Advanced Practice Nurses are licensed and registered nurses with graduate level education who have various roles such as directing care for patients and communities, administration of health care institutes, policy formulation and implementation. APNs are specialized in various fields such as Clinical Nurse Specialist (CNS), Nurse Practitioners (NP), Family Nurse Practitioners (FNP), certified registered nurse anesthetist (CRNA), and certified nurse midwife (CNM). The roles of ANPs differ by the field of specialization but can largely be divided in to traditional nursing roles and enacted roles (White et al., 2008). In this essay, the roles of FNP, CRNA, and CNM are compared in terms of educational requirement, scope of practice and licensure. In addition, the history and impact of Doctor of Nurse Practitioner movement on these roles is discussed together with the future trends expected in these roles.
FNPs provide primary health care for patients from children to adults and fill in the gap created by a shortage of primary care physicians. CRNA are specialized to work in operating rooms and in offering ambulatory care while CNMs serve childbearing women from health promotion during pregnancy to ante partum and postpartum care. The educational requirements for ANPs are regulated by the state board of nursing. Because of variability in the roles of APNs from one state to the other, the consensus model has been advanced to give uniform licensure, accreditation, certification and educational requirements for APNs (Stanley, 2009). In general all ANPs are required to have a master’s level education in nursing from an approved training institution. Phillips asserts that the educational curriculum should cover physiology, pharmacology, health assessment and relevant clinical experience (2012). In addition to the master’s degree, FNPS, CRNAs, and CNMs must complete nursing specialty programs in the field of specialization.
Initially, the licensure requirements for APNs was determined by the state nursing boards but the introduction of the consensus model has introduce uniformity in licensure requirements in the participating states. The basic licensure requirement for FNPS, CRNAs, and CNMs is a Registered Nurse (RN) license and a national certification in the APN specialty field. In addition, FNPS, CRNAs, and CNMs are required to pass a licensing examination which is written prior to certification. The licensing process involves credentialing and is performed by the American Nurses Credentialing Centre (ANCC), which is a division of ANA. Credentialing verifies a candidate’s qualification and capability to offer quality health care services. In addition to obtaining a practice license, FNPS, CRNAs, and CNMs may be required to have NPI number to enhance HIPAA transactions and DEA number for FNPs in the states that allow NPs to prescribe drugs and controlled substances.
Scope of Practice
Although the nursing roles of FNPs, CRNAs and CNMs are similar, their scope of practice varies greatly due to different enacted roles. APNs, FNPs, CRNAs and CNMs share common nursing roles such as promoting and maintaining health, patient education, counseling and acting as patient’s advocates. FNPs are specialized in offering primary health care at a family level (Nyirati et al., 2012). With the exception of surgeries, FNPs perform all other function of primary physicians. This includes health assessment, diagnosis, treatment, managing minor trauma including suturing and splinting, and prescribing medication. While some states allow FNPs to prescribe drugs and controlled substances independently, other states require FNPs to prescribe drugs under the supervision of physicians (Burgess, Martin & Senner, 2011). The role of FNPs is intricately related to the role of general NPs but differ in that FNPs offer family centered care. FNPs are also responsible for health promotion and disease prevention through patient education. FNPs are effective in provision of primary health care services and their service compares well to that of physicians in terms of quality and patient satisfaction (Gogan & Maybee, 2011).
CRNA role is in offering care in hospital operating rooms and in ambulatory care. The role of CRNA spans from pre operative assessments, through the actual surgery to post operative care. Pre operative assessment includes monitoring vitals, patient education on the surgical procedure, and preparing the patient for surgery. During surgery, CRNA administer anesthesia and monitor the patient’s vital signs. CRNA also aid in post anesthesia recovery and patient stabilization. CRNAs usually work independently during minor surgeries or in rural areas but work under anesthesiologists during major surgeries such as heart bypass surgery and organ transplants surgery.
CNMs are licensed in both nursing and midwifery. They provide healthcare services to child bearing women. Their scope of practice includes preconception care, prenatal and post natal care, labor and delivery care, newborn care, family planning, gynecological examination and menopausal management.
Comparison of FNPs, CRNAs and CNMs
FNPs, CRNAs and CNMs all specialized APNs. Their educational requirements are similar in terms of a master’s level education but differ only in the specialty exams and the curriculum undertaken. Licensure requirements vary with the requirements of State board of nursing and the specialty area. However, the baseline licensure requirement of a valid RN license and ANCC credentialing are common to all these advanced nursing fields. The greatest difference between FNPs, CRNAs and CNMs is in their scope of practice. While FNPs are specialized offering family centered primary health care services, CNMs offer health care services to child bearing women while CRNAs offer health care services to patients undergoing surgery.
DNP is a terminal professional degree in nursing with a curriculum that includes advanced practice, diagnoses and treatment of diseases. DNP provides specialty in the clinical aspects of diseases and can be compared to doctorate level education in other health care fields such as medicine and psychology. The DNP program gives nurses a doctorate level education and has been developed in response to quality requirements in health care delivery and emerging health care needs posed by an aging population and the rise of chronic and lifestyle diseases. In contrast to PhD degree in nursing which is research oriented, the DNP degree is aimed at enhancing nursing practice. DNPs have enhanced leadership skills which are important in managing the increasingly complex clinical facilities, strengthening nursing practice and enhancing health care delivery.
The American Association of Colleges of Nursing recommends nurse practitioner educational programs to transit from the MSN degree to DNP degree by 2015 (AACN, 2004). This requirement means that from 2015 onward, the DNP degree will be the entry level educational requirement for advanced nursing practice roles. The APNs licensed with an MSN degree will continue to practice. In terms of impact to the roles of FNPs, CRNAs and CNMs, the DNP degree will enhance these roles by giving practice nurses the advanced knowledge and skills required to handle emerging illnesses and to promote health. The DNP degree will also bridge the demand for qualified health care professionals to offer primary health care services and specialized services such as those offered by CNMs and CRNAs.
Expected Trends in the FNP, CRNA and CNM practice
Currently, APNs provide primary health care and are trained to work along side physicians. In the coming days, certain changes will be the driving force behind advance nursing practice. The first change is the expected adoption of the consensus model by all states. Currently, APNs are regulated by state board of nursing requirements which vary from state to state. The consensus model introduces uniform educational, certification, licensing, and credentialing requirements for APNs. This will make it easier for FNPs, CRNAs and CNMs move their practice from state to state and this will help meet the health care needs of rural communities which lack specialized health care providers.
The introduction of DNP degree will enable practice nurses to acquire skills and knowledge required to deliver quality health care services. This degree will enable FNPs, CRNAs and CNMs to play a bigger part in health care service delivery through nursing practice, management of nursing units, policy formulation and implementation. The role and scope of practice of FNPs will grow more in future to match that of primary health care physicians and hence meet the shortage of primary health care physicians. The roles of CRNAs will grow in response to the surgical intervention needs of an aging population while increased awareness on female reproductive health services such as family planning will enhance the role of CNMs.
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