NURS 682 Miami Dade College Nursing Role Responses – Description
Hi Professor Kue and Class,APRN roles and practice are multifaceted. Name the 4 APRN role types.The four Advanced Practice Registered Nurse role types are certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP). APRNs are educated in one of the four roles and one at least of six population foci, including family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related or psych/mental health (Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2011).Discuss the historical development of one APRN role.Nurse-midwifery dates back to 1925 here in the United States. The first program used public health registered nurses who had been educated in England (MedlinePlus, n.d.). Among these registered nurses was Mary Breckinridge, who established Kentucky’s Frontier Nursing Service (FNS). Breckinridge and other British nurse-midwives set up a care system comparable to what they have observed in Scotland (Blair, 2019). These nurses provided family health services and childbearing and delivery care at nursing centers for those who received inadequate healthcare in the Appalachian mountains (MedlinePlus, n.d.). The quality maternal and neonatal care provided by these nurse midwives resulted in significantly improved mother and baby health outcomes (Blair, 2019), which prompted the first nurse-midwifery education program in the United States in 1932 (MedlinePlus, n.d.) at the Maternity Center Association, Lobenstein Clinic in New Your City. In 1955, The American College of Nurse-Midwives (ACNM) a professional association that provides a leading example for excellence in midwifery education and practice in the U.S. was incorporated in nurse-midwifery programs. This association started the national accreditation of nurse-midwifery and national certification of nurse midwives in 1970’s (Blair, 2019).Since 1982, The U.S. Department of Education recognizes the Accreditation Commission for Midwifery Education (ACME), and the certification process now conducted by the American Midwifery Certification Board (AMCB) is recognized by the National Commission of Health Certifying Agencies. As a result of national accreditation and certification, Certified Nurse Midwives (CNMs) have direct third-party reimbursement and prescriptive authority in all 50 states. Presently, 39 Accreditation Commission for Midwifery Education (ACME) accredited programs exist in the United States. Most midwifery programs are in the schools of nursing. However, two are in university-based health-related professional schools. On the other hand, a direct entry non nursing route to midwifery education using the same nationally recognized accreditation and certification standards also started but not until 1997 at the State University of New York (Blair, 2019).As years pass, the nurse-midwifery practice continues to flourish, backed up by over 100 years of history and developed and ongoing robust base research. Numerous systematic reviews illustrate how CNM/CM practice can positively affect and cost-effectively meet women’s healthcare needs globally. For these reasons, nurse-midwifery educational programs and practitioners have grown substantially. In 2017, 11,826 CNMs were practicing in the country. Furthermore, due to the growth of midwifery education and practice, the passage of the Patient Protection and Affordable Care Act in 2010 was implemented. This resulted in a critical provision sought by CNMs for nearly 20 years: the same reimbursement as physicians under Medicaid for providing the same service. During this time, as healthcare dollars continue to be carefully allocated and specific outcomes measured more closely, CNMs and CMs can be expected to play a more prominent role in providing quality primary healthcare to women (Blair, 2019).Briefly describe the general responsibilities of each of the 4 APRN role types.Nurse Practitioners- are registered nurses with master’s or doctoral nursing preparation who perform comprehensive assessments, promote health, and treat and prevent illness and injury. In doing so, they diagnose, develop differential diagnoses, and order and interpret diagnostic tests. They prescribe pharmacological and nonpharmacological treatments while providing care in primary, acute, and long-term care settings. The population foci for NPs include adult-gerontological, family (across the life span), neonatal, pediatrics, women’s health-gender related, and psychiatric mental health. NPs practice autonomously and collaborate with other healthcare professionals as researchers, consultants, and patient advocates (Blair, 2019).Nurse-Midwives- According to the ACNM, midwifery, as practiced by CNMs and CMs, encompasses a full range of primary healthcare services for women from adolescence beyond menopause. These services include the independent provision of primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth, and postpartum, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections. CNMs and CMs provide initial and ongoing comprehensive assessment, diagnosis, and treatment. They conduct physical examinations; prescribe medications, including controlled substances and contraceptive methods; admit, manage, and discharge patients; order and interpret laboratory and diagnostic tests; and order the use of medical devices. Midwifery care practiced by CNMs and CMs also includes health promotion, disease prevention, and individualized wellness education and counseling. These services are provided in partnership with women and families in diverse settings such as ambulatory care clinics, private offices, community and public health systems, homes, hospitals, and birth centers (Blair, 2019).Clinical Nurse Specialists- Clinical nurse specialists diagnose, treat, and manage patients. They also provide expertise and support to nurses caring for patients at the bedside, help drive practice changes throughout the organization, and ensure the use of best practices and evidence-based care to achieve the best possible patient outcomes. They have the skills and expertise to identify where the gaps are in healthcare delivery. They can help design and implement interventions and assess and evaluate those to improve overall healthcare delivery (National Association of Clinical Nurse Specialists [NACNS], n.d.).Certified Registered Nurse Anesthetists- CRNA’s specific responsibilities include educating people before and after they receive anesthesia for a procedure or surgery, assessing a person’s physical response to anesthesia, and identifying possible risks to the person undergoing anesthesia, including allergies to anesthetics and issues related to health conditions they may have, such asthma or diabetes. Moreover, they also provide precise anesthesia dosages and work with surgeons, anesthesiologists, dentists, podiatrists, and other healthcare providers to provide anesthesia care to people undergoing all types of procedures. They care for people of all ages undergoing all types of surgical procedures (Cleveland Clinic, 2022).References:Blair, K. A. (2019). Advanced practice nursing roles: Core concepts for professional development. (6th edition). Springer Publishing Company. https://online.vitalsource.com/reader/books/9780826161536/epubcfi/6/10[%3Bvnd.vst.idref%3DCopyright]!/4Links to an external site.Cleveland Clinic. (2022, March 17). Nurse anesthetist (CRNA). https://my.clevelandclinic.org/health/articles/22561-nurse-anesthetist-crnaLinks to an external site.Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK209880/Links to an external site.MedlinePlus. (n.d.). Certified nurse-midwife. https://medlineplus.gov/ency/article/002000.htmLinks to an external site.National Association of Clinical nurse Specialists. (n.d.). What is a CNS? https://nacns.org/about-us/what-is-a-cns/
Lidiana Sosa CruzMondayJul 3 at 5:28pmManage Discussion EntryHello Professor and Class,Advanced Practice Registered Nurses (APRNs) provide high-quality healthcare. Some of the fundamental duties of APRNs include direct patient care, health promotion, education, and advocacy. This post discusses the four basic APRN position types, the historical evolution of one function (excluding nurse practitioner), and the general duties of each role.APRNs rolesNurse Practitioner (NP): NPs are APRNs who deliver primary and specialty healthcare aids to patients of all ages. They evaluate, diagnose, and manage acute and chronic health conditions, order understanding and diagnostic tests, prescribe medications, and develop and implement treatment plans. NPs frequently work autonomously or collaboratively with other healthcare professionals, concentrating on health promotion, disease prevention, and patient education (McMichael & Markowitz, 2022).Certified Nurse-Midwife (CNM): CNMs offer prenatal, delivery, gynecological, and family planning services. These advanced practice nurses focus on mental and physical well-being. In hospitals, birthing centers, and homes, CNMs work alongside obstetricians to provide care (McMichael & Markowitz, 2022).Certified Registered Nurse Anesthetists (CRNA): Provide anesthesia and manage patients’ pain before, during, and after surgery. They evaluate patients before surgery, prepare anesthesia plans, administer anesthesia medications, monitor patients during procedures, and manage post-anesthesia recovery. (McMichael & Markowitz, 2022). CRNAs collaborate with surgeons, anesthesiologists, and other healthcare professionals to safeguard patient safety and comfort throughout the preoperative period.Clinical Nurse Specialists (CNS): CNSs are APRNs who emphasize a particular patient population, area of nursing practice, or healthcare setting. They improve healthcare systems, apply evidence-based practices, conduct research, and educate employees while providing direct patient care. Noticeably, CNSs work in hospitals, clinics, colleges, and community organizations (McMichael & Markowitz, 2022).History of the Clinical Nurse Specialist RoleDue to healthcare’s growing complexity and requirement for specialized competence, the Clinical Nurse Specialist (CNS) job was created in the mid-20th century. At this time, nursing leaders saw the necessity of enhancing nursing practice and producing experts who could contribute to patient care, teaching, research, and healthcare policy (Tracy et al., 2022). The first clinical nurse specialist educational program was founded at Yale University in the 1950s. Clinical specialists who could provide advanced treatment, conduct research, and influence healthcare delivery were trained in this program (Tracy et al., 2022).Psychiatric-mental health, pediatrics, geriatrics, critical care, and others became CNS specialties. CNSs have advanced evidence-based practice, quality improvement, and patient safety. They help create and execute healthcare policies and procedures (Tracy et al., 2022).APRN Role Types’ General ResponsibilitiesCertified Nurse-Midwife (CNM):Prenatal, postpartum, and delivery assistance.Gynecological exams and family planning counseling.Educating patients about pregnancy, delivery, and reproductive health (Fliedner et al., 2020).Certified Registered Nurse Anesthetist (CRNA):Assessing patients’ anesthesia requirements and creating individualized programs.Monitoring and administering anesthesia during surgery.Pain management and post-operative care (Fliedner et al., 2020).Clinical Nurse Specialist (CNS):Expert clinical care for patients in a specialized field.Creating and using evidence-based recommendations.Healthcare education for staff, patients, and families.Quality improvement and research (Fliedner et al., 2020).Nurse Practitioner (NP):Comprehensive health exams and disease diagnosis.Preparing and administering treatment programs, including medicine.Health promotion and illness prevention.Patient education and counseling (Fliedner et al., 2020).ConclusionIn healthcare, APRNs are tasked with various responsibilities and are mandated to possess specialized knowledge and experience. The different types of APRNs provide distinct expertise to the healthcare team. Notably, the advanced nursing practice continues to evolve, as seen by the Clinical Nurse Specialist job. For this, APRNs will continue providing high-quality patient-centered care to meet the ever-changing healthcare demands.ReferencesFliedner, M., Halfens, R. J. G., King, C. R., Eychmueller, S., Lohrmann, C., & Schols, J. M. G. A. (2020). Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting. Journal of Hospice & Palliative Nursing, 23(1), 59–68. https://doi.org/10.1097/njh.0000000000000715.McMichael, B. J., & Markowitz, S. (2022). Toward a Uniform Classification of Nurse Practitioner Scope of Practice Laws. Medical Care Research and Review, 107755872211267. https://doi.org/10.1177/10775587221126777.Tracy, M. F., O’Grady, E. T., & Phillips, S. J. (2022). Hamric & Hanson’s Advanced Practice Nursing – E-Book: Hamric & Hanson’s Advanced Practice Nursing – E-Book. In Google Books. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=6nJ_EAAAQBAJ&oi=fnd&pg=PA98&dq=History+of+the+Clinical+Nurse+Specialist+Role&ots=_X8xeYClne&sig=3y_09pnPS8_omW8-BJN5x1anecU.
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