AbstractAdvanced practice registered nurses (APRN) are practitioners that carry out a wide variety of duties in a number of different settings. The FNP is a clinical role which provides direct care to family members across the lifespan, including prevention of illness and disease as well as the treatment and management of health concerns and conditions. Research and expert opinions have focused on the need to clearly communicate the role of NPs, and at least one study has defined this as a necessary competency of practice. As the role is still a new one for many in the medical profession it may take time and exposure in order for medical professionals and others to better understand the potential of the NP role and appropriate processes and responsibilities in collaboration.

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Assignment 4: Role and Settings
Advanced practice registered nurses (APRN) are practitioners that carry out a wide variety of duties in a number of different settings. There are both clinical roles which provide direct care such as the family nurse practitioners (FNP) alongside non-clinical roles which support nursing and healthcare systems. Both work towards increasing patient safety and positive outcomes. APRN are trained to work autonomously and independently to provide direct and indirect care, however often they are required by state regulations to work under the supervision of medical practitioners such as physicians. In other cases they were collaboratively with doctors and other professionals.

The role and setting of the family nurse practitioner
FNP serve an advanced practice role by providing primary health care to families. Fundamental to the practice of family centered care is the idea that the family is composed of individuals in different life stages and the status is dynamic rather than static. It is for this reason that families themselves are dynamic and changing as the members of the family continue to progress and develop through life stages (Kaakinen, Coehlo, Steele, Tabacco & Hanson, 2014, 159).

The scope of practice includes assessment and the management of wellness as well as acute and chronic conditions across the lifespan including proactive and prevention focused interventions. This can include providing scheduled vaccinations to young children, counselling women regarding birth control options, the treatment of respiratory infections and monitoring and care following surgical procedures. These are just some examples of the many duties of the FNP. The setting of the FNP can be private practice, a private clinic, as part of a health maintenance organization or network, or in a hospital context. Each setting has different dynamics relating to guidelines, collaboration and payment however the FNP serves the same role in each of providing primary health care from a family-centered perspective.

FNPs carry great responsibilities, and to assure patients and the public of their qualification each state has legal requirements defining core competencies which must be met prior to practicing in this role. The legislative requirements for practice as an APRN in Florida include graduation from a Masters or Doctorate level program in nursing in the specialty for which one intends to practice and registration with the board of nursing. (Florida Board of Nursing, 2016). The Florida Board of Nursing also has competency requirements which are more specific. This allows APRN who are specialized in family health care to practice as FNPs in private or public clinics or within a hospital or healthcare network setting.

A clinical role supporting patient safety
FNP provide care for families across the developmental spectrum in a clinical context (Ellis, Anderson & Spencer, 2015). As a clinical role, these practitioners have a direct responsibility for the safety of their patients. The National Patient Safety Goals (NPSG) are guidelines established by the Joint Commission which are updated annually. Whereas in a non-clinical role APRNs are responsible for patient safety through systems, direct care providers are responsible for the patient safety of individuals under their care.

The NPSG are divided into several categories including “Hospitals, Home Care, Critical Access Hospitals, Laboratory Services, Long Term Care, Nursing Care Centers, Office-Based Surgery, Behavioral Health Care, and Ambulatory Health Care settings” (Hudson Garrett, 2016, n.p.). Different guidelines may apply depending on the setting and context of FNP. The NPSG tend to be very detailed and cover nearly every aspect of treatment and practice from the identification of patients to the use of various medications. The FNP promotes patient safety therefore not only through provision of primary health care, but also by adhering to these best practices to promote safety as outlined in the NPSGs. In a clinical role the FNP may be practicing in the context of an accredited organization, in which case the compliance with NPSGs is required as a condition of accreditation (Hudson Garrett, 2016).

The emerging safety issues identified as the NPSG for a hospital setting include: improving the accuracy of patient identification, timely reporting of critical test results; proper labelling of medications and containers in all clinical settings; reducing the potential for patient harm when anticoagulant therapy is required; maintaining and communicating accurate information regarding the medication of patients; compliance with hand washing and hygiene guidelines; implementing evidence based practices to prevent infections related to healthcare services including central line associated bloodstream infection, surgical site infection and indwelling catheter associated infections (Hudson Garrett, 2016).

Research summary
Two research articles were reviewed which related to the role of FNP.
Schadewaldt, McInnes, Hiller, and Gardner (2013) provide a synthesis of various research relating to the perception of NPs and the factors which created challenges or facilitated their practice. In particular this was related to the need for collaboration with other health care providers including physicians. The studies which were reviewed were produced between 1990 and 2012. As a result of this research the authors found that there was tension between NPs and other medical practitioners, especially due to the difference in perspective with regard to the need for supervision of NPs. The study also found that there was evidence that exposure to NP practice served to change the point of view of medical professionals, and those who had more experience working with NPs tended to have a more positive view of their role. There remains various technical barriers to collaboration, including liability related issues.

Brault, Kilpatrick, D’Amour and others (2014) conducted research in the form of case studies to better understand the clarity and definition of the role of APRNs. The setting for this research was Canada, where qualitative research investigated these issues through semi structured interviews with a variety of stakeholders. They concluded that successful implementation of the NP role required a role clarification process to ensure that teams were appropriately structured to take advantage of the skills and potential of the NP. They further determined that communicating the NP role was in itself a necessary competency for the practice of NPs.

Expert opinion
Yee, Boukus, Cross, and Samuel (2013).provide their expert opinion with regard to the regulation of nurse practitioners in the United States. They describe that the need for NPs relates initially to the shortage of physicians in a context of increasing demand for care. State laws and regulations are however a patchwork when it comes to the regulation of NPs. Some states allow NPs to function independently, while others require the supervision of a physician as a condition of practice. The scope of practice for NPs therefore varies from state to state Yee et al., 2013). This regulatory practice can come into conflict with the facilitating mindset as it can in fact increase the costs when NPs can only practice under the supervision of physicians, and at the very least it impacts the practice opportunities for NPs when the payment for their work is made indirectly through physicians. An underlying theme in this opinion article is recognition and respect for the role of NPs, particular as it would appear that some states do not reflect an accurate understanding of the potential for NPs to provide primary care and to influence healthcare reform (Yee et al., 2013). A main message is that scope of practice for NPs is regulated not just through provisions directly on that issue, but also indirectly through payment provisions for NPs (Yee et al., 2013).

    References
  • Brault, I., Kilpatrick, K., D’Amour, D., Contandriopoulos, D., Chouinard, V., Dubois, C. A., … & Beaulieu, M. D. (2014). Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study. Nursing research and practice, 2014. doi: 10.1155/2014/170514
  • Ellis, K. K., Anderson, K. M., & Spencer, J. R. (2015). The Living Family Tree: Bridging the Gap Between Knowledge and Practice in a Family Nurse Practitioner Program. The Journal for Nurse Practitioners, 11(5), 487-492. doi: 10.1016/j.nurpra.2015.03.014
  • Florida Board of Nursing. (2016). Standards for Protocols: Physicians and ARNPs. Retrieved from: http://floridasnursing.gov/latest-news/standards-for-protocols-physicians-and-arnps/
  • Hudson Garrett, J. (2016). Overview of the 2016 National Patient Safety Goals. Journal of the Medical Science Liaison Society. Retrieved from: http://themsljournal.com/article/overview-of-the-2016-national-patient-safety-goals/
  • Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2014). Family health care nursing: Theory, practice, and research. FA Davis.
  • Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care–an integrative review. BMC family practice, 14(1), 132. doi: 10.1186/1471-2296-14-132
  • Yee, T., Boukus, N., Cross, D., & Samuel, D. (2013). Primary care workforce shortages: nurse practitioner scope-of-practice laws and payment policies. National Institute for Health Care Reform. Research Brief, 13. Retrieved from: https://www.floridanurse.org/ARNPCorner/ARNPDocs/ARNPResearchpaper2013.pdf