have acquired practice experiences and knowledge bases to prepare them for specialization (ie, concentrating on one part of the nursing field), expansion (ie, acquiring new skills), and advancement in recognized practice roles such as CNSs, NPs, CNMs, and CRNAs.(28) Graduate education is required for advancement and involves specialization, expansion, and integration of a broad range of research-based theories and skills.(29)

Advanced nursing practice extends beyond roles. It is a way of thinking and viewing the world based on clinical knowledge, rather than a composition of roles. Three researchers offer this conceptual definition:

Advanced nursing practice is the application

of an expanded range of practical, theoretical,

and research-based therapeutics to phenomena

experienced by patients, individuals, and

clients within a specialized clinical area of the

larger discipline of nursing.(30)

Advanced nursing practice and tides have been inconsistently defined in literature. The APN title is a general term for master's-prepared nurses who provide clinical care. The nurse practitioner title is a generic term for advanced practice nurses who traditionally have engaged in direct care in primary care settings. The CNS term applies to nurses who traditionally serve as role models for staff nurses in acute care settings through the subroles of expert practice, education, consultation, and research. Acute care nurse practitioners are APNs who provide care to acutely ill patients, regardless of setting.(31) The ACNP role also has been referred to as inpatient nurse practitioner, nurse specialist, advanced practice nurse, and tertiary nurse practitioner.(32)

Health Care Industry

The evolving role of advanced practice nurses in surgery

AORN Journal, May, 1998 by Denise M. Hodson

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