Nurse practitioner

A nurse practitioner (NP) is an advanced practice registered nurse (APRN) who has completed graduate-level education (either a Master of nursing or Doctor of Nursing Practice degree). Nurse practitioners treat both physical and mental conditions through comprehensive history taking, physical exams, ordering and interpreting diagnostic tests. NPs can then diagnose certain diseases and provide appropriate treatment for the patients, including prescribing select medications. NPs can serve as a patient's primary health care provider, and see patients of all ages depending on their specialty (family, pediatrics, geriatrics, etc.). The core philosophy of the field is individualized care that focuses on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. In addition to health care services, NPs conduct research and are often active in patient advocacy activities. To become licensed/certified to practice, Nurse Practitioners hold national board certification in an area of specialty (such as family, women's health, pediatrics, adult, acute care, etc.), and are licensed through the state nursing boards.

According to the International Council of Nurses, an NP/advanced practice nurse is "a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which would be determined by the context in which s/he is credentialed to practice."

Additional advanced practice RN roles include the certified registered nurse anesthetist (CRNA)s, CNMs, and CNSs.

Nurse practitioners can be educated and nationally certified in areas of family health (FNP), pediatrics, including pediatric acute/chronic care, pediatric critical care, pediatric oncology and general pediatrics (PNP), neonatology (NNP), gerontology (GNP), women's health (WHNP), psychiatry & mental health (PMHNP), acute care (ACNP), adult health (ANP), oncology (FNP, ACNP, ANP, PNP or ANP) emergency (as FNP or ACNP), occupational health (as ANP or FNP), etc. In Canada, NPs are licensed by the province or territory in which they practice.

History

The advanced practice nursing role began to take shape in the mid-20th century United States. Nurse anesthetists and nurse midwives were established in the 1940s, followed by psychiatric nursing in 1954. The present day concept of the APN as a primary care provider was created in the mid-1960s, spurred on by a shortage of medical doctors. The first official training for nurse practitioners was created by Henry Silver, a physician, and Loretta Ford, a nurse, in 1965, with a vision to help balance rising health care costs, increase the number of health care providers, and correct the inefficient distribution of health resources. There was some confusion about the varying titles and abilities of advanced practice nurses as the role was developed, which has persisted as the authority and responsibilities of the NP have evolved over time.

Scope of practice

In the United States, because the profession is state-regulated, care provided by NPs varies widely. Some nurse practitioners work independently of physicians while, in other states, a collaborative agreement with a physician is required for practice. The extent of this collaborative agreement, and the role, duties, responsibilities, medical treatments, pharmacologic prescriptions, etc. afford an NP to perform and prescribe again varies widely amongst states of licensure/certification. practice.

The scope of practice for NPs globally varies even more widely than the state-by-state discrepancies in the United States. The International Council of Nurses outlines the following general characteristics of advanced practice nursing: · Integrates research, education, practice and management · High degree of professional autonomy and independent practice · Case Management/personal case load · Advanced health assessment skills, decision-making skills and diagnostic reasoning skills · Recognized advanced clinical competencies · Provision of consultant services to other health providers · Plans, implements and evaluates programs · Recognized first point of contact for clients

The "Pearson Report" provides a current state-by-state breakdown of the specific duties a nurse practitioner may perform in the state. A nurse practitioner's role may include the following:

• Diagnosing, treating, evaluating and managing acute and chronic illness and disease (e.g. diabetes, high blood pressure)
• Obtaining medical histories and conducting physical examinations
• Ordering, performing, and interpreting diagnostic studies (e.g., routine lab tests, bone x-rays, EKGs)
• Prescribing physical therapy and other rehabilitation treatments
• Prescribing drugs for acute and chronic illness (extent of prescriptive authority varies by state regulations)
• Providing prenatal care and family planning services
• Providing well-child care, including screening and immunizations
• Providing primary and specialty care services, health-maintenance care for adults, including annual physicals
• Providing care for patients in acute and critical care settings
• Performing or assisting in minor surgeries and procedures (with additional training and/or under physician supervision in states where mandated; e.g. dermatological biopsies, suturing, casting)
• Counseling and educating patients on health behaviors, self-care skills, and treatment options

Practice settings

NPs practice in all U.S. states, Canadian provinces and territories and in all Australian states and territories. The institutions in which they work may include:

• Community clinics, health centers, urgent care centers
• Health maintenance organizations (HMOs)
• Home health care agencies
• Hospitals
• Hospital clinics
• Hospice care
• Nurse practitioner practices/offices
• Nursing homes
• Private & public schools, universities and colleges
• Physician/private medical practices
• Veteran's administration facilities
• Retail-based clinics
• Public health departments
• Walk-in clinics

Education, licensing, and board certification in the United States

There are a variety of paths to becoming a licensed nurse practitioner in the United States. The most typical begins with obtaining a Bachelor of Science in Nursing (BSN, usually 4 years), followed by a Masters of Science in Nursing (MSN, 1.5-3 years). Admissions to a MSN program also typically require completion of the Graduate Record Exam (GRE) and/or the NCLEX-RN.

Registered nurses initially trained at the associate degree or diploma level often must first complete a Bachelor of Science in Nursing (BSN) or enter various programs offering an ADN-to-MN/MSN bridge program. Some of these bridge programs may award a Bachelor's degree while the candidate continues to complete the elements of their Master's or Doctorate degree.

United States

While not every state includes specific language requiring a master's degree for NPs, the majority of states do require a master's degree, post-master's certificate or a doctoral degree. Further, the current nurse practitioner programs offered by all universities and colleges are at the master's, post-master's, or doctoral level. The current proposal is that all advanced practice registered nurse programs will require a Doctor of Nursing Practice (DNP) degree by 2015, thus effectively eliminating the MN or the MSN as an entry to practice degree. However, all state Nursing Boards will be required to revise their current Practice Acts in order for this to become mandatory. All U.S. states require national board certification for nurse practitioners before they are permitted to practice and the two biggest certifying bodies, the American Nurses Credentialing Center (ANCC) and the American Academy of Nurse Practitioners (AANP), do require applicants to hold a master's degree, post-master's certificate, or doctoral degree to be eligible to test for certification.

The variety of educational paths for NPs is a result of the history of the field. The first Nurse Practitioner program was created by a nurse educator, Loretta Ford, EdD, RN, PNP, and a physician, Henry Silver, MD, in 1965 at the University of Colorado as a non-degree certificate program. This program trained experienced Registered Nurses for their new advanced nursing roles as Pediatric Nurse Practitioners. In the late 1960s into the 1970s, continued predictions of a primary-care physician shortage increased funding and attendance in various certificate-based nurse practitioner programs. Then, during the 1980s Nurse Practitioner educational requirements were transitioned into graduate-level master's degree programs. Subsequently the national certifying organizations and state licencing boards began to require a master's degree for NP practice. However, already established NPs with certificate-based education were grandfathered in. Once again there are changes presently in the field, and by 2015 all new NPs will need to be trained at the doctorate level as a Doctor of Nursing Practice. Once again already established NPs with lesser education will be grandfathered in.

After completing the education program, the candidate must be licensed by the state in which he or she plans to practice. The state boards of nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a graduate degree in nursing and board certification by an accrediting body (ANCC, AANP). The license period varies by state; some require biennial relicensing, others require triennial.

Australia

In Australia, Nurse Practitioners are required to be registered by the Australian Health Practitioner Regulation Agency. The Australian professional organisation is the Australian College of Nurse Practitioners. (ACNP)

Role in healthcare

The role of Nurse Practitioners is very diverse. Nurse Practitioners are educated under the nursing model which is designed to provide holistic and preventive care engaging the individual as the primary leader in their own care and well-being. Nurse Practitioners bring the nursing history of patient advocacy to partner with the individual for mutually agreed upon treatments and optimal health outcomes. Nurse Practitioners often view the health and wellness of individuals within the family or community system and attempt to incorporate cultural relativism within their treatments and recommendations^{[citation needed]}. NPs are advanced practice nurses who provide high-quality healthcare services in primary care settings and are able to diagnose and treat a range of health problems.

Specialties

• Acute care nurse practitioner
• Adult nurse practitioner
• Family practice nurse practitioner
• Psychiatric nurse practitioner
• Geriatric nurse practitioner
• Pediatric nurse practitioner
• Obstetric nurse practitioner
• Neonatal nurse practitioner
• Emergency nurse practitioner

• "-C" and "-BC" indicate "certified" and "board certified" by a national certifying organization such as the American Nurses Credentialing Center, American Academy of Nurse Practitioners, or the National Certification Corporation (e.g., FNP-BC, NNP-BC, ANP-C, NP-C, WHNP-BC, etc.).

Post-nominal credentials and initials

See also: List of nursing credentials

Post-nominal initials NPs may use are regulated by the state in which they are licensed and include:

• ACNP-BC (Acute Care Nurse Practitioner - Board Certified; if certified by the ANCC)
• ACNPC (Acute Care Nurse Practitioner Certified)
• APRN-BC (Advanced Practice Registered Nurse - Board Certified; no longer awarded, replaced with specialty-specific credentials by the ANCC )
• ARNP (Advanced Registered Nurse Practitioner)
• CAS (Certificate of Advanced Study)
• CNP (Certified Nurse Practitioner)
• CPNP (Certified Pediatric Nurse Practitioner; if certified by the Pediatric Nursing Certification Board PNCB)
• CPNP-AC (Certified Pediatric Nurse Practitioner - Acute Care; if certified by the PNCB )
• CPNP-PC (Certified Pediatric Nurse Practitioner - Primary Care; if certified by the PNCB )
• CRNP (Certified Registered Nurse Practitioner; used primarily in Pennsylvania and Alabama )
• DNP (Doctor of Nursing Practice; the terminal practice degree for NPs)
• DNSc (Doctor of Nursing Science; equivalent to Ph.D., most D.N.Sc. programs now converted to PhD programs)
• FAAN (Fellow of the American Academy of Nursing AAN)
• FAANP (Fellow of the American Academy of Nurse Practitioners AANP)
• MA (Master of Arts in Nursing)
• MN (Master of Nursing)
• MSN (Master of Science in Nursing)
• NP-C (Nurse Practitioner - Certified; if certified by the AANP)
• PhD (Doctor of Philosophy)
• PMC (Post-Master's Certificate)
• RN (Registered Nurse)
• RN(EP) or NP (Registered Nurse - Extended Practice; Manitoba, Canada)
• RN(NP) (Registered Nurse - Nurse Practitioner; Saskatchewan, Canada)

See also

• Registered nurse
• Physician
• List of counseling topics

External links

• The Nurse Practitioner: The American Journal of Primary Health Care
• AANP Standards for NP practice in retail based clinics
• CNS and NP Practice in Canada