How to Become a Nurse Practitioner

There has been a large increase in the number of nurse practitioner programs and graduates. This was driven in part, perhaps, by the changing health care system, hospital downsizing, increase in ambulatory care and constraints on managed care.

A nurse practitioner (NP) is an advanced practice nurse who has education beyond the bachelor’s degree in a clinical specialty area strongly focused on primary care, though some subspecialties are hospital based. NPs have received specialized training, most often at the master’s level, in diagnosing and treating illnesses and providing health care maintenance.

The keys to the success of the of the nurse practitioner role have been the autonomous yet collaborative nature of the practice, accountability as a direct provider of health care services, emphasis on clinical decision making as a basic clinical skill, focus on health and healthy lifestyles as a foundation of practice and the cost-effective, accessible nature of the practice. These basic attributes of NP practice hold true regardless of setting or specialty focus.

While the performance of such roles bodes well for nursing in general and NPs specifically, there are also some questions about them taking on too much within the health care system. The concern is that if they take on an increasing amount of technical and medical work, then characteristics highly valued in the profession may be threatened like skill in caring and communication.

It is clear that while NPs provide autonomous practice and competent patient management, they also must protect their holistic, caring nursing role.

Case Management Nursing: An Approach to Community Health

In addition to considering the needs of populations, the community health nurse is prepared to provide direct care services to subpopulations within a community. These subpopulations may be a clinical focus in which the nurse has gained expertise.

Case management nursing is a nursing approach that merges knowledge from the public health sciences with professional nursing theories to safeguard and improve the health of populations in the community. An example of this is a case manager who follows older adults recovering from stroke and sees the need for community rehabilitation services. A nurse practitioner who gives immunizations to clients with the objective of managing communicable diseases within the community is also one.

The community health nurse cares for the community as a whole and considers the individual or family to be only one member of a group at risk. Competence as a case management nursing professional requires the ability to use interventions that take into account the broad social and political context in which the community problems occur and are resolved.

The educational requirements for entry-level nurses practicing in community health nursing roles are not as clear-cut as those for public health nurses. An advanced degree may not be required. However, nurses with a graduate degree in nursing who practice in community settings are considered community health nurse specialists, regardless of their public health experience.

The expert community health nurse understands the needs of a community through experience with individual families and working through their social and health care issues.

APN: Advanced Practice Nursing

APN: Advanced Practice Nursing

Why is there a need for advanced practice nurses (APNs)? The last quarter of the 20th century taught that detection, prevention, promotion, early intervention and education are not only cost-effective but also rational. They are ideally suited to deliver this type of health care.

Advanced practice nursing entails masteral or doctorate preparedness of nurses. Critical reflective thinking, self-directed learning and leadership skills are expectations for health-care providers in the 21st century. Therefore, this branch of nursing builds on the foundation of professional nursing practice and responds to the health care needs of the country.

Are APN’s contributions unique, valuable and can be evaluated? Let us take a look at the following examples:

• Clinical Nurse Specialist (CNS): In a hospital, the CNS must be able to identify how performance contributes to the patient-focused mission and goals of the organization. Does the CNS’s practice reduce length of stay, improve patient outcomes or enhance the efficiency of staff nurses?

• Certified Nurse Midwife (CNM): The CNM’s ability to better meet patient needs, or to provide services to groups of patients at a lower cost than services provided by physicians, should be measurable.

• Nurse Practitioner (NP): In an outpatient setting, the NP would need to document both the quality and quantity of services provided to patients and the ability to reduce hospitalization rates.

• Certified Registered Nurse Anesthetist(CRNA): In evaluating anesthesia services in a chronic low back pain clinic, the CRNA would want to clearly document quality of service and patient outcomes.

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