NSG5000 Role of the Advanced Practice Nurse CP06 – Week 3

NSG5000-Role of the Advanced Practice Nurse CP06 – Week 3

Consensus Model & Scope of Practice

The Consensus Model and the Nursing Model Act and Rules for APRN licensure are vital to Advanced nursing practice. Credentialing for APRNs comprises four components—Licensure, Accreditation, Certification, and Education (LACE).

Several recommendations from LACE committees have stressed the need for collaboration, transparency, evidence-based decision-making, and information exchange. The vision was to implement one national regulatory scheme that would benefit patients most and allow APRNs to be innovative and meet patient needs.

It is important that current APRNs and those aspiring to understand the Consensus Model documentation and familiarize themselves with the new changes (NCSBN ). However, there impedes reaching a unified scope of practice, state to state.

The term scope of practice refers to the legal authority granted to a professional to provide and be reimbursed for health care services. American Nurses Association has defined the scope of nursing practice as describing the who, what, where, when, why, and how of nursing practice. The scope of practice for APN authority has been a historic struggle for most advanced practice groups. This continues to be a debated issue among and within the health professions. Significant variability in state practice acts continues, such that APNs can perform certain activities in some states, notably prescribing certain medications and practicing without physician supervision, but may be constrained from this authority in some other states. The Consensus Model recommendations proposed regulatory language can be used by states to achieve a consistent scope of practice language and standardized APRN regulation.

Role Development Concepts

Role development is a process. It spans the lifetime of a career in advanced practice. Some common role issues you may face as you transition into a new role:

1. Role ambiguity
  1. Unclear expectations, responsibilities, and uncertainty
  2. Some degree of ambiguity in all professional positions because of the evolving nature of roles and the expansion of skills and knowledge
2. Role incongruity
  1. A role with incompatibility between skills and abilities and role obligations or between personal values, self-concept, and role obligations
  2. An adult NP in a role requiring pediatric skills and knowledge
3. Role conflict
  1. Occurs when role expectations are perceived to be mutually exclusive or contradictory
  2. The conflict between APNs and other nurses and between APNs and physicians
4. Interprofessional role conflict
  1. Conflicts between physicians and APNs
  2. Conflicts for physicians and APNs are the perceived economic threat of competition, limited resources in clinical training sites, lack of experience in working together, and the historical hierarchy.
5. Intra-professional role conflict
  1. APNs experience intra-professional role conflict with non-APNs
  2. APNs are concerned with providing direct clinical care to individual patients, whereas staff nurses and other APNs may be more concerned with 24-hour coverage
  3. Relationships among these APN groups and nursing difficulties remain
6. Role transition
  1. A dynamic process of change
  2. Changing from a staff nurse role to an APN role
7. Role stress
  1. A situation of increased role performance demand
  2. Returning to school while maintaining work and family responsibilities
8. Role strain
  1. The subjective feeling of frustration, tension, or anxiety
  2. The feeling of decreased self-esteem when performance is below expectations of self or significant others
9. Role stressors
  1. Financial or personal
  2. Academic demands and role expectations that are ambiguous, excessive, or unpredictable
10. Role insufficiency
  1. Feeling inadequate to meet role demands
  2. New APN experiencing the imposter phenomenon
11. Role supplementation
  1. Anticipatory socialization
  2. Role-specific educational components

Recognition of the role issues during school and post-graduation is important to role transition and immersion.

Ethical Decision Making

When you hear the phrase “ethics in healthcare,” the two thoughts that most likely come to your mind are resuscitation orders and end-of-life decisions your clients make. However, registered nurses (RNs) and APRNs frequently encounter situations during their care hours that create ethical dilemmas.

Ethical practice is not intuitive. There are several theories about ethical decision-making. Also, not all emotional situations pose an ethical dilemma.

Key Elements for Ethical Decision

Please remember what is correct for one person may not be correct for another. Look at the Nuremberg Code as it was the significant start of ethics in research, and that can carry over to nursing practice.

Ethical decision-making is an evolutionary process that identifies four phases: knowledge development, knowledge application, ethical environment creation, and social justice promotion within the healthcare system.

An important factor that affects ethical decision-making is your personal value system. Your life experiences over time may change your values. Values clarification is the recognition of these changes and understanding how they affect your actions and behaviors. Values clarification will not tell you what your values should be. It will only provide you with a means of discovering your values. If you know your values, you can recognize whether they are impinging on your client’s decisions.

As an APRN, your goal should be to foster an environment in which you acknowledge and address the ethical issues you face. You can achieve this goal by understanding advanced directives and being comfortable discussing them with your patients.