Distinguish between Advanced Practice Nursing and advanced nursing practice
The National Council of State Boards of Nursing (NCSBN) recognizes an Advanced Practice Nurse (APN) role to be either a Certified Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist, or a Certified Nurse-Midwife (APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee [NCSBN], 2008). APN’s provide direct patient care, which requires an increased number of clinical skills, abilities, and regulations compared to non-APN roles (Hamric, Hanson, Tracy, & O’Grady, 2014). A study by Dowling, Beauchesne, Farrelly, and Murphy (2013), identified four attributes associated with advanced practice nursing: clinical expertise, leadership, autonomy, and role development.
Advanced nursing practice is a Master’s nursing education that encompasses a broad range of theoretical and evidence-based practice knowledge. These roles do not partake in direct patient care. Examples include administration/nurse executives, informatics, and clinical educators (Hamric et al., 2014).
My specialty track is as an APN Certified Nurse Practitioner. My role designation will be as an acute care NP providing care to the adult-gerontological patients as well as providing primary care for the whole family as a Family Nurse Practitioner (FNP). An FNP degree will allow me to work in areas such as pediatrics, obstetrics or family practice. An acute care NP degree allows me to work in a specialty such as Nephrology, Orthopedics, Cardiology, or Oncology, as well as in the hospital setting (APRN Consensus Work Group & NCSBN, 2008).
Compare the role of the APN to the Physician Assistant (PA)
One of the four subsections of an APN is a Certified Nurse Practitioner (CNP). Although Nurse Practitioners (NPs) and Physician Assistants (PAs) are both considered mid-levels, there are quite a few differences between the two Master level degrees (Physician Assistant Education, 2020). APNs/NPs must have graduated from a nursing school and passed boards as an RN prior to starting NP school. PAs are required to have a BSN that is pre-medicine based before being accepted into a PA program. PA school curriculum is modeled after the medical school curriculum, with the focus being more on determining the underlying issue of the patient and treating it. APNs/NPs focus is more on humanistic, behavioral, and natural sciences that give a more holistic approach to the patient. PAs also do more rounds in specialty areas such as dermatology and psychiatry (Physician Assistant Education, 2020).
APNs/NPs are required to have 500-700 hours of clinical experience before getting their license, whereas PAs are required upwards to 2,000 hours of clinical experience before receiving their license (Physician Assistant Education, 2020). Most of the APNs/NPs clinical experience is based on learning diagnostic techniques, common medical procedures and case management. APNs are required to choose a specialty, such as pediatrics or mid-wife, before starting the graduate-level course degree, whereas PAs are able to rotate between many different medical specialties in school and then choose the type of specialty they want after they graduate (Physician Assistant Education, 2020).
After graduating from an accredited PA program, PAs must take the Physician Assistant National Certifying Exam (PANCE) by the National Commission on Certification of Physician Assistants (NCCPA) in order to practice medicine (National Commission on Certification of Physician Assistants [NCCPA], 2020). NPs are not required to pass a national certifying exam; their requirements are to provide proof of graduation from a nursing program and pass the NCSBN exam within their designated specialty. To maintain their license, every two years PAs must complete 100 hours of continuing medical education and pass a recertification exam every six years. In comparison, NPs are required to complete 75 continuing education hours every five to six years (Physician Assistant Education, 2020).
Florida is a restricted practice state for NPs (American Association of Nurse Practitioners [AANP], 2018). Having a restricted practice environment will limit the APN in at least one way per the American Association of Nurse Practitioners. Nurse practitioners will need to have supervision, delegation and/or team management throughout the duration of their career by another health care provider in order to provide patient care (Peterson, 2017). For example, NPs in Florida are unable to write narcotics independently and will need another MD to co-sign for controlled substances for the patient to receive the requested narcotic. In contrast, having full practice abilities in states such as Connecticut and Colorado, NPs are allowed to practice independently and prescribe controlled substances without a need for a co-signature from an MD (AANP, 2018).
This will affect the efficiency and autonomy of providing care as an APN because it requires an MD to spend extra time confirming the medication is okay to give and delays the NPs care if MD is unable to co-sign quickly. This can also be seen as a positive in the fact that you have two eyes for every patient. Honestly, in the early years, I will be okay with this restriction because I know I am new, and it will help to increase confidence in prescribing and managing patients at a provider level.