Table of Contents
- Advanced Practice Roles in Nursing
- Nurse Practitioner
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- Nurse Administrator
- Informatics Specialist
- Nurse Educator
- Selected Advanced Practice Role
- Leadership Attributes of the Advanced Practice Role
- Available Attributes
- Attributes in Development
- Health Policy and the Advanced Practice Role
- Health Issue
- Changes and Nursing Roles
- The Effect of the Policy
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The reformation of the healthcare system with the emphasis on the quality and accessibility of the provided services has had a considerable impact on the nursing practice. In particular, nowadays, the roles of nurses may include those of practitioners, educators, administrators, etc. As a result, the ambitious nurses have many paths to choose from, but the right choice cannot be made without knowledge of the nursing activities, regulatory requirements, and the potential place of work. In turn, the healthcare industry may obtain a mediocre specialist due to the incompatibility of one’s professional skills with the chosen role. Therefore, the following paper focuses on the overview of the several advanced practice roles, and the analysis of the selected nursing specialty and leadership attributes that are important for the contemporary healthcare professional, as well as the issue of the US health policy.
Advanced Practice Roles in Nursing
Nowadays, the roles of a nurse working in almost any setting (e.g. clinic, hospital, health center, etc.) have become rather diverse due to the increasing autonomy of such healthcare professionals. The most significant of them include the ones of a nurse practitioner, educator, informatics professional, and administrator.
The nurse practitioner is the most common role in the advanced clinical practice, with it focusing on the provision of care to the patients suffering from either acute or chronic illnesses. The core functions of such healthcare professionals to some extent include diagnostics and treatment of various disorders under the supervision of a physician. On the other hand, the managerial, educational, and scientific activity of the nurse practitioners is relatively insignificant, especially in comparison with the other nursing roles. It primarily focuses on the informal leadership without actual authority, which reduces the impact of the decisions made by such specialists, as well as the patient-centered education (e.g. the promotion of a healthy lifestyle). The researches they are engaged in are usually directly connected with their core competencies, with such nurses performing a supportive function (Jansen & Zwygart-Stauffacher, 2009). However, the focus on the patients makes raises the demand for such a role, contrary to the role of other types of healthcare professionals that are reviewed further.
The clinical practice of a nurse administrator is primarily centered on the organization of work of a nursing team or, in some cases, a particular department of the healthcare facility. Therefore, it usually does not take part in the direct provision of care, relying on the subordinates in this matter. In contrast to the nurse practitioners, nurse administrator primarily focuses on the managerial and to a certain extent educational activity, such as scheduling and development of plans, including those related to the training and education of other nurses. Moreover, even without the direct involvement, the administrator supervises and oversees the provision of care, ensuring its compliance with the quality standards. The research activity of the administrator is centered on the optimization of the work processes, e.g. cost-efficiency, distribution of workload, etc. (Jansen & Zwygart-Stauffacher, 2009). As a result, nurse administrator is a manager for other advanced practitioners.
A nursing informatics specialist deals with the data that circulates within the healthcare facility, with this task being the core of his/her clinical practice. The lack of contact with the patients and the focus on educative and to a lesser extent managerial functions makes the role of this specialist similar to that of the nurse administrators. In particular, such professional maintains the IT infrastructure of the clinic, ensuring the constant information support of its staff. The research conducted by a nurse usually focuses on the safety of data, as well as its application and exchange with maximum efficiency (Jansen & Zwygart-Stauffacher, 2009). As a result, such advanced practitioner plays a supportive role.
Finally, a nurse educator primarily focuses on the training of the personnel in a healthcare facility. Once again, the contact with the patients is minimal, which makes the role of an educator similar to that of an informatics specialist or administrator when it comes to the primary care. The educative function is the primary focus manifested in the organization of the knowledge exchange within the facility through the use of both internal and external resources and the evaluation of the efficiency of this process. The administrative function of the nurse educator is rather limited, being centered on the development of study plans that correspond to the work schedule of nurses. Finally, the research conducted by such specialist focuses on the improvement of the educational process, as well as the development of new methods of knowledge sharing (Jansen & Zwygart-Stauffacher, 2009). In other words, such a nurse makes a significant contribution to the quality of care.
Selected Advanced Practice Role
In any state of the U.S., an advanced registered nurse practitioner (ARNP) has to cope with several requirements before she can practice nursing. In the case of Florida, there is a need for the license, i.e. the confirmation of one’s right to work as a healthcare professional that is issued by the local board of nursing (Florida Board of Nursing, n. d.). At the same time, given the limitations imposed on such specialists (e.g. the supervision of the physician, the limited range of functions, etc.) the membership in the nursing organization may improve the working conditions. Within the boundaries of Florida, the ARNP may receive support form the Florida Nurses Association, which is the only entity that maintains a direct contact with the organizations operating on the scale of the entire country (e.g. the American Nurses Association), thus providing a comprehensive protection to all nurses within the state. The Florida Nurse Practitioner Network unites the local nursig entities ensuring the seamless knowledge exchange between the different counties. Finally, the Florida Association of Nurse Practitioners provides legislative support (Nursing Licensure, n. d.). As a result, the ARNP may reach relative autonomy in almost any setting.
Another requirement to be considered by the ARNP is the presence of a certificate. In Florida, it can be issued by several specialty boards, including the American Nurses Credentialing Center and the American Academy of Nurse Practitioners. However, there are certain conditions to be met, including the presence of a license mentioned above, as well as the sufficient level of education (a Master’s degree is a minimal requirement). In addition, the advanced practice certification on the national level, as well as the presence of malpractice insurance, may be necessary (Florida Board of Nursing, n. d.). It is possible to assume that such measures were implemented to improve the overall quality of care and reduce the number of incidents in the nurses’ work.
Finally, the health profile of the state of Florida, namely Miami-Dade County, allows making the assumption related to the work environment (setting) of the ARPN that is to work in any city, county or metropolitan area. For example, a significant number of people suffering from the chronic diseases, such as colorectal cancer (1,280 cases) assume that the health center providing the long-term care without hospitalization may be the most favorable option (Florida Charts, 2015). This statement is supported by a high share of the overweight adults (39.8%), as well as those who do not follow the recommendations related to physical activity. However, a considerable number of patients requiring hospitalization, namely the ones diagnosed with diabetes (77,928 cases) and heart failure (3,914 cases), dictate the need for the presence of the facilities that provide comprehensive care, such as hospitals (Florida Charts, 2015). Therefore, a hospital is the most likely place of work for the ARPN in Florida, with the treatment of chronic conditions in the adults, and anesthesia (in the case of cancer) being the primary focus of their activity. Moreover, the overall setting is to be composed of the healthcare specialists such as physicians, registered nurses, and ARPNs, with their age not exceeding 54 years (Florida Center for Nursing, 2016).
Leadership Attributes of the Advanced Practice Role
The use of tests has allowed identifying one’s leadership style as democratic. In other words, in any setting, there is a close contact of a leader with the subordinates. The working team as a whole may participate in the discussion and decision-making process, which simplifies the achievement of goals and ensures the productivity in the work environment. However, this is associated with the cost of the reduced speed of the majority of processes within the facility. In general, it is possible to point out one’s leadership attributes that are both sufficiently developed and intertwined with the image of a democratic leader. The first of them is self-knowledge. Being able to be sensitive to one’s emotions and feelings, as well as the intuition serves to represent one’s goal with a high degree of clarity, which is the inherent quality of a leader. In turn, it helps to find one’s focus in life, understand other people, and recognize the right opportunity (Marquis & Huston, 2009). A nursing leader possessing this trait is difficult to manipulate as she knows exactly what she wants.
Another attribute is communicability. Communication is a tool that is necessary for anyone engaged in the managerial work, especially in case a person uses a democratic style of leadership. A person that does not know how to communicate is unable to express their ideas and transmit them to the others. As a result, the goals set for the team it leads are likely to remain unachieved (Marquis & Huston, 2009). However, if a person possesses a highly developed communicability, it is possible to state that the establishment of connections with the rest of the team will be relatively easy.
Attributes in Development
At the same time, there are attributes to be developed for the efficient use of the democratic leadership style. The first of them is patience. As mentioned before, the potential setting (e.g. hospital) is likely to be composed of various healthcare specialists, with each of them requiring a specific approach. Without patience, it will be problematic to establish productive relationships with all members of the team, which is likely to affect its productivity. Another attribute is perseverance, i.e. the ability to move towards the goal despite all the obstacles and difficulties that may be in the way. Due to the shift in the healthcare system towards quality, it is expectable to deal with the problems that may arise during its transformation, e.g. an increased workload, limited financial resources, and the lack of qualified nurses. In turn, some of the plans of the nursing team may be disrupted in case its leader is not perseverant. The final attribute to be developed is the ability to make requirements for other members of the team to follow, as well as define the need for them (Jansen & Zwygart-Stauffacher, 2009). In particular, when dealing with other nurses, it is imperative to define whether there is the potential a positive change prior to making demands. In some cases, it may be irrelevant resulting only in the worsening of the relationships between the leader and the rest of the team. On the other hand, the more promising and talented a particular nurse is, the higher must be the level of requirements.
All of the three described leadership attributes are to be developed on a personal level, which means that all of them can be attained in a similar way. First of all, the lack of a specific trait should be formulated as a problem. It must be depicted with depth and intensity strong enough to generate a desire to address the issue. When such a desire occurs, it will be possible to find the required time and effort, as well as start searching for the solutions. The next period ((about a month) must be dedicated to the resolution of the problem. The inner attention must be strengthened and the observation of one’s behavior, words and thoughts, especially during the work, is to be carried out on a regular basis. The internal work on the desired attribute, as well as the analysis of everything that was said and done during this period must also take place regularly (Marquis & Huston, 2009). After that, it will be possible to move on to the next trait.
The attained qualities must be evaluated through the creation of a model of the potential leader competencies and tools of their assessment. It should be noted that many of the most important traits may not be evident in the course of work (depending on the setting, types of colleagues, etc.), thus requiring separate estimation. The evaluation of the newly obtained attributes is to be carried out through self-reflection, namely in the form of the mental case study. For example, in case of patience, it is possible to imagine a situation of a subordinate that successfully deals with the substantial part of the work but is constantly late. Another option is the situation when a good professional provokes conflicts in the team. In case of perseverance and the ability to make requirements, the situation may revolve around the implementation of a major change within the team, (for example, regarding the evaluation of the work efficiency). In each of the cases, it is necessary to define the optimal course of actions (Jansen & Zwygart-Stauffacher, 2009). By applying it to the advanced nursing practice in a particular setting, it will be possible to determine whether the level of the development of one’s leadership attributes is satisfactory.
Health Policy and the Advanced Practice Role
Nowadays, the majority of the most common health problems in the developed and industrialized societies, such as obesity, heart disorders, cancer, etc., usually stem from the unhealthy lifestyle of people. In turn, it takes place due to the negative behavioral patterns that were attained during childhood and adolescence, which means that there is a way of addressing this problem. In particular, according to the research conducted by Robert Wood Johnson Foundation, a positive educational experience during childhood may have an impact on the health and well-being of a person, which makes it a potential preventive measure. At the same time, the problem lies in the fact that the current health policy does not take it into account, so that the U.S. is ranked 25th out of 29 developed countries when it comes to investments in the respective health programs (Robert Wood Johnson Foundation, 2016). Naturally, it does not contribute to the high health level of the nation. For example, the review of the relevant literature and other scientific sources demonstrates that only in the state of Florida, the situation can be perceived as critical, with more than a third of the adult population being overweight because of not meeting the recommendations related to physical activity and living a sedentary life (Florida Charts, 2015). In turn, it facilitates the development of a wide array of chronic and acute diseases and disorders, including strokes, high blood pressure, diabetes, cancer, and osteoarthritis (Akabas, Lederman, & Moore, 2012). In other words, the health and productivity of the nation are decreased significantly.
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Changes and Nursing Roles
Based on the above facts, it is imperative that the early-life promotion of a healthy lifestyle becomes one of the primary points in terms of the national health policy. In particular, it is necessary to affect the government to ensure an increase of investments in the health programs for children. In turn, it will be possible to implement a wide array of comprehensive measures that will positively influence the development of people at the early stages of their life with the goal of reducing the share of the patients that are overweight or suffer from obesity and related health disorders (Akabas et al., 2012). Moreover, as representatives of the healthcare system, the ARPNs may contribute to the implementation of the described policy. This statement is especially true for the nurse educators, but any practitioner can make a contribution. In particular, such healthcare specialists may collaborate with schools and other educational facilities, using their professional skills to create favorable conditions for the personal development of children. Nurses can also provide them with the integrated socio-psycho-pedagogical assistance during the process of their self-development and self-realization, thus giving them an opportunity for the preservation of health during the period of study. Finally, the APRNs may take part in the formation of the necessary knowledge and skills required for the maintenance of a healthy lifestyle, namely in the form of lectures and discussions. The topics of the latter may cover such problems as the connection between health and physical activity, the impact of healthy people on the life of the country, prevention of bad habits, etc.
The Effect of the Policy
The implementation of such policy will have a significant effect on the public health and healthcare. In particular, by engaging children in active physical culture and sport, it will be possible to prevent many disorders that are associated with the sedentary lifestyle. Another consequence is the considerable number of young people with high spiritual qualities that are capable of being highly productive and possess the ability to defend the interests of the country. The education-related measures may also facilitate the creation of a sustainable scientific-practical system of the prevention of bad habits, and, therefore, crimes (Akabas et al., 2012). In turn, the strain on the health system will be reduced significantly, making it possible to reallocate some of the financial resources within it, namely for the purpose of quality enhancement. Once again, this measure will guarantee the maintenance of the people’s health on the level that can be perceived as satisfactory for such a highly developed country as the United States.