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Roles in Advanced Practice Nursing

Advanced practice registered nurses (APRNs) are seen as the future of healthcare. APRNs are at the frontlines of primary care and preventive care services provided to the public, having a degree of autonomy to diagnose, treat, and advise patients on general illnesses. Each APRN role has a significant purpose and specialty in clinical contexts. Transitioning from an RN to an APN may be challenging as one loses the expert status but pushes one to grow as a professional and clinician. The purpose of this paper is to explore the APRN roles and discuss the personal transition into the CNP role after graduation.

Four APN Roles

Certified nurse practitioners (CNPs) are the most common role, working in a variety of general care environments ranging from local provider offices to hospitals. CNPs have a wide range of responsibilities but are certified to diagnose and treat patients with acute and chronic illnesses, prescribe medications and therapies, order tests, and provide health education. CNPs require a master’s degree in nursing. The certified nurse specialist (CNS) role is very similar to that of a CNP, although their practice is typically less autonomous, and they practice in large clinical environments such as hospitals. CNS provides advanced nursing care, but with a focus on interdisciplinary collaboration in order to provide acute care management as well as develop quality improvement programs. CNS practice is meant to incorporate both individual-level care of CNPs as well as macro-level models of care, but CNS typically have fewer care prerogatives, such as most states do not allow CNS to prescribe medication (Winger et al., 2020).

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Certified registered nurse anesthetist (CRNA) is a highly specialized nursing role, working in care environments such as operating rooms, outpatient surgical centers, and dental offices. CRNA has the role of administering anesthesia and any related care prior and afterward procedures that may require it, such as surgical, therapeutic, obstetrical, and diagnostic procedures. CRNA requires graduation with a minimum of a master’s degree from a nurse anesthesia program and a 1-year full-time work experience as an RN in critical care. Certified nurse-midwives (CNM) focus on providing primary and specialized care to women, in work environments such as hospitals, community clinics, and birthing centers. CNM can provide gynecological exams, family planning, prenatal care, neonatal care, and low-risk labor and delivery. CNM must complete a minimum of a master’s degree of science in nursing degree with a midwifery specialty track for courses (Winger et al., 2020).

The rationale for Choosing CNP Role

My primary motivation for choosing the CNP role is that it directly allows for the treatment of patients. I entered the nursing profession to help others and provide direct care. The CNP role more directly represents this than any of the other roles. The secondary motivation is the challenge, because of the highly diverse clinical situations that a CNP faces. It challenges me as a clinician to learn and evolve, understanding various clinical contexts and patients. Therefore, I will be able to provide competent care to a wide variety of patients, while also enjoying a degree of autonomy as a clinician which I value.

Plans for Clinical Practice

Upon graduation, the plan is to begin practicing as an NP in a general clinical setting, either a local provider or hospital. The goal is to garner experience and establish a strong foundation for future practice. This may be challenging but a general care facility, particularly as large as a hospital, will expose me to a greater variety of situations, patients, and clinical diagnoses, which will help me gain confidence and a significant skill set for any future practice. Analyzing the various nursing roles, I am more aware now of how critical the CNP role is in providing basic care and requires both flexibility and competence. Other nursing roles, although also require responsibility, they are much more specialized. Therefore, their education and training can help them prepare for any clinical contexts within the scope of their role. CNPs on the other hand have to be prepared for virtually anything and bear the responsibility of directly treating patients, not just providing an examination or a medical procedure like other roles.

Role Transition

The transition from an RN to a CNP is often seen as challenging and stressful. One primary factor that influences this is the shift in professional status, particularly changing from an ‘expert’ status in the RN role to a rather inexperienced and low-level position as an NP. One can experience potential loss of confidence and alteration of professional identity. Another factor to consider may be previous clinical experience as an RN, which will provide a foundation and confidence in succeeding as a CNP (Barnes, 2015). The strategy to address the first issue would be to acknowledge the differences in the scopes of practice between the two positions. Nurses rely on Benner’s Theory of Transition which can be modified to ease the transition between expert RN status and novice NP. Another strategy is to put emphasis on the first year of practice as a CNP, particularly in choosing a specialization and work environment. The first year establishes a foundation that will lay the groundwork for future employment and career. Therefore, one must manage anxiety, establish a support network, and obtain experience as a more autonomous provider (Abel, 2018).

Conclusion

This paper highlighted the roles and care environments for the four APN roles. Each one is different but equally important in providing general and specialized care. The personal transition from an RN to a CPN was discussed, which highlights certain challenges but will help to get accustomed to clinical contexts of autonomous healthcare provision. This is partially why the CNP role was chosen, as it allows to consistently grow as a clinician and face a variety of situations to help as many patients as possible.

References

Abel, L. (2018). Transition: The road to becoming a nurse practitioner. The Nurse Practitioner, 43(6), 8. Web.

Barnes, H. (2015). Exploring the factors that influence nurse practitioner role transition. The Journal for Nurse Practitioners, 11(2), 178–183. Web.

Winger, J., Brim, C. B., Dakin, C. L., Gentry, J. C., Killian, M., Leaver, S. L., Papa, A. R., Proud, M. E., Riwitis, C. L., Salentiny-Wrobleski, D. M., Stone, E. L., Uhlenbrock, J. S., Zaleski, M. E., Lee Gillespie, G., Kolbuk, M. E., Oliver, N., Carman, M., Kraus, R., Breuer, G. J., … Proehl, J. (2020). Advanced practice registered nurses in the emergency care setting. Journal of Emergency Nursing, 46(2), 205–209. Web.