Essay: Becoming a Nurse Practitioner

The healthcare system, not only in the United States but around the world, is in a constant state of evolution. Everyday new evidence based practice discoveries allow for policy and practice changes that affect patients, practitioners, and the legal system around us. Because of this, as we begin the journey to becoming Family Nurse Practitioners, it is crucial that we first establish what exactly a Nurse Practitioners role in healthcare is. We need to discover how it is defined by not only legal requirements but also the competencies and leadership qualities that are essential for this field, as well as the barriers and multitude of resources available to Nurse Practitioners around the nation. This paper will give the clear, concise answers to these questions all while establishing what really is the Nurse Practitioners role in our healthcare world today.
Advanced Practice Role Definition
Throughout the development of the foundation of Advanced Practice Nursing, the definition and scope of practice has been a topic of confusion and debate. For many, Advanced Practice Nursing is an encompassing term that is poorly explained but yet revolves around the same basis: extensive knowledge, higher education, and a concept of an expanded scope of practice. The AACN gives clearer direction to the actual definition of APN when it stated that Advanced Practice Nursing is defined as nurses who provide direct patient care with higher degrees of education such as a master’s degree with licensure, that also improve overall disease process outcomes and impacts/implements healthcare policy nationwide (Denisco & Baker, 2015). While this does give a definition and guidance for regulation as to what is considered Advanced Practice Nursing, the definition and terminology is still to this day in a constant evolving pace due to the high demand and influx of Nurse Practitioners emerging in healthcare. Currently Nurse Practitioners are considered the largest group of Advanced Practice Nursing with more than 192,000 licensed practitioners in the United States of America (Denisco & Baker, 2015). Research has shown that by 2025 there will be an average of 250,000 Nurse Practitioners providing care to patients and will still be unable to meet the population demand by at least 20% (Poghosyan, Boyd, & Knutson, 2014). These statistics alone show that the Nurse Practitioners Role is vital to our healthcare system and something that needs to be explored and expanded on in the beginning of our career development.
Nurse Practitioners Role
Nurse Practitioners are a key factor in the concept of Advanced Practice Nursing and their role, as discussed, is something that is and will continue to be a major influence in our healthcare community. A Nurse Practitioner is described as a nurse/clinician with expertise in diagnosing/treating patients while making strides in overall disease prevention and management of patients’ health (“American Association of Nurse Practitioners: What’s an NP?”, 2018). There are an extensive amount of competencies and training that are required in order to become a Nurse Practitioner. According to the AANP a NP must complete a higher degree program whether that be a master’s program or doctoral that includes both didactic and clinical courses that provide that knowledge and skills one would need in order to provide patient care in primary, acute, and long-term health settings (“American Association of Nurse Practitioners: What’s an NP?”, 2018). These competencies are specifically outlines in the Family Nurse Practitioners Roles, National Standards and Guidelines. For example, Nurse Practitioners are required to integrate evidence based practice, leadership qualities, implement and improve healthcare policies, and have ethical and professional accountability for the role while practicing. (“Competencies for Nurse Practitioners”, 2017). These standards and guidelines are woven into all degree plans when studying to become a Nurse Practitioner.
In addition to these competencies, it is also required for all fifty states that you become nationally certified and licensed and abide by the specific laws and regulations of the state you are practicing. This is where the Nurse Practitioners role becomes skewed. While each state has the same requirements for becoming a NP, the actual regulatory and legal requirements vary from state to state in regards to autonomy. In the state of Tennessee Nurse Practitioners are required to be supervised by a physician. This means that the overseeing physician has control and ultimately responsibility for the services provided by their NP in both direct care and prescriptive authority (“Tennessee Scope of Practice Policy”, 2018). This differs from the majority of the country where NPs have sole authority with no physician role or supervision required. This inconsistency is a common barrier to the standardization of the NPs role in Advanced Practice Nursing and also a main reason as to why NPs should get involved in professional organizations after certification.
In the state of Tennessee, there are professional organizations that are essential to become a member of once you are a licensed Nurse Practitioner. There are locational organizations such as the Middle Tennessee Advanced Practice Nurses, and the Greater Memphis Area Advanced Practice Nurses, as well as the state Tennessee Nurse Practitioner Association (“American Association of Nurse Practitioners: What’s an NP?”, 2018). These organizations are beneficial in providing resources to the NP community as well as advocating and promoting policy healthcare policy reforms and most importantly continued standardization of the Nurse Practitioner role in the state of Tennessee. This is something I view as a critical part of becoming a Family Nurse Practitioner in the primary care field.
Primary Care Nurse Practitioners encompass a wide variety and broad concept type of patient population that includes all ages and all aspects of health over a lifespan. This concept is what drove me to pursue my degree with the end goal being in Primary Care. Primary Care NPs make up the majority of NPs in Advanced Practice Nursing and are projected to continue to be in the years to come. Research has shown that Primary Care NPs in healthcare are to increase by 30% by 2020, making an average from 55,000 Nurse Practitioners to 72,000 NPs nationwide (“Projecting the Supply and Demand for Primary Care Practitioners through 2020”, 2016). With this projection it is also said that the number of Primary Care Physicians will increase about the same rate. This is an important factor in the state of Tennessee because of the legal requirements for practicing NPs and subsequently plays a large role in the leadership qualities it will take to work cohesively with physicians in my future career.
Leadership Attributes of the Advanced Practice Role
In any workplace environment and career, leadership attributes are a key part in being successful. In the nursing world, when making this change to become a Nurse Practitioner and accepting a greater deal of responsibility, these qualities are even more important to have in regards to patient care. According to the Nurse Practitioner Core Competencies, some leadership competencies include, collaboration with integrated health teams to improve care, use of critical and reflective thinking, communication of healthcare related knowledge, and development and implementation of practice principles (“Competencies for Nurse Practitioners”, 2017). A key concept within those competencies, collaboration with integrated health teams, revolves back to Participative Leadership.
Participative leadership is a management style where every team member is involved in the decision/outcome of a situation (“Participative Leadership”, 2018). This is extremely important in healthcare because research has attested that patients are more likely to benefit from interdisciplinary care teams, especially in the primary care setting (Kooienga & Carryer, 2015). With that being said, key leadership qualities such as decision making, a positive attitude, appropriate delegation, etc. are all essential in helping implement a successful participative leadership setting.
Because these skills and qualities are a significant part of transitioning into becoming a Nurse Practitioner, it is important that we begin developing them now. Some ways that one could expand or develop these skills start at our current practice level with getting involved in our units and management. Joining committees in your workplace is a great start to enhance these skills because it often gives you a chance to work beside your management team as well as be a visual part and help to your colleagues. These are just a few of the ways to grow our leadership skills to be successful and provide teamwork in our primary care settings, especially in the state of Tennessee with the restrictive scope of practice laws.
Controversies
The state of Tennessee is one of a dozen states that have restrictive scope of practice laws in regards to Nurse Practitioners (Fletcher, 2016). When compared to other states, the main restrictions are centered mainly around full autonomy for Nurse Practitioners. Like previously stated in the state of Tennessee, NPs are required to be under the direct supervision of a physician. For several Nurse Practitioners, this is a large area of controversy due to the belief that they are equally qualified to provide the same care/treatments as physicians do in the primary care setting (Fletcher, 2016). Because of this, there are organizations such as the TNNPA, or the Tennessee Nurse Practitioners Association, that push for legislative reforms to continue to expand the Nurse Practitioners scope of practice to be all encompassing. According to an article found in the Tennessee, the reason this has become such a controversy in our state is because it has turned physicians and nurse practitioners against each other (Fletcher, 2016).
Many physicians have the concern that the quality of care provided by an autonomous Nurse Practitioner would not be the same as the care provided by a physician. With that being said, the State of Tennessee has created a task force in an effort for nurse practitioners and physicians to come together for the benefit of primary care patients throughout the state (Fletcher, 2016). With these known controversies, it is vital as we enter the field we become members of organizations that can promote reforms as well as offer resources in our specific practice areas.
Resources
With now having a basic understanding of the Nurse Practitioners role in healthcare, it is important to be aware of the resources available to NPs not only online but in the communities as well. The main online resource available to Nurse Practitioners would be the American Association of Nurse Practitioners website. It is a central hub of information. It contains everything from continuing education resources, certification information, to research, conferences, and job search tools (“American Association of Nurse Practitioners”, 2018). This is an essential website for new Nurse Practitioners to be aware of as they being their careers. While there are other online resources, a key part of being successful is finding personal resources within your community.
One of the core resources in our community is the Tennessee Nurse Practitioners Association. This association provides a multitude of resources to Nurse Practitioners in the state of Tennessee. They work diligently to remain an active voice in state legislation as well as provide yearly conferences for NPs across the state (“TNNP”, 2018). While this is particular resources, there are smaller subsequent regional resource organizations that are available in your area of practice. These resources and organizations are key components for Nurse Practitioners to be aware of, especially in the start of our careers.
Conclusion
Becoming a Nurse Practitioner is an immense step in advancing your career in nursing. It is a new world of increased autonomy, immeasurable responsibility, and expansion of your knowledge. Because of this, it is vital that we are fully aware of what our roles as Nurse Practitioners are going to be as we enter this field. We need to be conscious of what Advance Practice Nursing means to us, the qualities we need to obtain to be a leader in the healthcare world, as well as potential barriers and resources that are available to us. Now having this education and knowledge, moving forward to become a Nurse Practitioner, I know that I will personally hold these concepts close in order to implement safe patient care throughout my future career.