What is a Nurse Practitioner?
By Kelly Mansfield
Retrieved from www.patientcaretechniciansalary.net
In the 1960s, Medicare and Medicaid extended
services to low income groups, the elderly, and those with disabilities. The
increase in healthcare coverage created a shortage of qualified physicians.
In
1965, the first nurse practitioner program was created to fill that void. Nurse
practitioners
(NP) can work independently or with a physician to diagnose,
prescribe and manage a patient’s overall care. Their ability to practice
independently varies based on state legislature. They are found in hospitals
and clinics as well as many specialty areas. In 2010, the Institute of Medicine
(IOM) released the Future of Medicine report recommending state legislation
needed to remove barriers preventing nurse practitioners from practicing to the
full extent of their license.
What do all the
letters mean?
Some of the confusion around the role of nurse practitioner comes
from the various names and credentials surrounding the profession. Initially, a
nurse practitioner held a certification. This quickly evolved to a masters
degree in the 1970s. Now, there are a variety of nurse practitioners with
different degrees and credentials. Most nurse practitioners are
certified
by either the American Academy of Nurse Practitioners (AANP) or the American
Nurses Credentialing Center (ANCC). If the AANP provided the certification, the
title will be NP-C, usually with a specialty proceeding the designation. This
equates to the designation of FNP-C for a family nurse practitioner. The
designation for ANCC is similar - FNP-BC. State designations are either
Advanced Registered Nurse Practitioner (APRN) or Advanced Practice Nurse (APN).
A recent change to the role of nurse
practitioner is the addition of a Doctoral Program (DNP). The goal of the AACN
was to move advanced practice nursing to a doctoral degree by 2015. The
doctoral program adds a research aspect to the role of a nurse practitioner. Nurse
practitioners utilize this research knowledge to integrate evidence-based
practice into clinical settings.
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The nursing Ph.D. was officially
established in the 1970s. Prior to that time, nurses received a doctor of
education degree to teach nursing. Other options were a Ph.D. in a social
science with a minor in nursing or a DNSc (Doctor of Nursing Science). A
nursing Ph.D. is primarily focused on research and advancing nursing science. This
nursing career is founded on a Doctor of Philosophy degree and concentrates on
developing new nursing science and education of the next generation of nurses.
Ph.D. nurses use a variety of research methods including qualitative,
quantitative and mixed methods to explain phenomenon. The role of the Ph.D.
nurse includes designing studies as well as evaluating and interpreting the
results. Nursing studies surround a wide range of health issues which can be
clinical in nature as well as focusing on public health issues, patient
experiences, social determinants of health and health care policy.
The Paradigm of
Nursing Research
Traditionally, research in nursing
has been centered around the research programs of Ph.D. nurses. Until the 1990s,
there was a gap between research and practice. The 2001 IOM report stated,
“Between the care we have and the care we could have lies not just a gap but a
chasm.” This gap was the motivation for the implementation of evidence-based
practices. Evidence- based practice (EBP) is defined as nursing practices which
are based on the results of scientific research. Nursing education was adapted
to teach the skills necessary to investigate practice issues and implement EBP
solutions. The move to EBP began to close the chasm between research and
practice. It encouraged nurses in many specialties to become involved in
research and moved nursing towards a translational model.
Translational Research
The concept of translational
research is to integrate research into practice. Improved access to current
research will improve the health system by bringing new knowledge to the
bedside. There are 5 levels of translational research. In the first level (T0),
health issues are identified. In the next step (T1), research is translated to
humans. This can be done via clinical trial, interventions or treatments in
controlled settings. In stage 3, research is applied to create evidence-based
practice (T2). Then, the research is disseminated to the bedside (T3) and the
outcomes are evaluated (T4).
Nursing Roles in
Translational Research
As nurses have breached the gap
between research and practice, they have integrated translational research into
the nursing model. Translational research is the basis for evidence-based
practice. In nursing, a Ph.D. nurse works to identify health issues (T0) and
translate that research to humans (T1). A DNP integrates that research into the
healthcare system (T3). Both groups are active in evaluating the outcome of the
interventions (T4).
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Working together
Issues in
Collaboration
One of the largest issues in nursing
collaboration is a lack of resources. The Campaign for Action was created to
monitor the recommendations of the OIN report. In 2018, they reported 7,039
nurses graduating from a DNP program and 801 graduating with a Ph.D. While
there is an increase in graduates in both areas, there is still a shortage of
both advanced practice nurses and doctoral graduates. Also, the number of DNP
students is too large to be effectively supported by Ph.D. nurses. The
recommendation of the OIN report was to double the number of doctoral-prepared
nurses by 2020. Continuing to support the growth of nurses with advanced
degrees will also support nursing partnership.
References
American
Association of Colleges of Nursing. (2019). Fact sheet: The doctor of nursing
practice (DNP). Retrieved from https://www.aacnnursing.org/Portals/42/News/Factsheets/DNP-Factsheet.pdf
Carter,
M. (2006). The Evolution of Doctoral Education in Nursing. Jones and Barrett.
Pg 27-35
Dellabella,
H. (2015). 50 years of the nurse practitioner program Clinical Advisor. Retrieved
from https://www.clinicaladvisor.com/home/web-exclusives/50-years-of-the-nurse-practitioner-profession/
Campaign
for Action. (2017). Number of people receiving doctoral degrees annually. Retrieved
from https://campaignforaction.org/resource/number-people-receiving-nursing-doctoral-degrees-annually/
Midlevel
U. (2015). How to sign your name as a nurse practitioner. Retrieved from https://www.midlevelu.com/blog/how-sign-your-name-nurse-practitioner
Stevens,
K. (2013). The impact of evidence-based practice in nursing and the next big
ideas. The Online Journal of Issues in Nursing retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html
Trautman,
D., Idzik, S., Hammersla, M., Rosseter, R. (2018). Advancing scholarship
through translational research: The role of PhD and DNP prepared nurses. The
Online Journal of Issues in Nursing, retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No2-May-2018/Advancing-Scholarship-through-Translational-Research.html
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