Specialists in nursing have existed since early 1900s with nurse anesthetics and nurse midwives having been the pioneers. They lay formative foundations in early 20th century for advanced nursing practice. The roles of advanced nurses have not been clear historically. There was and still there is a lack of clarity in roles of different advanced nurses. This paper delineates the roles of clinical nurse specialist and nurse practitioners.
Nurse practitioners and clinical nurse specialists are two of advanced practice nurses with nurse midwives and nurse anesthetists constituting the rest. Clinical nurse specialists provide care in a wide range of specialty areas, which include oncology, cardiac, neonatal, obstetric/gynecological and pediatric nursing. Nurse practitioners deliver frontline acute and primary care in schools, community clinics, hospitals and other health providing institutions. Other services performed by nursing practitioners are diagnoses and treatment of injuries and common acute illnesses, conducting physical exams, providing immunizations, and management of chronic conditions, which include diabetes, kidney disease, high blood pressure among others (National Association of Clinical Nurse Specialists, 2001).
I interviewed a number of clinical nurse specialists and nurse practitioners in the process of gathering information required to complete the assignment. I identified New York Presbyterian hospital located in New York City. To be able to have a wide scope of information, I identified five CNPs and Five NPs to facilitate the process. Clinical Nurse Specialists (CNP’s) are highly specialized experts in a certain nursing field such as; specialized to deal with old people, critical care, diabetes or fractures. Nurse Practitioner (NP) is a registered graduate nurse whose focus is to give direct care to patients. Most of the interviewees held mid-level management positions in their respective practices and some were in senior management positions. The demographic section, helped in identifying whether the nurse chosen was a CNS or NP. Their employment and work setting was also important in helping know the nurse in charge.
All the interviewees were willing and happy to provide me with the information required. I managed to convince them to participate in my interview during their break sessions. The interview comprised of administering a questionnaire to the respondents and a brief general discussion. I managed to interview all of them within five days; only one respondent was called up for an emergency in the middle of an interview. Therefore, I managed to get the activity successfully done with minimal interrupted session. To provide me with the information, I have copied a sample of the questions I administered.
They have a variety of roles, which include coordination, health care provision, coaching, educating, researcher, advocate administrator and leader. They also promote patients advocacy in the selection of treatment and treatment modalities. They also apply the principles of ethical decision making when selecting treatment modalities. They also help in the formulation of patients expected outcomes with the family members and health care team basing reasoning on scientific and clinical knowledge. Other roles they admitted on doing were incorporating of evidence based research into nursing interventions usually within the population. They assess, plan, implements and evaluate health care with the help of other professionals or the primary care providers helping in the meeting of comprehensive patients needs. According to the interviewees clinical nurse specialists are most of the times placed in charge of the nursing care departments in the hospital. Clinical nurse specialists also have the skills and training mostly required to guide in experienced staff and other nurses on ways to optimize patients care through educating them. Some of the clinical nurse specialists admitted that they also provided education and nursing care to patients. Although they are well educated, they are not permitted to treat any patients without the presence of a physician. They are also not allowed to write any prescriptions. Other roles that they accepted to performing were promotion of using of evidence-based research and working in interdisciplinary teams (Zuzelo, 2010).
Nurse practitioners, on the other hand, work under indirect guardianship of the doctors while at the same time applying skills acquired during training to consult. They all agreed to prescribing drugs by using principles in pharmacokinetics, indications, routes and drug dosage, and drug interactions and the side effects. They also agreed to performing problem focused and comprehensive physical examinations. They also write and transmit prescriptions as a measure to minimize errors. They also diagnose and manage chronic and acute illnesses while they attend the illness experience. NP’s also select, perform, and interpret common diagnostic laboratory tests and common screening. They also monitor therapeutic parameters including medication adjusts, and patient’s response.
According to the research activity carried out CNS and NPs roles, emphasize on diagnostic reasoning skills and critical thinking in clinical decision-making. They also emphasize on maintaining clinical records reflecting on therapeutic and diagnostic reasoning non-pharmacological and behavioral treatment used in developing of care plans. Both roles interpret and analyze patients’ history, physical findings, present symptoms, and diagnostic information to help in the formulation of differential diagnosis, implementing and designing a care plan to attain. Restoring and promotion of health and employing of therapeutic interventions after appropriate diagnosis had been carried out while at the same time paying close attention to cost, safety, simplicity, efficacy, acceptability and invasiveness (Cowen & Moorhead, 2011).
Strengths and weaknesses of each role
Nurse practitioners are involved in the diagnosis of patient’s illnesses, whether acute or chronic. This has raised many questions in the field of medicine and patients, and researchers are wondering on the quality and safety of them carrying out this role. This is because an error in diagnosis would result in complete disarray in the care plan. It would be even fatal since they are not as qualified in making diagnoses compared to doctors. Updating of drug sheet is directly related to their work of taking care directly to patients. They monitor the progress of a patient make required changes along the way on drug prescription issues. The role is also integrated with the studying of the laboratory results since they prescribe drugs and care plans to be adopted (Sullivan-Marx, 2010).
The CNS role of educating and empowering the patients and other nurses is of importance to the medical institution. This is because by educating and coaching the nurses, they are able to provide quality services during service provision. The patients are also able to take good care of themselves in terms of medication and in future to avoid returning to hospitals. Since they are involved in leadership, and are indirect contact with all patients and care givers, they have firsthand experience of the issues that face their colleagues and patients. This role well integrates with the role where they help in the formulation of changes in the hospital setting after research is carried out. They have the knowhow of the areas affected and prioritize in making changes required. I think they ought also to be allowed to prescribe drugs for patients in the presence of a medical practitioner (Cowen & Moorhead, 2011).
In conclusion, the roles of the Clinical nursing specialists and those of the nurse practitioners should be well defined. This will help in ensuring that the two APN’s do not conflict in their work places while at the same time neglecting some important roles. Role clarification would also help the patients in identifying whom to consult for different reasons. This is because most of the patients in primary care confuse the clinical nurse specialists with nurse practitioners. To be able to device and reform the roles of the CNS and NPs, it is wise for the clinical nurse practitioners board and nurse practitioners boards to come together in a bid of discussing a way forward. In the US, some of the CNS’s are recruited without having sufficient education like required. Such recruitments should not happen in the future as it leads to inadequate services to patients and medical institutions.
Zuzelo, P. R. (2010). The clinical nurse specialist handbook. Sudbury, MA: Jones and Bartlett Publishers.
National Association of Clinical Nurse Specialists. (2001). Clinical nurse specialist: The journal for advanced nursing practice : official journal of the National Association of Clinical Nurse Specialists. Philadelphia: Lippincott Williams & Wilkins. 1999 National Conference for Nurse Pactitioners. (January 01, 1999). Nurse Practitioner, 24, 6.)
Sullivan-Marx, E. (2010). Nurse practitioners: The evolution and future of advanced practice. New York: Springer Pub.
Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, Mo: Mosby Elsevier. https://www.ncsbn.org/06_LPN_RoleDelStudy_NCLEX_30_Web.pdf