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Advanced Nursing Practice.
I would like to explore the different fields of Advanced Nursing Practice.

The four that I will address are the Nurse Anesthetist, the Clinical Nurse Specialist, the Nurse Practitioner and the Nurse Mid-wife.

Advanced Practice Nurses are Registered Nurses with specialty training at the master 's-degree level, in primary care settings, such as the Nurse Practitioners and Nurse Midwives and acute care of inpatients, such as the Clinical Nurse Specialists and in operating rooms, such as Nurse Anesthetists. This has opened a door in the nursing field. Nurses ' roles are no longer limited. Nurses now have opportunities to advance their career and expand their roles. Advanced Practice Nurses can be more directly involved in patient care decisions and be more independent from the physician. Advanced Practice Nurses are respected role models for Registered Nurses.

What are Advanced Practice Nurses?

As defined by the American Nurses ' Association Congress of Nursing Practice:

Nurses in advanced clinical nursing practice have a graduate degree in nursing. They conduct comprehensive health assessments and demonstrate a high level of autonomy and expert skill in the diagnosis and treatment of complex responses of individuals, families and communities to actual or potential health problems. They formulate clinical decisions to manage acute and chronic illness and promote wellness. Nurses in advanced clinical practice integrate education, research, management, leadership, and consultation into their clinical role. They function in collegial relationships with nursing peers, physicians, professionals, and others who influence the health environment. (McLoughlin 1992).

Roles in Nurse Midwifery and Nurse Anesthesia developed in the first half of the 20th century, while the Certified Nurse Specialist and the Nurse Practitioner roles developed in the second half of the century. There were many elements that created the demand for Advanced Practice Nurses. The large number of



References: Bigbee, J.L. (1996) History and Evolution of Advanced Nursing Practice. In Advanced Nursing Practice: an Integrative Approach. W.B. Saunders, Philadelphia, pp. 3-24. Creasia, J.L., Parker, B. Conceptual Foundations: The Bridge to Professional Nursing Practice, 3rd Edition. St. Louis: Mosby Inc., 2001. Ford, L.C. (1995) Nurse Practitioners. Myths and Misconceptions. Journal of the New York State Nurses Association, 26 (7), 69-74. Komnenich, P. (1998) The Evolution of Advanced Practice in Nursing. In Advanced Practice Nursing: Emphasizing Common Roles. FA Davis Company, Philadelphia, pp. 8-46. Manley, K. (1997) A conceptual framework for advanced practice: an action research project operationalizing an advanced practitioner/ consultant nurse role. Journal of Clinical Nursing 6: 179-190. Nursing facts: advanced practice nursing: a new age in health care. Washington, D.C.: American Nurses ' Association, 1993. (PR-11). Pearson LJ. 1992-93 Update: how each state stands on legislative issues affecting advanced nursing practice. Nurse Pract 1993;18:23-38.

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