Advanced Practice Nurse

Role Development for Advance Nursing (Precise description of the Advanced Practice Nurse's Role as Researcher)
To look at the role of researcher we first need to define who makes up the Advanced Practice Nurse. The Advance Practice Nurse (APN) for the purpose of this description as a researcher includes not only the 4 roles that require additional licensure: Certified Nurse Midwife, Certified Nurse Practitioner, Certified Nurse Anesthetist, and Clinical Nurse Specialist but also the Masters prepared Registered Nurse in the areas of leadership and education. The responsibility of all APN's is to maintain the integrity and advancement of the nursing profession through ongoing oversight of current practice in all areas of nursing to determine
that our profession is maintaining patient centered, quality, cost-effective care within all settings of nursing. The APN develops, educates and implements Best Practice protocols which come about from evidence-based research that is then translated into standards of practice for all care areas. The evidence-based research allows scientific support of nursing practices as well as to ongoing development of changes in practice to improve quality and cost effectiveness while still being patient centered.
Research by the APN takes many forms of which participation can be found at multiple levels and in multiple settings. In Clinical setting research may be done by the APN to gather data by direct observation of clinical practice to assess that policy, standards and all regulatory practices are being followed. The gathered information is then utilized with the help of staff and administrations to develop performance improvement practices, education programs and annual competency programs for staff to maintain quality, effective practice. Research by literature review of changes in practice that promote improved patient outcomes can be done through which the APN determines relevance to current practice, then helps to translate the updated research based practices into current care policies of their health institution. The APN can design, develop, run and or participate in a formal scientific research projects that can then lead to changes in practice across the continuum of all Nursing and medical practices. Through whatever type of research the APN may use to bring about evidenced based practice changes, it is the APN's duty and responsibility to develop and promote evidenced based practice for nursing through the use of research.
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's Leadership role as consumer advocate) Describe the Master’s prepared nurse’s role as consumer advocate.
The consumer is determined by use of a service and consumer advocacy would be to support, promote, and/or argue for the consumer. The Masters prepared nurse (MSN) is in a unique position to be a consumer advocate for many different types of consumers encountered in a professional nursing career. Advocacy can be found in the many roles of the MSN such as collaborator, educator, role model, administrator, policy maker, direct patient care nurse, researcher, professional organization member/officer, legislative lobbyist and consumer. The MSN's goal as a consumer advocate is to promote safe, quality, ethical, cost effective, person centered services specific to the needs of the consumer or consumer group that is being advocated for. The consumer may also be the MSN who through advance education has learned the importance of understanding and using evidence based practice, professional associations, standards of care, policies and regulations in their own professional practices. In Direct patient care you become the advocate for your patient (the consumer of nursing services). As the patient consumer advocate you see that they are receiving safe, quality, evidence based, efficient care that is patient centered/planned which you advocate to all who are involved with their care. The education of the patient (consumer) of their rights (legal, moral, ethical) and encouragement to participate in their daily plan of care is another part of the advocacy process. As an administrator/leader your consumer advocacy broadens as it now incorporates advocating for the multiple roles under your leadership position (staff, clients, suppliers, collaborative professions, etc.). Policies, practice models, regulations, care delivery systems are all impacted as leaders advocate for those impacted by the services they are responsible for. Consumer advocacy is part of every aspect of the MSN's professional career and it is through the educational process they learn to understand and manage the complexities of this role and to be a recognized expert so as to be an effective advocate.
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's role as change agent)
The master's prepared nurse (MSN) has the responsibility to be an ongoing change agent in the healthcare world that is always moving toward patient centered, quality care, efficient cost effective practices that improve positive health outcomes. Through additional education and understanding of research modalities to promote evidence based practice, the MSN incorporates this into practice by identifying practice changes needed for the safe, improved health outcomes, plans on how to incorporate the change of practice with the training and education, implements the practice with a test of change that after evaluation can then be implemented throughout the organization. The evidenced based practice is then continually evaluated with needed training, education and modification where needed to continue to have safe effective outcomes. If an evidenced base practice is identified as a change of practice that could be beneficial throughout the healthcare community, the MSN can through national professional organizations and professional publications promotes this change to the healthcare community. It is an integral part of the practice of MSN to lead the profession in ongoing performance improvement initiative with measurable outcomes that embrace the culture of ongoing change that promote and environment of safe quality cost effective patient centered care. The MSN is in a position to be a positive change agent because of their influence/connection to patients, nursing staff, the organization and professional community. As a participant in on going continual practice performance evaluations, areas of improvement of skills and practice can be identified. In keeping up to date on new evidenced based guidelines, the MSN can identify and implement changes in practices within the organization which may be to implement an update or a complete change of practice. In our hospital MSN staff lead the monitoring of National and hospital chosen indicators with specific goals that indicate safe quality care then develop projects under the topic of "transformational care at the bedside" which are practice changes to help meet the national patient safety goals which is an example of fulfilling the role of change agent effecting daily practice within our organization.
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's role as clinician) Describe the Master’s prepared nurse’s role as clinician. A clinician is someone who works with patients. Direct patient care in different settings is generally the first role nurses begin their career with and should continue to be a part of a Masters prepared nurses career but generally does not remain the only part. The masters prepared nurse (MSN) develops the competency as well as the responsibility to advance to other roles within the healthcare delivery system or other related organizational systems to develop, promote, improve, evolve practices, regulations and education that lead to improved outcomes through evidenced based, quality, cost effective practice. The MSN clinician as a direct patient care provider has the responsibility to participate in and promote patient centered care that will improve outcome and promote quality of life choices of the patient. This is done through on-going education of the patient about all aspects of their healthcare as well as healthy practices for daily living during every patient interaction, participation in patient care planning or discussions in the inpatient or outpatient settings, and remaining up to date on all evidence based practice changes in order to implement them in patient interactions. The MSN clinician has the preparation to advance to other roles such as those in administration, education, research and advance licensure roles of Nurse Practitioner, Mid-wife, nurse anesthetist, Clinical Nurse Specialists. Within all these roles the clinician uses their expertise to guide the bedside nurse, advance nursing practice, and effect system/organizational/governmental agencies to bring about safe/quality outcomes for an ever increasingly diverse population.
Role Development for Advance Nursing (Precise description of Master's prepared nurse's role as collaborator) Describe the Masters Prepared Nurses role as a collaborator
Let us first look at what collaboration means which simply put is working together with others for a common goal or on a specified project. Beginning educational programs that prepare nurses to be able to function in a community or hospital setting focus on skills and knowledge to assess needs and plan care for their patients with an inter-disciplinary approach. The inter-disciplinary approach has each practitioner setting their own plans of care independently of each other than coming together to discuss each groups plan and goals for the patient. This may appear collaborative because multiple discipline come together to discuss the patient but in actuality each discipline continues their care based on their individual plans of care. True professional collaboration requires additional education on group dynamics, conflict resolution and management, and how to integrate the nursing role, knowledge and skills with all those participating on a collaborative team. The masters prepared (MSN) or advance practice nurse (APN) through their additional education acquire the skills to be a dynamic part of a professional collaborative team promoting patient centered care that improves patient safety and health outcomes. The "at the bedside" MSN has the critical thinking and clinical judgment to develop and promote effective, quality, patient centered practices through collaboration with each member of the health professional team. The MSN uses collaboration skills when participating on many inter-disciplinary professional patient centered teams such as patient care, management, educational or research. As healthcare is moving to make all care patient centered the MSN can promote collaborative practice of all disciplines to move away from an inter-disciplinary format where each group sets goals and care plan for the patient to daily collaborative planning of patient care where the patient is involved to allow the patient to direct/control the direction of care from all disciplines. In collaborative practice the nurse has individual responsibilities yet understands the shared responsibilities of the care team as well. Collaboration is part of the daily fabric of the career of the MSN as it is used in all forms of professional interaction as well as in the changing Healthcare environment. Collaborative teams come together at times by chance, by planning, by shared interest or by leader assigned designation. The MSN through the collaborative process is able to promote care that focuses on expert evidenced based practices that promote patient centered and patient controlled care.
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's role as consultant)
The masters prepared nurse (MSN) is recognized through education and experience as a leader and expert in a nursing specialty that prepares them to fulfill the role of consultant based on this knowledge and experience. Consultant roles may be an ongoing or integrated role within an organization such as those at our institution in the areas of Ethics, Infection control, and Pain Management. These nurses are experts in their field who consult with staff on individual patient concerns, consult with management on development of care practices, and at an organizational level consult to develop best practice and professional protocols within these areas of expertise. When expert professional advice and guidance is needed in research, leadership, education, or healthcare practice/policy change than the MSN may also be hired as an independent consultant. As a consultant you are expected to be objective, professional, competent, observant, an information expert, an advocate, a problem solver, an educator and a change agent for the project or healthcare practice. The consultant role may involve giving expert advice to nursing or other professions on healthcare practices, developing educational programs around practice changes that have been identified to improve the quality of healthcare outcomes, identify and develop efficient cost effective evidence based practice changes that meet the needs of the patient and staff, or be the specialty expert for research projects. As with all aspects of healthcare, the role of consultant for the MSN is every changing and multifaceted. Nursing consultants are being utilized in areas outside of direct patient care such as Informatics in the development of Electronic Medical Records Systems, as Legal experts, and in the political arena as experts for healthcare reform. The MSN preparation in leadership, research, education development and nursing expertise makes them uniquely qualified for the role of consultant in all areas of healthcare related reform.
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's role as manager of systems)
The masters prepared nurse (MSN) through the development of skills in the areas of coordinator of interdisciplinary teams, clinical decision making, critical thinking, disease prevention, health promotion and supportive care, is in a unique position to fulfill the role of "manager of systems". With the changing healthcare environment there is a greater need to coordinate health services to allow for quality, evidence based, cost effective supportive care across the continuum of primary, acute, rehabilitative and outpatient services. MSN primary role is to bring together and participate on care teams of health professionals that focus on delivering quality patient centered care that optimizes the patients' health/wellness with a given episode of illness that then continues into the community to prevent future illness and promote improve health outcomes beyond the current illness episode. Improved health outcomes require participation of the MSN not only in direct patient care but in quality improvement projects, organizational policy reviews, education program development to maintain staff competencies, community based health promotion programs, patient/family health education that promotes involvement in health care decisions and through professional organization membership participates in health care reform. The goal to provide optimal care requires the MSN to see that the patient is connected into all system resources that will bring about the best outcome which can be through the coordinated management of nursing, primary physician, specialists, finance support, information support and community systems. Beyond direct coordination of healthcare services, the MSN promotes optimal care by participating in and/or leading reviews of all aspects of healthcare delivery systems to identify system errors then develop and implement process changes to promote quality safe effective care. The systems management role of health care is every changing and evolving yet maintains the core value at its center to see that quality, evidence based, effective, outcome based care is provided to all within the healthcare system
Role Development for Advance Nursing (Precise description of the Master's prepared nurse's role in improving healthcare delivery and outcomes)
The master's prepared nurse (MSN) is in a unique position to be an ongoing influence on healthcare delivery and positive outcome promotion through contact with patients using the healthcare system, nurses in large numbers in many roles throughout healthcare system, other non- nursing health professionals and affect governing regulatory bodies through participation with professional organizations or working directly with regulatory organizations. From the beginning of a nurse's career they learn to be an advocate for safe, quality, effective care for those whose care they have been charged with. In the shared governance role of many healthcare organizations, all nurses participate in, promote, plan, evaluate, implement care practices that are evidence based that show they improve patient outcomes. The MSN through the leadership roles they hold identifies nursing and medical practices that may need monitoring, further education, or changes to improve the safe, efficient, cost effective, positive health outcomes for the patients within the healthcare system. The MSN develops educational training programs; develops, runs and implements evidence based research that may change practices for improved patient outcomes; and becomes the resource for their nursing specialty to guide or collaborate with other professions for this same goal. The MSN who have acquired the additional Advance Practice Licensure works closely with Physicians either directly or with independent practice collaboration to promote the delivery of patient center, quality care.
This direct collaboration leads to greater recognition by those in the health care policy making arena so as to have a greater effect on identifying, planning and implementing changes within healthcare delivery that will allow for better outcomes. Lifelong learning through continuing education is promoted for all nursing and it is the MSN who have increase involvement in this process to see that there is quality, transformational educational programs available for all nurses that again lead to improve outcomes by keeping practices up to date. As all levels of nursing continue to take responsibility in all settings (inpatient, community, education, regulatory boards, government, etc.) with the focus being improved outcomes, the MSN will be recognized as an expert in healthcare and will be involved in collaborative planning groups such as our own CNO, Dr. Linda Burnes-Bolten, to influence the future of Healthcare delivery as it continues to look for improve health outcomes within a quality, cost effective, efficient healthcare delivery
system.
Role Development for Advance Nursing (Precise description of negotiation skills for the Master's prepared nursing role)
In the landscape of the ever changing Healthcare system with the current move to patient centered, quality, cost effective care, nurses must develop strong negotiation skills not only to help encourage their patients to follow prescribe health care treatments but to work with all parts of the healthcare industry to adopt proposed evidence based practice/policy changes that are shown to improve outcomes.
Negotiation is a process used by all to bring about understanding and agreement toward a common goal which could entail bargaining and compromise to reach the agreement. The masters prepared nurse (MSN) as a leader uses negotiation skills to influence individuals or organizations in order to gain the support for healthcare policies/practices that meet the goal of improved, cost effective patient centered
care. The process and skills of negotiation need to become second nature for the MSN. This entails: first always plan and prepare by understanding the value of the proposal to all involved parties and the benefit the proposal brings to each; second after identifying all interested parties, it helps to try to gain support from as many as possible prior to any formal discussion of the proposal; third remember the ultimate goal which in the case of nursing would be to make sure your proposal speaks to safety, cost effectiveness, quality and patient centered improved outcomes and is evidence based which will make it difficult for it not to be accepted as these are the goals for all healthcare changes; fourth at the presentation and discussion of proposals don't take anything personal steering clear of negative, emotional responses and staying with facts that support your goal even having already determine compromises that would be acceptable; and finally end with an agreement and implementation plan for your proposal. The skill of negotiation as part of the MSN role makes the difference in being an effective leader and change agent starting from patients adopting the healthcare treatments/care practices to improve their outcomes to improving the healthcare delivery system as a whole.
Role Development for Advance Nursing (How you will implement roles 1-9 in your professional development)
Many of the roles discussed are already part of my current professional practice but as I further my education toward my MSN, I hope to broaden their use as I move into more of a leadership role at Cedars-Sinai with the first step to advance to a position on the highest level of our clinical ladder, the CNIV. Within this leadership role I will be able to use research, collaboration, negotiation, consultation roles as I work with others to identify and monitor current nursing practices and determine if the practice is meeting all national safety standards and goals. Where the practices may not be fulfilling the goals, evidence based research can be done to look for changes in practice that then meets these goals/standards. I will fulfill the role of change agent by helping to develop a plan, educate staff, and implement the new evidence based practice guidelines with continued evaluation /monitoring to insure improved outcomes. I will continue in the clinical role either with direct patient care, participating as part of the patient care rounds or doing patient care satisfaction follow up to see that patients' needs are being met. Consumer advocacy is part of the CNIV position with my direct patient care, implementation of evidence based practice changes, clinical expertise shared with staff, monitoring performance improvement indicators and representing my area on hospital wide committees where I help to support the organizational goal for patient centered care. Through my involvement in our shared governance committees I am actively involved in a project to develop a peer review process which will contribute to improved healthcare delivery and outcomes through review of peer practices to see that they are meeting the standards of care and identifying practice changes within nursing standards of care that will improved patient health outcomes as well as promote staff and patient satisfaction within the organization. The role of manager of systems will be fulfilled with participation on interdisciplinary patient care teams, follow up with patients to see that after discharge they are connected into all healthcare services to see that their ongoing health needs are being met so as not to have to be readmitted into the hospital setting within 30 days of their discharge, and by my involvement in quality improvement projects, organization policy review, and staff competency maintenance education programs. The development and implementation of the Electronic Medical Record with Bar Code medication scanning is an ongoing project from which at varying times I incorporate all the 9 identified professional roles in my capacity as end-user, trainer, implementation specialist and participant in the design committee with representatives from all departments of the organization. I have gained a greater understanding of these roles and how they are utilized in professional practice to be able to continue to strengthen the roles I currently participate in and expand on them in the future.