Family Nurse Practitioner

Family Nurse Practitioner

Name of Student

Institution

Family Nurse Practitioner

Introduction:

The future of nursing lies in the growth and development of the curriculum to accommodate different specialties. The American Nurses Association (2014) cites that; advanced practice registered nurses have in the recent past played a very important role in the advancement of health care. The nursing profession has grown to acknowledge nurse specialists as clinical nurse specialists, family nurse practitioners, nurse informaticists, nurse educators and nurse administrators. Acknowledging the specific roles of the different specialties is an important landmark for the development of the nursing profession. For clarity purposes, it is pivotal to differentiate between advanced nursing practice and specializing in a particular area of nursing. According to Hamric et al. (2013, p. 68), specialization in nursing involves the development of expanded skills and knowledge in the area of the nursing profession. In this case, a nurse who has gained experience in a particular area of nursing may be said to have specialized. On the other hand, advanced nursing practice involves the application and integration of a wide range of evidence-based and theoretical knowledge, coupled with advanced nursing education, like graduate nursing. The American Nurses Association (2004) proposed the masters and doctoral education in nursing to enhance advanced nursing practice. In addition, advanced nurse practitioners play a pivotal role in the development of knowledge base in the nursing profession.

This paper is dedicated to comparing and distinguishing the roles of advanced nurse practitioners, and expounding on the practice background and guidelines for the specialty of the family nurse practitioner. The paper will also expound on the legal requirements, organizational setting, competencies required, and the professional organizations associated with the advanced practice role of the family nurse practitioner. Lastly, the paper will discuss the leadership roles in advanced nursing practice, and the health policy as applies to advanced nursing practice.

Advanced Practice Roles in Nursing:

In as much as there are specific roles of the advanced practice nurse specialists, the curriculum for the essentials of master’s education and advanced nursing practice outlined by the American Association of Colleges of Nursing (AACN, 2006) provides some similar roles for the advanced nurse practitioners. These roles cut across all the cadres of the advanced nurse practice. According to Hamric et al. (2013), the advanced practice Nurses share the same core competencies and core values, which in turn define the similarity in their roles. Hamric et al. (2013, P. 70) assert that, all the APNs perform the role of direct clinical practice, as a central competency that defines other competencies. The second category of roles common to all the APNs is the focus of care to the families and individuals. According to the AACN (2006), all the APNs must focus their practice to the individual patients, families and organizations. In regard to education, Hamric et al. (2013, P. 71) connotes that all APNs are supposed to teach others, and participate in programs that promote education in nursing and curriculum development. Similarly, AACN (2006) notes that all APNs are mandated with the role of carrying out research. In this area, the advanced nurse practitioners are expected to utilize new knowledge, embrace technology, utilize information systems, apply new knowledge and supervise lower cadres on carrying out research.

The advanced practice nurses are also mandated with the role of understanding policy, and recommending policy and system changes. Hamric et al. (2013) posits that all APNs must be advocates of policy changes where necessary, and should display high-level competence in supporting policy implementation. Additionally, APNs are expected to play the role of initiating and agitating for policy development. The American Association of Colleges of Nursing (2006) also reiterates that all APNs are tasked with the role of promoting professional ethics and acting as role models for the other members in the profession. They are expected to identify the common ethical dilemmas in the practice of nursing and how the said dilemmas influence the delivery of care, and provide a solution accordingly. The APNs are also tasked with the role of ensuring the development of the profession. As regards professional development, the advanced practice nurses are supposed to advocate highly for the profession, and recruit able students in the profession (AACN, 2006). The development of theory in nursing is also a role of all the advanced nurse practitioners. According to Hamric et al. (2013), advanced nurse practitioners are expected to review, update, apply, build and recommend theories to facilitate the development of the body of knowledge in the nursing fraternity. In relation to human diversity and the varied social issues, the advanced practice nurses are expected to deliver culturally competent care. The master’s curriculum requires that the advanced nurse practitioners practice in collaboration with other colleagues of the multicultural skilled workforce, in order to ensure that the systems address the very needs of the populations. Lastly, all the advanced nurse practitioners are tasked with the role of promotion and prevention of disease. Regardless of there are of practice and specialization, advanced nurse practitioners must show concern and action towards disease prevention and health promotion (AACN, 2006). With regard to health promotion coupled with disease prevention, the advanced nurse practitioners develop, monitor, and implement holistic care plans with a view to addressing the needs of the society.

Despite the similarities in the general roles of advanced nurse practitioners, there are specific roles that distinguish a nurse practitioner, nurse educator, nurse informaticist and nurse administrator. According to Hamric et al. (2013), a nurse practitioner provides specialized and primary healthcare to families, individuals, communities and other organizational settings. The nurse practitioners practice in a varied range of settings like schools, home-based clinics, hospitals, nursing homes, nurse-managed clinics and workplaces. They provide a wide range of service-products, ranging from adult care, pediatric care, gynaecological care, mental health, gerontological care and specialized forms of care. In their practice, the advanced nurse practitioners take health histories, do physical examinations, diagnose injuries and common illnesses and treat them, and manage deviations in vital signs. In addition, the advanced nurse practitioners treat chronic conditions and interpret x-rays and other laboratory parameters (ANA, 2011, p. 2). On the other hand, a nurse informaticist is a nurse who specializes in nursing science, computer science and information science, with a role of managing information, data and knowledge (ANA, 2008). The nurse informaticist plays the role of supporting nurses, patients, other consumers and providers of healthcare in decision-making in their roles and settings. In doing so, the nurse informaticist utilizes information technology, information processes and information systems. They thus must possess excellent thinking and critical skills. As clinicians, they do extensive research, and are experienced in applying and implementing the nursing process.

Contrary to the roles of the nurse informaticist and the nurse practitioner, a nurse educator’s main role is to teach (Zwygart-Stauffacher & Jansen, 2005). The advanced nurse practitioner roles wouldn’t be in existence without the nurse educators. The nurse educators are also tasked with the role of demonstrating high-level competency in the prongs of clinical skills, research and nursing education. The American Association of Colleges of Nursing (AACN, 2006) points out that, nursing educators are expected to demonstrate high-level competency and show leadership in the nursing profession. They thus act as role models in the nursing profession. The American Nursing Association (ANA, 2008) reiterates that nurse educators are tasked with developing a learning culture among nurses, and affecting positive change and public policy in the country’s political process. On the contrary, a nurse administrator is tasked with the role of managing other staffs in the healthcare delivery setting. These could be health centers, clinics and medical centers. Their role is to ensure that a cost-effective method has been applied in the implementation of organizational policies (Zwygart-Stauffacher & Jansen, 2005). They thus should possess excellent critical thinking and organizational skills. As administrators, these nurses also oversee the implementation of projects and also participate in handling the pressure of the workplace. Unlike the nurse practitioners who are involved directly with the implementation of policy, the nurse administrators are tasked with setting the policies and overseeing their implementation. Apart from being part of the administrative branch of the organization, nurse administrators deal with the issues of the personnel who are below them directly.

Advanced Practice Role for Family Nurse Practitioners:

Regulatory, Certification and Legal Requirements-State of Florida

Chapter 464 of the 2013 Florida Statutes, part 1 outlines the Nurse Practice Act, which documents the regulations of all the nurses in the State of Florida. The statute outlines the legal requirements, as well as the examination regulations for advanced practice of nursing in the State of Florida. Advanced nursing practice as an FNP falls under the class of advanced nursing practice. In the provisions, section 012 of the chapter outlines the regulations for certification of advanced nurse practitioners in the State (The 2013 Florida Statutes, 2013). According to the regulations, a nurse wishing to be certified for advanced practice in the State of Florida applies to the department to confirm ownership of a professional license and the fulfilment of the requirements of the board. The board requires that one has completed a post-basic nursing educational programme that prepares one for advanced nursing practice (The 2013 Florida Statutes, 2013).). Proof of this must be produced for a confirmation by the registering members of the board. In addition, one produces evidence of certification by a certification board for which he or she has specialized. In addition, the applying nurse is required to show evidence of graduation from an institution of higher education, leading to acquiring a master’s degree programme in the said area of practice. The regulations also provides for the scope of practice for the advanced nurse practitioners, though with scanty details about some specialties. From the regulations, it is clear that the certification as an advanced nurse practitioner in the State of Florida takes four steps, which are confirmed by the Florida Board of Nursing. The steps are completion of a post-basic nursing programme, certification by a specialty board, possession of a nursing specialty master’s degree and relationship of supervision with a monitoring physician (The 2013 Florida Statutes, 2013).

Nursing Professional Organizations in Florida

In line with the roles of advanced nurse practitioner identified by Hamric et al. (2013) and AACN (2006), as well as, ANA (2008), I purpose to join professional organizations during my practice in the State of Florida. The professional organizations will serve as an avenue for professional development, and will, in addition,, facilitate the achievement of practice goals as defined in the code of practice for advanced nurse practitioners (ANA, 2008). The Florida Nurses Association is a branch of the American Nurses Association in the State of Florida. It is an avenue for pure professional development (Florida Nurses Association, 2012). Through this forum, I will benefit in agitating nursing issues in the area of family health nursing and championing policy change. In addition, the association provides an avenue for educational resources, as well as seminars for research and development (Florida Nurses Association, 2012). Since the Florida Nursing Association is the single-most nursing association in the state of Florida that represents nurses of all specialties under one umbrella, it is one among the most appropriate to join.

Apart from the Florida Nurses Association, there are other professional nursing organizations in the State of Florida that are beneficial to advanced nurse practitioner. The Florida Center for Nursing (FCN) is a nursing organization that provides online information and materials for research. Joining such an organization will facilitate the accomplishment of the role of professional development in building the body of knowhow in the nursing profession (Florida Center for Nursing, 2014). The other professional organization is the Florida Nurse Practitioner Network (FNPN) (State Nursing Organizations, 2013). Such an organization is important in agitating the special interests of nurse practitioners. As an advanced family nurse practitioner, I will not hesitate to join such an organization. In addition, there is the Florida League of Nursing (State Nursing Organizations, 2013). I would join this organization to utilize it as an avenue for personal, professional development.

Organizational Setting, Population and Colleagues

According to the Florida Association of Nurse Practitioners (FLANP, 2014), family nurse practitioners are trained to practice in primary care settings. Their scope of practice allows them to assess, diagnose, manage and treat both chronic and acute illnesses in primary health care settings. In addition, family health nurse practitioners are expected to provide primary care to both healthy families and those with acute or chronic health problems. Currently, there is a looming health crisis in the State of Florida, with about 48% of physicians expected to retire in 10 years’ time (FLANP, 2014). There is ongoing agitation for the state to widen the scope of advanced nurse practitioners to save the State from a health crises. If this agitation goes through, the population of patients/families per nurse practitioner is going to rise. With regard to colleagues in practice, the professional code of conduct requires that a nurse practices team working and promotes team spirit. In the practice, I am going to work with physicians, community health nurses, fellow family health nurses, assistant nurses, community pharmacists, community dentists and even paramedics. The oath of professional conduct demands that I respect them and cooperate with all of them for the benefit of individual patients, family and the community.

Leadership Role in Advanced Practice:

Leadership development and participation in leadership activities is an obligation of an advanced nurse practice in the fulfillment of advanced nurse practice roles, as stipulated by AACN (2006). According to Hamric et al. (2013), all advanced nurse practitioners are required to show leadership to the other members of the profession, and participate in leadership activities aimed at promoting the growth of the profession. Participation in leadership for advanced nurse practitioner is, therefore, not an option, but a mandate as per the roles of advanced nurse’s practitioners.

After taking the 18-questions test on the leadership styles developed by Lewin, I found out that I am a delegative leader. Linking this with my leadership philosophy, as well as, the leadership attributes I possess, I agree with the findings about my being a delegative leader. According to Cherry (2014), a delegative leader is effective while leading a group of qualified people. In the field of nursing, almost all cadres are oriented to leadership issues. Independent decision-making is, therefore, emphasized. Leading such a group is a bit easy since the members are self-motivated. Some of the leadership attributes I possess are independent thinking, free will and problem-solving skills. The trait of independent thinking allows me to make decisions in hard situations even where I have no one to consult. In the practice of nursing, a practitioner is faced with many situations where there is a need to make a decision and save a life of a patient. Also, since leadership is about making choices, I have applied this trait in many situations that required making hard decisions. Additionally, the trait of free will has enabled me to communicate my mind and provide opinion without the fear of intimidation. The trait of problem-solving skills has enabled me to handle the challenges associated with life, as well as, the profession.

In my practice as a family health nurse, I have experienced challenges which were a bit hard to handle, and I attribute this to the leadership attributes that are missing in me. Being a delegative leader, I do not have some attributes like group management skills. I fill the gaps by learning from others, and reading about leadership styles. Cherry (2014) outlines three distinctive leadership styles together with the accompanying traits. Borrowing from others has been an important milestone in filling the gaps into becoming a successful nurse leader.

Health Policy and the Advanced Practice Role

Policy: Racial and Ethnic disparities in healthcare:

Despite the efforts of the government through the department of health and the other government branches to work on decreasing disparities in health, research shows that health disparities in the US is a reality (American College of Physicians (ACP), 2010). ACP (2010) reiterates that, even by holding social insurance and social income constant, the white majority citizens of the US are likely to access better health compared to the ethnic minority citizens of the US. In the survey, ACP (2010) had made recommendations geared towards addressing the issue in the year 2003. Upon assessing the issue in 2010, ACP (2010) found that some recommendations were implemented successfully and bore, fruits while a lot needed to be done to address the other recommendations and address the problem once and for all.

Regarding the current policy, the US Department of Health (2011) developed the National Partnership for Action programme to address the issue. The initiative was aimed at promoting awareness of the significance of health inequalities in society. Additionally, the initiative aimed at strengthening the health system, to promote linguistic and cultural competency, and utilize current research to address the problem of disparities in health. The department aimed to achieve its goals through mobilization, and nearly 2000 individuals attended its first summit (US Department of Health, 2011). However, the problem of racial and ethnic disparity still looms (Chin et al. 2012). Going by these, the approach with which the stakeholders have adopted towards addressing this issue needs to change.

The Change Process

The key players and parties of interest in this policy change are the governments, the non-governmental organizations, health personnel, the political class and interest groups. However, the government stands as the main player. Since the US Department of Health had come up with very good suggestions, the approach to implementation is what needs to be changed. The government needs to play a pivotal role in promoting inclusiveness of the proposed policy. Firstly, it needs to review the policy regularly to and assess its performance. Secondly, the relevant stakeholders need to be involved in the change process (Bryant, 2002). Thirdly, the government needs to instill the change process to the health personnel, health administrators and non-governmental organizations. Fourthly, the masses need to be taught about their rights to access to health regardless of their ethnicities. Lastly, the process needs to be regularly monitored.

How I would lead the Change Process to achieve results

If I were mandated to lead the change process, I would start by ensuring that I mobilize the relevant stakeholders in and incorporate them in the process of change. Bryant (2002) suggests that the stakeholders need to appreciate the need for change. I would make sure that ii carry out enough research regarding the challenge, for evidence-based information about the need for change. I will then initiate the process by mobilizing all the relevant stakeholders and informing them of the need for a change. Watt, Sword and Krueger (2005) emphasize the need for a commonality of purpose while implementing change in health reforms. The second step I would make is to liaise with the relevant government agency to ensure that policies are enacted. At this step, I may involve an interest group to mobilize the political class into adopting the recommended policy changes. Once the political class adopts the policy, I will embark on mobilizing the relevant stakeholders for the implementation of the change. At this step, the health administrators are very essential. Awareness campaigns will be instituted to mobilize health administrators and other personnel to support the bill. After implementation, regular reviews will follow to assess the progress.

The Likely Change in Healthcare

When the approach to the implementation of the proposed changes in policy is changed, more stakeholders are likely to understand the policy and support it at the initial stages. Such support will lead to successful implementation of the proposed changes. The attitudes of the health personnel and other stakeholders will change towards the delivery of care to all citizens regardless of their class, race and ethnic group. The result is that more members of the ethnic minorities will access health, and the disparity will narrow.

Conclusion:

In sum, this paper has discussed the roles of advanced practice nurses by comparing and contrasting them. The common roles of nurse educators, practitioners, administrators and nurse informaticists were compared and contrasted. The role of the family nurse practitioner was discussed in relation to regulations and legal requirements, leadership roles, nursing practice and policy development, in regard to the State of Florida in the US. Finally, the paper has discussed the roles of an individual advanced nurse practitioner in policy change, in relation to the racial and ethnic disparity in healthcare delivery in the United States.

References

American Association of Colleges of Nursing (AACN). (2006). The essentials of doctoral education for advanced nursing practice. Washington, DC: Author.

American College of Physicians (ACP). (2010). Racial and health disparities in healthcare, updated 2010. Washington, DC: Author.

American Nurses Association (ANA). (2004). Public health nursing: Scope and Standards of practice. Washington, DC: Author.

American Nurses Association (ANA). (2008). Nursing informatics: Scope and standards of practice. Washington, DC: Author.

American Nurses Association (ANA). (2011). Advanced practice nursing: A new age in healthcare. Washington, DC: Author.

American Nurses Association (ANA). (2014). Advanced practice nurses. Retrieved from http://www.nursingworld.org/

Bryant, T. (2002). Role of knowledge in public health and health promotion policy change. Health Promotion International, 17(1), 89-98.

Cherry, K. (2014). Lewin’s leadership styles. Retrieved from http://psychology.about.com/library/quiz/bl-leadershipquiz.htm

Chin, M. D., Marshall, H., Amanda, R. C., Robert, S. N., Alicia, A. C., Anna, P…. & Scott, C. C. (2012). A roadmap and best practices for organizations to reduce racial and ethnic disparities in healthcare. Journal of General Internal Medicine, 17(1), 992-1000.

Florida Association of Nurse Practitioners (FLANP). (2014). Florida healthcare crisis: Advance practice nurse solution. Retrieved from http://flanp.org/florida-healthcare-crisis.html

Florida Center for Nursing (FCN) (2014). About FCN. Retrieved from http://www.flcenterfornursing.org/

Florida Nurses Association. (2012). About the Florida nurses association. Retrieved from http://www.floridanurse.org/aboutFNA/

Hamric, B. A., Hanson, M. C., Tracy, F. M., & O’Grady, T. E. (2013). Advanced practice nursing: An integrative approach. Cambridge, MA: Elsevier Health Sciences.

“State Nursing Organizations” (2013). Retrieved from http://theagapecenter.com/Organizations/State-Nursing.htm

The 2013 Florida Statutes. (2013). Regulations of professions and occupations: Chapter 464-Nursing. Retrieved from http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0464/0464.html

US Department of Health. (2011). National partnership for action. Washington, DC: Author.

Watt, S., Sword, W., & Krueger, T. (2005). Implementation of a healthcare policy: An analysis of barriers and facilitators to practice change. BMC Health Services Research, 5(3), 33.

Zwygart-Stauffacher, M., & Jansen, P. M. (2005). Advanced practice nursing: core concepts for professional role development (3rd ed). New York, NY: Springer Publishing Company.