HL0902 Nursing

Introduction

Nursing is a core pillar in the healthcare system. Nurses play a major role in the care of patients; they provide primary care ensuring the needs are met and assess if the priorities are changing. Nurses are also involved in implementing health policies in the health sector. There are different cadres of nursing including enrolled nurses, registered nurses, nurses specializing in oncology and emergency and nurse practitioners. An advanced nurse practitioner is a nurse who has attained their master’s degree o consequently their doctoral degree and has the responsibility to make a diagnosis, order diagnostic imaging, prescribing medications and performing minor surgeries. According to the Australian College of Nurse Practitioners, the roles of an advanced nurse practitioner involve performing physical assessment, ordering and interpreting diagnostic tests and prescribing medications. Furlong and Smith,(2013) state that advanced nurse practitioners are important in the health care system since they make a huge contribution to the healthcare system in client-centered care. American Nurses’ Association,(2014) states that a nurse practitioner has been trained at masters and doctoral level to provide care to acute and chronic illnesses. The advanced nurse practitioner has autonomy to practice as an individual, provide primary care and increase the availability of healthcare opportunities (Fitzpatrick,2010).

The availability of specialized nurses in the health care system provides an opportunity for evidenced-based care provision to patients hence improved outcomes. The nurses have the opportunity to provide the best care with their areas of specialization. Various world nursing organizations have come up with the scope of practice of advanced nurse practitioners(American Nurses Organization,2012). There is a need for various countries to make policies that favor the independent practice of advanced nurse practitioners. This increases the availability of health which is among the basic human rights according to(Yamin,2013).

Role of advanced nurse practitioners

In Australia, advanced nurse practitioners are employed by state and territory governments while in private practice the nurse practitioner can be in their own practice. A nurse practitioner has a role in management. This involves leadership in the hospital for example as the chief nurse and overseeing nursing activities in an assigned ward. The junior nurses are accountable to the nurse practitioner and they are the channel of communication to and from the administration. According to Carryer, Gardner, Dunn& Gardner,(2013) in Australia, the nurse practitioner is a clinical leader who advocates for the rights of the patients while at the same time is involved in policy-making which produces positive patient outcomes. Therefore nurse practitioners in leadership provide chances of proper decisionmaking and consultation between different cadres of healthcare workers.

An advanced nurse practitioner is involved in the diagnosis of a patient, ordering laboratory investigation for a patient and interpretation, ordering imaging studies and interpreting them and prescribing medications to the client. Therefore a nurse practitioner provides clinical care to the patient. This is as a result of a shortage of physicians whose job description mainly involves this role. According to Mundinger, Kane, Lenz, Totten, Tsai, Cleary & Shelanski,(2013), a study conducted showed that patients assigned to physicians and nurse practitioners had the same outcomes in terms of satisfaction and health status. The physicians and nurse practitioners had the same responsibilities. Therefore a nurse practitioner is up to the task to perform proper primary nursing care with the right training.

Research is a key element in the observing changes in the healthcare sector while at the same time steering new introduction of drugs and vaccines to combat diseases. An advanced nurse practitioner is involved in conducting research affecting nursing practice, medicine, and trends in the medical world. Nursing practitioners having direct contact with patients, drugs, specimens and other healthcare workers have the vast knowledge to contribute to research. Moreso their practice in nursing enriches their ability to take part in complex researches. Nurse practitioners have the advantage in research due to a rich expertise as a result of training in the undergraduate and postgraduate studies. According to Lambert & Housden, (2017) nurse practitioners have skills and knowledge in nurse practitioner and nurse practitioner-led researches.

Advanced nurse practitioners are involved in program development, for example, HIV reduction programs, maternal mortality programs and emerging and reemerging diseases programs. Nurse practitioners are involved in policy and decision making in issues affecting the healthcare sector. This involves hospital policy and protocol due to diverse knowledge in nursing and medical care. Moreso nursing practitioners are in direct contact with patients who and are able to make prompt decisions. According to McGee, Relf,& Harmon,(2016) development of such programs include HIV related infection for nurse practitioners as they are primary care providers.

Advanced nurse practitioners are involved in referrals to specialists and consultant physicians. This varies in different countries and different respective states of the countries mentioned. The nurse practitioner needs to determine the need to refer the patient and if it is within the scope. The referral is deemed invalid if it is older than twelve months. According to Lowe, Jennings, Tregaskis, Kenneally& Bucknall,(2018), a study done in Australia in major urban center nurse practitioners made referrals to general practitioners and specialists while referrals made to them were from registered nurses. general practitioners, specialists and healthcare service agencies.

Advanced nurse practitioners are involved in providing clinical care in their specialized areas of practice if they choose to work in hospitals. Case scenario of a nurse practitioner providing care in geriatrics where they have specialized in the care of old people and the various physiologic changes that occur with aging. According to a study done  in four hospitals in the Intensive care unit patients were managed by two different teams one comprising of nurse practitioners and the other physicians and the outcomes were the same indicating high level of expertise(Hoffman, Tasota, Zullo, Scharfenberg,& Donahoe,2011)

Advanced nurse practitioners provide education to junior nurses on the specialty. They also incorporate evidence-based care which has been approved into practice in collaboration with the junior nurses. They provide mentorship to nurses, nurse students and even other healthcare workers due to their experience and knowledge. The teaching involves rounds and presentations, clinical instructions and home visits. The nurse practitioner is also charged with the role of conducting health education to the patient. According to Price et al(2012), the nurse practitioner expertise equips one to conduct teaching to different groups.

An advanced nurse practitioner is involved in guiding patients in the care continuum. This refers to the whole process of diagnosing the patient, ordering for investigations and interpreting them, prescribing medications, referral and follow up. Since nurse practitioner has advanced skills in different areas such as pediatrics they provide different services leading to the improved health care of the client. They advise on general health, referral to various specialists for further care. Continuum of care refers to the various health services provided at all stages from birth, adolescence, adulthood, aging, and death. It involves a state of wellness, illness, deterioration, back to wellness or death. Nurse practitioner is involved in promoting health, correcting pathophysiologic changes and the diagnosis of terminal illness. According to Silver, Ford and Day(2015), pediatric nurse practitioners have led to increased positive outcomes of pediatric acute and chronic diseases.

Decisionmaking in the clinical area involves resource allocation, staff motivation ideas, moral-ethical dilemmas, solving conflicts, consulting other healthcare workers and ensuring the smooth flow of operations. This is enhanced by proper knowledge of hospital policies and protocol and training on some of the various issues. The advanced nurse practitioner is involved in decision making due to their rich skills in management. This is done in collaboration with other nurses, managers, physicians and hospital administration. Decisionmaking involves critical thinking, assertiveness, and ability to make rational decisions especially because of the delicate issues dealt with in the healthcare system.

Standards of practice in australia

According to the Nursing and Midwifery Board of Australia,(2014), the first standard of practice includes assessing using diagnostic capability. This refers to the ability to demonstrate knowledge in health sciences, ability to collect data which may help in diagnosis, is able to prioritize health care needs, assesses comorbidities affecting the person receiving care, can perform a clinical examination including physical, mental, social and cultural aspects. The nurse practitioner is able to synthesize history and is able to assess social factors influencing one’s health. A nurse practitioner should make the decision to use diagnostic investigations while considering cost and efficacy for the person, orders screening and investigations and ensures proper interpretation of the results. He communicates effectively to the person receiving care the results. A nurse practitioner involves developmental factors, pathophysiology and environmental risks in making a diagnosis, diagnose urgent situations and able to correctly pick a diagnosis from the differential diagnoses.

The second standard of practice in Australia for nurse practitioners is planning care and engaging others. This involves exploring different options of care for the client and obtaining new information affecting the nurse practitioner practice. Provides evidence-based education to clients regarding their diagnostic information and communicates the diagnosis including the prognosis. Nurse practitioner plans individual treatment for the client while using extensive pharmacology and pharmacokinetics at this level of practice. He works together with the client and chooses within a range the most therapeutic options. A nurse practitioner is involved in commencing and ceasing medications. He refers clients to agencies and specialists and collaborates with other healthcare professionals to accept referrals.

The third standard of practice involves prescribing pharmacological and nonpharmacological interventions. The nurse practitioner conducts his practice in an ethical manner in regard to the care of the client. He prescribes pharmacological intervention while performing safe evidence-based invasive and noninvasive interventions. He advises the person receiving care on the side effects, benefits, interactions of the interventions. A nurse practitioner works hand in hand with her healthcare professionals and other agencies such as disabled and old aged. A nurse practitioner practices within the territorial and state legislation governing nurse practitioner practice. He remains aware of the ever-changing diverse practice of nurse practitioner.

The fourth standard of practice involves outcomes evaluation of practice. The nurse practitioner evaluates if the goals set in the plan of care have been accomplished. He plans on modifying care or ceasing fro the client in collaboration with other healthcare workers. The nurse practitioner uses indicators to measure the effectiveness of the strategies put in place. The nurse practitioner participates in research to meet gaps identified in the healthcare sector while using research-based innovations in practice to increase productivity and outcomes. The nurse practitioner acts as an educator and mentor to fellow healthcare workers and promotes the role of nurse practitioner in professional terms.

Standards of practice internationally

According to the American Nurses’ Association,(2014), the first standard of practice involves the right qualifications such as masters and doctorate level to practice and be licensed by the respective body. A nurse practitioner should be able to practice the process of care. This includes performing an assessment which involves history taking, thorough physical examination, identifying certain risk factors facing the client and ordering diagnostic investigations and the ability to interpret the results. There should be a diagnosis made by analysis and collection of data and ability to make a differential diagnosis from the results of diagnostic procedures. The nurse practitioner develops a treatment plan by developing a patient education plan and implementing pharmacological and non-pharmacological interventions. The nurse practitioners’ plan should be individualized, scientific and consistent with learning chances. The nurse practitioners should plan for followup for the client to evaluate goal outcome and criteria.

The nurse practitioner provides education to the patient and to the family regarding the health status, promotion, and maintenance of health through self-care and consultation of other healthcare workers. The practitioner ensures optimum healthcare and promoting a safe environment. He acts as a healthcare team leader in the provision of healthcare while collaborating with other health care workers to promote optimum health care. The nurse practitioner participates in the documentation of care while ensuring the privacy and confidentiality of these documents. The patient’s advocate is the nurse practitioner by participating in the health policymaking at national and international levels. The nurse practitioner participates in continuing education and applies standardized guidelines in their practice. The role of the practitioner is an educator, mentor, manager, consultant, and researcher. He participates in research by conducting, disseminating and applying findings in practice

Impact of the role on health care system

According to Oliver, Pennington, Revelle& Rant,(2014), advanced nurse practitioners have contributed to decreased hospitalization rates and positive overall outcomes on the health of the clients. This implies that the practice of nurse practitioners improves the overall healthcare system. There increased availability of healthcare options amongst highly qualified nurse practitioners.

A study conducted in  Australia, Canada, New Zealand, United Kingdom and United States(Woo, Lee & San Tam,2017)showed that nurse practitioners strengthen the healthcare workforce. In the intensive care unit, nurse practitioners ensured continuity of care as they developed more contact with the environment and patients compared t the physicians. The length of the patient’s hospitalization was shortened while their initiated multidisciplinary rounds showed proper coordination.

The advanced nurse practitioner role is very important in the Australian setting since it addresses the gap in the healthcare system. The ration of physicians to the population is decreased and therefore there is a need to ensure that every citizen has easy access to healthcare. Nurse practitioners who have rich expertise in diagnosis, treatment, and referral are involved in reducing the long waiting hours in hospitals. According to Woods and Murfet(2015), the role of nurse practitioner in Australia remains underrecognized and underutilized

Conclusion

Nurses play an important role in the healthcare system most importantly being the primary healthcare provider. This provides the opportunity to examine various challenges facing the clients hence need to further education towards one’s preference. Nurse practitioners are nurses at an advanced level who provide an opportunity for patients to receive specialized highly skilled care. The importance of these healthcare professionals can’t be underestimated and there is a need to provide policies and legislation that favors the practice of the professionals.

References

American Nurses’ Association. (2010). Nursing: Scope and standards of practice. American Nurses Association.

American Nurses Association. Task Force on Standards of Practice for Primary Health Care Nurse Practitioners, Council of Primary Health Care Nurse Practitioners (American Nurses Association), & Council of Primary Health Care Nurse Practitioners (US). (2014). Standards of practice for the primary health care nurse practitioner. American Nurses’ Association.

American Nurses Association. Task Force on Standards of Practice for Primary Health Care Nurse Practitioners, Council of Primary Health Care Nurse Practitioners (American Nurses Association), & Council of Primary Health Care Nurse Practitioners (US). (2012). Standards of practice for the primary health care nurse practitioner. American Nurses’ Association.

Carryer, J., Gardner, G., Dunn, S., & Gardner, A. (2013). The core role of the nurse practitioner: practice, professionalism and clinical leadership. Journal of Clinical Nursing, 16(10), 1818-1825.

Fitzpatrick, J. J. (2010). The future of nursing: Leading change, advancing health. Nursing Education Perspectives, 31(6), 347-348.

Furlong, E., & Smith, R. (2013). Advanced nursing practice: policy, education and role development. Journal of clinical nursing, 14(9), 1059-1066.

Hoffman, L. A., Tasota, F. J., Zullo, T. G., Scharfenberg, C., & Donahoe, M. P. (2011). Outcomes of care managed by an acute care nurse practitioner/attending physician team in a subacute medical intensive care unit. American Journal of Critical Care, 14(2), 121-130.

Lambert, L. K., & Housden, L. M. (2017). Research Reflection: Nurse practitioner engagement in research. Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie, 27(1), 107-110.

Lowe, G., Jennings, N., Tregaskis, P., Kenneally, A., & Bucknall, T. (2018). Profiling Nurse Practitioner practice patterns at a major urban acute health service. Collegian, 25(3), 277-283.

McGee, K. S., Relf, M., & Harmon, J. L. (2016). The Development of an HIV Training Program for Nurse Practitioners. Journal of the Association of Nurses in AIDS Care, 27(3), 240-245.

Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y., Cleary, P. D., … & Shelanski, M. L. (2013). Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. Jama, 283(1), 59-68.

Nursing and Midwifery Board of Australia. (2014). Nurse practitioner standards for practice.

Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447.

Price, D., Howard, M., Hilts, L., Dolovich, L., McCarthy, L., Walsh, A. E., & Dykeman, L. (2012). Interprofessional education in academic family medicine teaching units: a functional program and culture. Canadian Family Physician, 55(9), 901-901.

Silver, H. K., Ford, L. C., & Day, L. R. (2015). The pediatric nurse-practitioner program: expanding the role of the nurse to provide increased health care for children. Jama, 204(4), 298-302.

Woo, B. F. Y., Lee, J. X. Y., & San Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human resources for health, 15(1), 63.

Woods, M., & Murfet, G. (2015). Australian nurse practitioner practice: value adding through clinical reflexivity. Nursing research and practice, 2015.

Yamin, A. E. (2013). The right to health as a human right in international law. Human Rights Quarterly, 21(4), 1123-1129.