In the current world, the health care sector faces many challenges including rising costs, inadequate staff, and poor access to health care. This situation has called for the need for Advanced Nursing Practice (APN). The International Council of Nurses (2003) defines an Advanced Nursing Practice (APN) as,
“a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Master’s degree is recommended for entry-level.”
Most countries have realized that “optimizing the nursing contribution to health care systems and governments through expanding their role is an effective strategy for improving health services” (Scott, 1999). The roles commonly identified as APN internationally include nurse practitioner, clinical nurse specialist, and nurse anesthetist (Schreiber et al., 2003).
A Critical Exploration of the Scope and Utility of Advanced Nursing Practice within my Area of Practice
My area of study involves agency nursing. Most of the agency staff nurses at the hospital are specialized in surgical nursing or NICU, though they are frequently forced to provide services in other areas so as to fill gaps. One of the roles that an APN can play in my area of study is that of the clinical nurse specialist (CNS). A clinical nurse specialist is an advanced practice nurse who provides expert nursing care to a specialized population (Winnipeg Regional Health Authority, 2006). The clinical nursing specialist also develops clinical guidelines, conducts education programs and research, triggers system change, provides expert support and consultation, and acts as a case manager (Canadian Nurses Association, 2006).
In our case, a clinical nurse specialist can first strengthen the agency staff nurses by providing expert coaching on new nursing knowledge that will enable them to work in different settings. This can be achieved by the clinical nurse specialist developing education programs that promote the use of evidence-based care in nursing so as to expand their nursing roles (Chen, 2000). Through the education programs, the clinical nurse specialist can educate the agency staff on how to handle work in different settings.
Secondly, the clinical nurse specialist can act as a role model to the agency staff nurses. This would entail the clinical specialist working together and in the same environment with the agency staff nurses. In this case, the clinical nurse specialist does not have to provide any guidelines. Instead, the agency staff nurses are expected to observe the actions of the clinical specialist nurse and emulate them with an aim of learning how to provide expert care in different settings. For this to be successful, a lot of attention to the actions of the clinical nurse specialist will be required. Thus, the agency staff nurses will have to be extra keen.
Thirdly, a clinical nurse specialist can provide consultation and mentoring services to the agency staff (Daniel, 2004). This will require that the agency staff seek consultation with the clinical nurse specialist whenever they encounter a situation that they are not very confident in handling. The clinical nurse specialist ill in turn be expected to offer the necessary guidelines. After several consultations, the agency staff will be confident in handling situations in different nursing settings.
Fourthly, a clinical nurse specialist can play a key role in promoting collaboration among the health team members. This can be achieved by organizing weekly meetings among the health team members whereby every member is supposed to give a report. The reports in this case can cover one’s own area of practice or general observations and recommendations. Collaboration among the health team members improves health care services in that the patient receives expertise care. Collaboration of health team members also helps to create good relationships and promotes communication among the health team members. Good relationships and communicate rresultto a good working environment and ease in consulting each other. This in turn contributes to the timely delivery of health care. Collaboration also contributes to one’s professional growth as one interacts with experts.
Finally, the clinical nursing specialist in his capacity as a case manager can effect systems change in the hospital (Leyden et al., 2000). This will involve talking with the hospital management to ensure that the agency staff is rotated in different settings frequently. Rotating the agency staff in different settings frequently will enhance mastery of nursing concepts learned in the education program. This will in turn yield confidence while undertaking roles in the various settings which will, in turn, improve the delivery of health care. The clinical nurse specialist can also encourage the hospital management to see that it supports the professional growth of nurses by providing continuous learning to the agency staff and encouraging collaborative practices in the hospital.
All these roles of the clinical nurse specialist will be directed towards a single goal of ensuring that the agency staffs acquire additional competencies which will enable them to fill gaps by working in different nursing stoats to provide comprehensive health care to the public.
The Legal, Ethical and Professional Implications of Shifting Interdisciplinary Boundaries within the Demands and Challenges of Contemporary Health Care
The nursing profession is usually bound by several legal, ethical and professional codes (Bryant-Lukosius & Dicenso, 2004). Nurses are subject to legal, ethical and professional duties in cases of interdisciplinary shifts. The legal, ethical and professional concern in nursing arises from the professional duties of nurses as a breach in the professional duty leads to a breach in the law and ethical considerations are made to determine situations in which the duties are breached. There is a nursing professional body that regulates the conduct of nurses. It is important to note that the nursing professional governing body has more influence on the conduct of nurses than the law itself (Bryant-Lukosius & Dicenso, 2004).
To start with, the law requires that all nurses be responsible for their own actions and act only in their areas of competence and preparation. By making interdisciplinary shifts, this law is usually violated as nurses are made to fill gaps in areas that they are not specialized in. Thus, there is need to ensure that nurses attain the competency in all the settings in which there services could be required (Hamric, 2005). This can be attained by an advanced nursing practitioner introducing education programs for the interdisciplinary nurses. The advanced nurse can also teach the interdisciplinary nurses on how to work in various settings by modeling. Furthermore, the advanced nurse practitioner can encourage the policy-makers in nursing to ensure that they offer the interdisciplinary nursing course in higher institutions of learning so as to enhance competence when it comes to the actual practice.
The law also requires that registered nurses acting in another area apart from their defined scope be allowed to do so either through medical delegation or by adopting institution protocols (Edmunds, 2002). This is meant to ensure that there is accountability among nurses. So as to make interdisciplinary changes legal, there would be need to adjust all the regulated and controlled acts in nursing so as to expand the scope of nursing practice (Villeneuve & MacDonald, 2006).This adjustment would be aimed at ensuring that nurses have the freedom to provide services in any area of interest as long as they own the knowledge, skills and abilities that are essential in that particular area. The adjustment can also allow room for supervision of practice by the regulatory bodies so as to ensure that the required standards are met. Alternatively, nurses wanting to work in interdisciplinary areas can establish good relationships with physicians and so as to earn personal credibility from them which will result to medical delegation.
On the other hand shifting interdisciplinary boundaries will ensure that all patients can access health care even in cases of inadequate nursing personnel. By doing so, the nurses will be acting ethically according to the ethic of duty of care to all patients (Bryant-Lukosius & Dicenso, 2004). Secondly, interdisciplinary shifts involve collaboration with other care providers in a hospital setting, which is ethically acceptable. However, this can be controversial and especially in health team collaboration as a patient’s condition may be discussed thus interfering with the confidentiality of the patient. Consequently, making interdisciplinary shifts is a way of advocating for the patient’s rights to be treated in a case where there are inadequate personnel. Finally, making interdisciplinary shifts is a way of being responsible to the needs of all patients.
Shifting interdisciplinary boundaries will also create room for nurses to practice autonomy. This is because by working in a completely different setting, a nurse will be in a position to think through and explore many ways in which he or she can provide health care services in that setting. The nursing code of ethics allows autonomy and thus, the shifting of interdisciplinary boundaries will be viewed as ethical.
In addition, shifting interdisciplinary boundaries will aid in maintaining the integrity of the profession. Nursing profession requires that nurses attend to patients in good will of providing the best health care services to them. Interdisciplinary shifts will ensure that patients receive the best care possible even in absence of adequate personnel to provide health care services. Lack of interdisciplinary shifts in hospitals with inadequate health personnel will mean that some patients are going to be denied access to health care services, which is their right. Thus, making interdisciplinary shifts would be a good way of addressing such a situation.
At the same time, making interdisciplinary shifts, it will be possible for nurses to acquire professional self-development as they will gain more knowledge and expertise as they provide care to patients in different settings (Hamric, 2005). In cases whereby interdisciplinary shifts involve collaboration, nurses will end up gaining a lot of experience in health care provision. Secondly, interdisciplinary shifts will promote good communication skills in professionals as there must be good communication between the interdisciplinary member and the independent members. Thirdly, interdisciplinary shifts will create the virtue of obedience and respect to seniors as the interdisciplinary member has to follow instructions given by the interdependent member. Professional goodwill, trust, and credibility are the other virtues that are promoted by interdisciplinary shifts.
Need Strategies to Advance the Development of Nursing From My Own Perspective and that of the Profession
It is important that nurses put more effort so as to develop skills in other areas of health care apart from their specific areas of specialization. By doing so, it will be possible to fill gaps that would otherwise result to lack of timely provision of health care or in worse cases, inaccessibility to health care.
To start with, there is need for hospital managers to conduct surveys on issues affecting the nursing practice. After the survey is done, the management can come up with ways of developing and implementing the role of a clinical nurse specialist in hospitals.
Secondly, there is need to converse with the policy makers so as to change the regulations governing registered nurses. As discussed earlier, registered nurses are restricted from practicing in other areas apart from their trained areas. Otherwise, regulations require that they will have to receive authority either by adopting institution protocols or by medical delegation. This regulation leads to nurses who are competent in more than one area being restricted to deliver their services. At the same time, this regulation inhibits professional growth, hence need to be reviewed.
Thirdly, there is need to standardize the education requirements for clinical nurse specialists to graduate level. This will ensure that every nurse who is expected to play the role of a clinical nurse specialist is able to perform the tasks of expert coaching, ethical decision making, leadership and all other roles that are expected of a clinical nurse specialist.
Fourthly, there is need to determine the level at which the regulations and policies in nursing prohibit or allow the development of new roles in nursing. After these levels are determined, then necessary adjustments can be sought.
Fifthly, there is need to lobby for nurses to practice advanced practice roles and to ensure that the boundaries to which nurses can develop new roles in nursing are not very limited as it is the case in many countries.
Consequently, it is important that any new role played by nurses be recognized and acknowledged. New advanced nursing roles come up as a result of the needs of the population and thus there is need to embrace them as they seek to serve the public. It’s also important to support the existing advanced practice roles like those of case management, nurse practitioner, clinical nurse specialist and primary health care practitioner roles (Wang et al., 1995).This is because all these roles are aimed at improving access to health care services and service delivery, which is the overall idea behind advanced nursing practices.
In addition, the role of a nurse anesthetist can be initiated in hospitals. This is because use of anesthesia is required in all areas of nursing. A standard curriculum to offer anesthesia education should also be formulated so as to ensure the anesthetist role is carried out with high standards. This would be important because currently, most anesthetist roles are performed through informal arrangements. Having the role of a nurse anesthetist would ensure that this role is practiced professionally.
Moreover, consultations can be done with the instructors who offer midwifery so as to determine whether transfers between the midwifery and the nursing programs could be possible (Sutton & Smith, 1995). This would also require a critical examination of the presence of any comparable areas in the two areas of study.
Furthermore, programs that offer higher education for the midwifery can be initiated. This would lead to better health care services to the expectant women as currently; most of the midwifery nurses have not received higher education (Gillespie, 2000). Consultations with the midwifery practitioners can also be made so as to discuss the possibility of coming up with graduate programs for the clinical nurse specialists that would be responsible for providing health care to women.
Finally, it would be important to establish hospital-based training programs for the newly and locally developed advanced nursing roles. This would promote innovation among the nursing staff. It would also promote the growth of home-grown nursing roles which would be very beneficial in offering health services to the public.
In conclusion, the call for advanced nursing practice in many countries is as a result of challenges facing the health sectors. Currently, the health care sector is experiencing many challenges including rising costs, inadequate staff and poor access to health care. The roles commonly identified as APN internationally include: nurse practitioner, clinical nurse specialist and nurse anesthetist (Schreiber et al., 2003). One of the roles that an APN can play in my area of study is that of the clinical nurse specialist (CNS). A clinical nurse specialist is an advanced practice nurse who provides expert nursing care to a specialized population (Winnipeg Regional Health Authority, 2006). A clinical nurse specialist can strengthen the agency staff nurses by providing expert coaching on new nursing knowledge, acting as a role model to the agency staff nurses while working together in the same environment, providing consultation and mentoring services to the agency staff nurses and by effecting systems change in the hospital and by encouraging collaboration among the members of the health tem.
On the other hand, the nursing profession is usually bound by several legal, ethical and professional codes. The law requires that all nurses be responsible for their own actions and act only in their areas of competence and preparation. By making interdisciplinary shifts, this law is usually violated. At the same time, shifting interdisciplinary boundaries will ensure that all patients can access health care even in cases of inadequate nursing personnel. By making shifts in the interdisciplinary boundaries, the nurses will be acting ethically according to the ethic of duty of care to all patients. Consequently, it will be possible for nurses to acquire professional self development as they will gain more knowledge and expertise as they provide care to patients in different settings.
It is thus important for nurses to put more effort so as to develop skills in other areas of health care apart from their specific areas of specialization so as to fill gaps that would otherwise result to lack of timely provision of health care or in worse cases, inaccessibility to health care. Some of the need strategies towards achieving this include: adjustment of regulations, creating education programs and collaboration.
Bryant-Lukosius, D. & Dicenso, A. (2004). A framework for the introduction and evaluation of advanced practice nursing roles. Journal of Advanced Nursing, 48 (5), 35-50.
Canadian Nurses Association (2006). Report of 2005 dialogue on advanced nursing practice. Ottawa: Canadian Nurses Association.
Chen, D. (2000). The current issues in advanced practice nursing in Taiwan. Geneva: International Council of Nurses.
Daniel, C. (2004). Higher level practice in nursing: the making of a profession. Professional Nurse, 19(7), 361-362.
Edmunds, M. (2002). Standardizing our status. The Nurse Practitioner, 27, 66
Gillespie, L. (2000). Beyond imagining: a nursing perspective on the future health care system. Medical Journal, 42(5), 244-245.
Hamric, A.B. (2005). Advanced nursing practice. St Louis: Elsevier.
International Council of Nurses (2003). Definition and characteristics of the role. Geneva: International Council of Nurses.
Leyden, C.G., Caravalho, J. Y. & Saylor, C.R. (2000).An evaluation of a nurse case-managed program for children with diabetes. Pediatric Nursing, 26, 296-302.
Schreiber, R., MacDonald, M., Davidson, H. & Moss, L. (2003).Advanced nursing practice: opportunities and challenges in British Columbia. London: Victoria.
Scott, R. A. (1999). A description of the roles, activities and skills of clinical nurse specialist in the United States. Clinical Nurse Specialist, 13(4), 183-189.
Sutton, F. & Smith, C. (1995). Advanced nursing practice: new ideas and new perspectives. Journal of advanced nursing, 21, 1037-1043.
Villeneuve, M. & MacDonald, J. (2006). Toward 2020: visions for nursing. Ottawa: Canadian Nurses Association.
Wang, J., Yen, M. & Snyder, M. (1995). Constraints and perspectives of advanced practice nursing in Taiwan. Clinical Nurse Specialist, 9(5), 252-255.
Winnipeg Region Health Authority (2006). Improve patients care outcomes: adding a clinical nurse specialist to your team. Winnipeg: Winnipeg Region Health Authority.