Potential Crisis in Nurse Practitioner Preparation in the United States

2019 ◽  
Vol 20 (2) ◽  
pp. 57-63 ◽  
Author(s):  
Mary O'Neil Mundinger ◽  
Michael A. Carter
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
American Association ◽  
Clinical Care ◽  
The United States ◽  
Position Statement ◽  
Historical Background ◽  
Policy Position ◽  
Colleges Of Nursing ◽  
Practitioner Education

The Doctor of Nursing Practice (DNP) degree was established to expand nurse practitioner education by adding new competencies. In 2004, the American Association of Colleges of Nursing released a position statement that redefined practice from only clinical care of patients to include nonclinical care. This policy position likely contributed to the rapid growth of DNP programs. Historical background on the development of the DNP is provided. An analysis was conducted of the programs reported in the American Association of Colleges of Nursing list of accredited DNP programs between 2005 and 2018 to compare whether the programs prepared graduates for advanced clinical practice or administrative or leadership. During this time, 553 DNP programs were established, 15% ( n = 83) are clinical, and 85% ( n = 470) are nonclinical. The adequate production of nurse practitioners in the future may be in jeopardy with this imbalance in educational resources, especially with the nation's growing need for primary care clinicians.

Nurse Practitioner Challenges to the Orthodox Structure of Health Care Delivery: Regulation and Restraints on Trade

1985 ◽  
Vol 11 (2) ◽  
pp. 195-225
Author(s):  
Karla Kelly
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Delivery ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Allied Health ◽  
Care Delivery ◽  
The United States ◽  
Care Providers ◽  
Allied Health Care

AbstractUntil recently, physicians have been the primary health care providers in the United States. In response to the rising health care costs and public demand of the past decade, allied health care providers have challenged this orthodox structure of health care delivery. Among these allied health care providers are nurse practitioners, who have attempted to expand traditional roles of the registered nurse.This article focuses on the legal issues raised by several major obstacles to the expansion of nurse practitioner services: licensing restrictions, third party reimbursement policies, and denial of access to medical facilities and physician back-up services. The successful judicial challenges to discriminatory practices against other allied health care providers will be explored as a solution to the nurse practitioners’ dilemma.

Aged care nurse practitioners in Australia: evidence for the development of their role

2013 ◽  
Vol 37 (5) ◽  
pp. 594 ◽  
Author(s):  
Shannon Clark ◽  
Rhian Parker ◽  
Brenton Prosser ◽  
Rachel Davey
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
The United States ◽  
Aged Care ◽  
Service Planning ◽  
Current Evidence ◽  
Ageing Population ◽  
Healthcare Outcomes ◽  
The Impact

Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings. Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required. What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner. There is international evidence that nurse practitioners provide high-quality healthcare. Despite being established in the United States for nearly 50 years, nurse practitioners are a relatively recent addition to the Australian health workforce. What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations. What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.

Holistic Nursing Values in Nurse Practitioner Education

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Elizabeth Kinchen
Keyword(s):  
Nursing Education ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
High Reliability ◽  
Reliability And Validity ◽  
Advanced Practice Nursing ◽  
Patient Centered ◽  
Holistic Nursing ◽  
Nursing Values ◽  
Practitioner Education

AbstractMuch has been written about the inclusion of holistic nursing values and practices in undergraduate nursing education, but their inclusion and influence in advanced practice nursing education has not been fully explored. Nurse practitioners (NPs) are nurses, so it is assumed that the nursing perspective provides a framework for NP education and practice, and that NP education represents the blending of a holistic nursing approach with medical diagnosis and treatment. Nurse practitioners are taking increasing responsibility for filling the gap in primary healthcare availability in the U.S., and in the current political and economic healthcare climate, NPs are in a position to promote primary care models that honor comprehensive, patient-centered, and relationship-based care. As a result, it becomes essential to quantify the inclusion of these values in NP educational programs and coursework, as instilling core values for practice begins in educational environments. This quantitative, descriptive study explored the inclusion of holistic nursing values by NP faculty, using the Nurse Practitioner Holistic Caring Instrument (NPHCI). The NPHCI exhibited quite high reliability and validity in the sample, including confirmation of its three subscales. Survey results suggest that NP faculty actively incorporate holistic nursing values in educational coursework, and that age, length of time teaching in NP programs, highest educational degree, and academics as the primary area of practice were important indicators of the inclusion of holistic nursing values in NP program curricula. Findings add to knowledge of NP education, but further study is warranted.

TRANSCULTURAL DIABETES CARE IN THE UNITED STATES – A POSITION STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS

2019 ◽  
Vol 25 (7) ◽  
pp. 729-765 ◽  
Author(s):  
Jeffrey I. Mechanick ◽  
Stephanie Adams ◽  
Jaime A. Davidson ◽  
Icilma V. Fergus ◽  
Rodolfo J. Galindo ◽  
...  
Keyword(s):  
United States ◽  
Diabetes Care ◽  
American Association ◽  
The United States ◽  
Position Statement

The Development of Nurse Practitioner Preparation beyond the Master's Level: What is the Debate About?

2010 ◽  
Vol 7 (1) ◽  
Author(s):  
Kelly Brar ◽  
Geertje Boschma ◽  
Fairleth McCuaig
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
The United States ◽  
Master's Level ◽  
Close Attention ◽  
Doctor Of Nursing Practice ◽  
History Of ◽  
Doctor Of Philosophy ◽  
Career Options ◽  
Practice Doctorate

The nursing discipline in the United States (US) has a history of creating various doctorates. One such degree, the Doctor of Nursing Practice (DNP), serves as an alternative to the traditional Doctor of Philosophy (PhD) degree for Nurse Practitioners (NPs) exploring career options. The availability of the DNP has sparked a debate within the profession: close attention to the issues is warranted for any school considering the development of a DNP program. However, some of these issues are not applicable, or apply differently to other contexts including Canada, where the highest level of education for an NP is a PhD. This article will review the history of doctoral education in both countries, compare the practice-focused and research-focused doctorates, discuss the issues of debate, and explore implications for NP practice. To fully inform the decision of the NP, we recommend further research to explore the need for a practice doctorate.

The Role of the Neonatal Nurse Practitioner in the Community Hospital Level I Nursery

2012 ◽  
Vol 31 (3) ◽  
pp. 141-147 ◽  
Author(s):  
Julie Hatch
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Neonatal Intensive Care ◽  
Community Hospital ◽  
Clinical Care ◽  
Advanced Practice Nursing ◽  
Tertiary Center ◽  
Neonatal Nurse Practitioners ◽  
Level I ◽  
Nursing Roles

Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country’s Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP’s experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.

scholarly journals “I’m Not a Doctor. I’m a Nurse”: Reparative Boundary-Work in Nurse Practitioner Education

2018 ◽  
Vol 6 (2) ◽  
pp. 105-120 ◽  
Author(s):  
LaTonya Trotter
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Boundary Work ◽  
Group Cohesion ◽  
Professional Identities ◽  
External Threats ◽  
Bedside Nursing ◽  
Diagnostic Medicine ◽  
Practitioner Education ◽  
Future Physician

Boundary-work is constitutive of both jurisdiction and professional identities. For groups attempting domain expansion, changed boundaries present risks for group cohesion. In this article, I examine the boundary-work that nurse-practitioners-in-training perform to negotiate the contradictions of moving into the new terrain of diagnostic medicine. I found that students engaged in reparative boundary-work that re-inscribed the new terrain of the nurse practitioner into the “old work” of bedside nursing. These strategies not only resolved the contradictions of nurse practitioner identity, but they also provided strategies of action for negotiating new relationships with future physician colleagues. This analysis demonstrates that the defense of breached boundaries is activated not only by external threats but also by the internal threats of jurisdictional expansion.

scholarly journals Understanding the Role of Advanced Practice Providers in Oncology in the United States

2018 ◽  
Vol 14 (9) ◽  
pp. e518-e532 ◽  
Author(s):  
Suanna S. Bruinooge ◽  
Todd A. Pickard ◽  
Wendy Vogel ◽  
Amy Hanley ◽  
Caroline Schenkel ◽  
...  
Keyword(s):  
Patient Care ◽  
Nurse Practitioners ◽  
Clinical Care ◽  
Gynecologic Oncology ◽  
Physician Assistants ◽  
The United States ◽  
Direct Patient Care ◽  
Advanced Practice ◽  
Patient Counseling ◽  
Number Of Patients

Purpose: Advanced practice providers (APPs, which include nurse practitioners [NPs] and physician assistants [PAs]) are integral members of oncology teams. This study aims first to identify all oncology APPs and, second, to understand personal and practice characteristics (including compensation) of those APPs. Methods: We identified APPs who practice oncology from membership and claims data. We surveyed 3,055 APPs about their roles in clinical care. Results: We identified at least 5,350 APPs in oncology and an additional 5,400 who might practice oncology. Survey respondents totaled 577, which provided a 19% response rate. Results focused on 540 NPs and PAs. Greater than 90% reported satisfaction with career choice. Respondents identified predominately as white (89%) and female (94%). NPs and PAs spent the majority (80%) of time in direct patient care. The top four patient care activities were patient counseling (NPs, 94%; PAs, 98%), prescribing (NPs, 93%; PAs, 97%), treatment management (NPs, 89%; PAs, 93%), and follow-up visits (NPs, 81%; PAs, 86%). A majority of all APPs reported both independent and shared visits (65% hematology/oncology/survivorship/prevention/pediatric hematology/oncology; 85% surgical/gynecologic oncology; 78% radiation oncology). A minority of APPs reported that they conducted only shared visits. Average annual compensation was between $113,000 and $115,000, which is approximately $10,000 higher than average pay for nononcology APPs. Conclusion: We identified 5,350 oncology APPs and conclude that number may be as high as 7,000. Survey results suggest that practices that incorporate APPs routinely rely on them for patient care. Given the increasing number of patients with and survivors of cancer, APPs are important to ensure access to quality cancer care now and in the future.

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