RUNNING HEAD: Role of an APN

ROLE OF AN ADVANCED PRACTICE NURSE (APN)

Introduction
Advanced Practice Registered Nurses (APRNs) have prolonged in numbers and
competences over the past several decades and APRNs are being highly valued as an essential
part of the health care system. APRNs include certified registered nurse anesthetists, certified
nurse-midwives, and clinical nurse specialists and certified nurse practitioners. The APRN
performs acts of diagnosis, and treatment of alterations in health status independently or in
collaboration with a licensed physician, prescribe, dispense, and administer medical therapeutics
.APRN practice is also characterized by the advanced role in the clinical decision-making and

RUNNING HEAD: Role of an APN

leadership in the area of working environment. The purpose of this paper is to gain knowledge
about the core APN competencies, various roles of APN s, their scope of practice, and future
recommendations for the role of APNs.
Advanced nurse practitioner Competencies
APN are regulated by both state and federal laws and licensed as registered nurses in
the states in which they practice. Most states require APNs to be nationally certified in their
specialty area by the APN specialtys professional organization. National APN certification
requires graduation from an accredited APN educational program and successful completion of a
national certification examination (Stanley 2011)
The APRN performs acts of diagnosis, and treatment of alterations in health status
independently or in collaboration with a licensed physician, prescribe, dispense, and administer
medical therapeutics and corrective measures (APRN Joint Dialogue Group Report, 2008) . The
APN evaluates and documents patient/family progress toward attainment of expected outcomes
and provides consultation to other providers to optimize the plan of care and affect system
change. The APN provides comprehensive clinical coordination and case management and acts
as an advocate for the patient and family within the health care facility, the community, and the
legislative arena. The APN may be involved in program planning, validation and research.
(www.acnpweb.org)
APNs play an expanded role in nursing, providing cost effective, practical, accessible
healthcare for individuals, families and/or groups in a wide range of settings. Such settings
include the home, hospitals, schools, community agencies, public and private clinics and private
practices. Nurse Practitioners are able to diagnose and manage many disorders and chronic
diseases, prescribe medications, order diagnostics, and make referrals to specialists. They are

RUNNING HEAD: Role of an APN

able to do complete physicals and medicals, and care for patients during and after
pregnancies(Stanley 2011).
Nurse Practitioners see many clients with chronic diseases such as diabetes, hypertension,
heart failure, osteoarthritis, and mental health concerns. They also see patients when they are
acutely ill such as in emergency departments or in critical care units. The educational programs
are offered to NPs in various specialties like family and community medicine (FNP), pediatrics
(PNP), gerontology (GNP), women's health (WHNP), psychiatry and mental health (PMHNP)
occupational health, acute care (ACNP), oncology (ONP), adult health (ANP) and emergency
medicine by the area of previous clinical experience (Hamric, Spross, & Hanson, 2009)
Roles and scope of nurse practitioners
A nurse practitioners employer, professional organization, collaborating physician, nurse
practice act, Medicare provider and insurance carrier can play role in defining the scope of nurse
practitioner (Klein 2005). According to the American academy of nurse practitioners the scope of
APN practice is as follows: Nurse practitioners are primary care providers who practice in
ambulatory, acute and long term care settings. According to their practice specialty theses
primary care providers provide nursing and medical services to individual, families and groups.
In addition to diagnosing and managing acute and chronic illnesses they emphasize health
promotion and disease prevention. Teaching and counseling individuals, families and groups are
major part of NPs role. Nurse practitioners practice autonomously and in collaboration with
health care professionals and other individuals to diagnose, treat and manage the patients health
problems (AANP 2010).

RUNNING HEAD: Role of an APN

The scope of APN in New Jersey includes the following : in addition to all other tasks
which a registered nurse perform, an APN may manage deviations from wellness and long term
illness, consistent with the needs of the patient and scope of practice. These are:
1. initiating laboratory and other diagnostic tests
2. prescribing or ordering medications and devices
3. Prescribing and ordering treatments including referrals to other licensed health care
professionals and performing specific procedures.(AANP 2010)
Future recommendations
The first successful nurse practitioner (NP) program was developed at the University of
Colorado in 1965 by Loretta Ford, RN, and Henry Silver, MD. The first nurse practitioners knew
that they must be highly competent, and they must satisfy all physician and patient critics, and
also they knew the new role must combine the best of nursing with new assessment and
diagnostic skills. Tremendous effort was taken by these NPs to pass nurse practice acts and to
obtain some degree of prescriptive authority for NPs in all 50 states and the District of Columbia
by 1999. The potential for NPs has become clearer over the years, and NPs are now accepted into
the mainstream of healthcare delivery (Edmunds 2000)
The greatest obstacle facing NPs at present is their ghost-provider" status. Because the
clinical services NPs provide are often billed under a physician or hospital name, no
comprehensive aggregate data exists describing primary care delivered by NPs. So in future NPs
should have the opportunity to collect data about what they do, and, as professionals, they would
welcome additional scrutiny of their performance. Currently, almost all NPs are salaried

RUNNING HEAD: Role of an APN

employees of agencies or physician groups. According to Edmunds (2000) expansion of

Medicaid coverage for all types of NPs and institution of NP inclusion in home health
regulations are goals for the future (Edmunds 2000)
Conclusion
Nurse practitioners are one of the few health care providers mandated to carry two
licenses to practice. The scope of a nurse practitioner depends upon the basic nursing combined
with the additional specialized training. This entitles the NP to practice in various health care
settings. Nurse practitioners have proven over time that there is a demand for primary care
services and a need to address the upcoming shortages of care. With millions of people in the
U.S. eligible to participate in the healthcare exchanges, this will only accelerate the development
of our profession to accommodate the increased utilization of patient services. Any barriers
surrounding advancement of the nurse practitioner role should be removed to allow growth and
meaningful expansion. As more providers recognize NPs as equals in patient care, the quality of
health outcomes will increase leading to lower healthcare costs and better patient satisfaction.

References
American Academy of Nurse Practitioners (2010) Scope of Practice for Nurse Practitioners,
Retrieved from www.aanp.org on January16, 2012

RUNNING HEAD: Role of an APN

AACN. (2008, July 7). Retrieved January 15, 2011, from Consensus Model for APRN
Regulation: Licensure, Accreditation, Certification andEducation, www.aacn.nche.edu
APRN Joint Dialogue Group Report (2008) Consensus Model for APRN Regulation: Licensure,
Accreditation, Certification & Education , Retrieved from www.nonpf.com.On
January15, 2012
Edmunds, M.W (2000) Nurse Practitioners: Remembering the Past, Planning the Future: Factors
Shaping the Nurse Practitioner Movement, Medscape nurses 2000; 2(1)
Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). Advanced Practice Nursing: An
Integrative Approach. St. Louis: Elsevier.
International Council of Nurses (2002) ICN Announces Position on Advanced Nursing Roles.
Retrieved from www.icn.ch Retrieved on January15, 2012

Klein, T.A (2005) Scope of practice and the nurse practitioner: Regulation, Competency,
Expansion and Evolution, advanced practice nursing e journal 5(2).Retrieved from
www.medscape.com on January16, 2012

Stanley, J.M. (2011). Advanced Practice Nursing: Emphasizing Common Roles. F.A.Davis,
Philadelphia, PA.

RUNNING HEAD: Role of an APN