Advanced nurse practitioner PDF

ADVANCED NURSE PRACTITIONER 1
ROLE OF ADVANCED
NURSE PRACTITIONER
Name:
Institutional affiliation:

ADVANCED NURSE PRACTITIONER 2
TABLE OF CONTENTS
Page
1.Introduction 3
2.Role of advanced nurse practitioner 4, 5 ,6
3.Standards of practice in Australia 7 , 8
4.Standards of practice internationally 9
5.Impact of the role on healthcare system 10
6.Conclusion 11
7.References 12

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INTRODUCTION
Nursing is a core pillar in the healthcare system. Nurses play a major role in the care of
patients; they provide primary care ensuring the needs are met and assess if the priorities are
changing. Nurses are also involved in implementing health policies in the health sector. There
are different cadres of nursing including enrolled nurses, registered nurses, nurses specializing in
oncology and emergency and nurse practitioners. An advanced nurse practitioner is a nurse who
has attained their master's degree o consequently their doctoral degree and has the responsibility
to make a diagnosis, order diagnostic imaging, prescribing medications and performing minor
surgeries. According to the Australian College of Nurse Practitioners, the roles of an advanced
nurse practitioner involve performing physical assessment, ordering and interpreting diagnostic
tests and prescribing medications. Furlong and Smith,(2013) state that advanced nurse
practitioners are important in the health care system since they make a huge contribution to the
healthcare system in client-centered care. American Nurses’ Association,(2014) states that a
nurse practitioner has been trained at masters and doctoral level to provide care to acute and
chronic illnesses. The advanced nurse practitioner has autonomy to practice as an individual,
provide primary care and increase the availability of healthcare opportunities (Fitzpatrick,2010).
The availability of specialized nurses in the health care system provides an opportunity
for evidenced-based care provision to patients hence improved outcomes. The nurses have the
opportunity to provide the best care with their areas of specialization. Various world nursing
organizations have come up with the scope of practice of advanced nurse practitioners(American
Nurses Organization,2012). There is a need for various countries to make policies that favor the
independent practice of advanced nurse practitioners. This increases the availability of health
which is among the basic human rights according to(Yamin,2013).

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ROLE OF ADVANCED NURSE PRACTITIONERS
In Australia, advanced nurse practitioners are employed by state and territory
governments while in private practice the nurse practitioner can be in their own practice. A nurse
practitioner has a role in management. This involves leadership in the hospital for example as the
chief nurse and overseeing nursing activities in an assigned ward. The junior nurses are
accountable to the nurse practitioner and they are the channel of communication to and from the
administration. According to Carryer, Gardner, Dunn& Gardner,(2013) in Australia, the nurse
practitioner is a clinical leader who advocates for the rights of the patients while at the same time
is involved in policy-making which produces positive patient outcomes. Therefore nurse
practitioners in leadership provide chances of proper decisionmaking and consultation between
different cadres of healthcare workers.
An advanced nurse practitioner is involved in the diagnosis of a patient, ordering
laboratory investigation for a patient and interpretation, ordering imaging studies and interpreting
them and prescribing medications to the client. Therefore a nurse practitioner provides clinical
care to the patient. This is as a result of a shortage of physicians whose job description mainly
involves this role. According to Mundinger, Kane, Lenz, Totten, Tsai, Cleary & Shelanski,
(2013), a study conducted showed that patients assigned to physicians and nurse practitioners
had the same outcomes in terms of satisfaction and health status. The physicians and nurse
practitioners had the same responsibilities. Therefore a nurse practitioner is up to the task to
perform proper primary nursing care with the right training.
Research is a key element in the observing changes in the healthcare sector while at the
same time steering new introduction of drugs and vaccines to combat diseases. An advanced
nurse practitioner is involved in conducting research affecting nursing practice, medicine, and

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trends in the medical world. Nursing practitioners having direct contact with patients, drugs,
specimens and other healthcare workers have the vast knowledge to contribute to research.
Moreso their practice in nursing enriches their ability to take part in complex researches. Nurse
practitioners have the advantage in research due to a rich expertise as a result of training in the
undergraduate and postgraduate studies. According to Lambert & Housden, (2017) nurse
practitioners have skills and knowledge in nurse practitioner and nurse practitioner-led
researches.
Advanced nurse practitioners are involved in program development, for example, HIV
reduction programs, maternal mortality programs and emerging and reemerging diseases
programs. Nurse practitioners are involved in policy and decision making in issues affecting the
healthcare sector. This involves hospital policy and protocol due to diverse knowledge in nursing
and medical care. Moreso nursing practitioners are in direct contact with patients who and are
able to make prompt decisions. According to McGee, Relf,& Harmon,(2016) development of
such programs include HIV related infection for nurse practitioners as they are primary care
providers.
Advanced nurse practitioners are involved in referrals to specialists and consultant
physicians. This varies in different countries and different respective states of the countries
mentioned. The nurse practitioner needs to determine the need to refer the patient and if it is
within the scope. The referral is deemed invalid if it is older than twelve months. According to
Lowe, Jennings, Tregaskis, Kenneally& Bucknall,(2018), a study done in Australia in major
urban center nurse practitioners made referrals to general practitioners and specialists while
referrals made to them were from registered nurses. general practitioners, specialists and
healthcare service agencies.

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Advanced nurse practitioners are involved in providing clinical care in their specialized
areas of practice if they choose to work in hospitals. Case scenario of a nurse practitioner
providing care in geriatrics where they have specialized in the care of old people and the various
physiologic changes that occur with aging. According to a study done in four hospitals in the
Intensive care unit patients were managed by two different teams one comprising of nurse
practitioners and the other physicians and the outcomes were the same indicating high level of
expertise(Hoffman, Tasota, Zullo, Scharfenberg,& Donahoe,2011)
Advanced nurse practitioners provide education to junior nurses on the specialty. They
also incorporate evidence-based care which has been approved into practice in collaboration with
the junior nurses. They provide mentorship to nurses, nurse students and even other healthcare
workers due to their experience and knowledge. The teaching involves rounds and presentations,
clinical instructions and home visits. The nurse practitioner is also charged with the role of
conducting health education to the patient. According to Price et al(2012), the nurse practitioner
expertise equips one to conduct teaching to different groups.
An advanced nurse practitioner is involved in guiding patients in the care
continuum. This refers to the whole process of diagnosing the patient, ordering for investigations
and interpreting them, prescribing medications, referral and follow up. Since nurse practitioner
has advanced skills in different areas such as pediatrics they provide different services leading to
the improved health care of the client. They advise on general health, referral to various
specialists for further care. Continuum of care refers to the various health services provided at all
stages from birth, adolescence, adulthood, aging, and death. It involves a state of wellness,
illness, deterioration, back to wellness or death. Nurse practitioner is involved in promoting

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health, correcting pathophysiologic changes and the diagnosis of terminal illness. According to
Silver, Ford and Day(2015), pediatric nurse practitioners have led to increased positive outcomes
of pediatric acute and chronic diseases.
Decisionmaking in the clinical area involves resource allocation, staff motivation ideas,
moral-ethical dilemmas, solving conflicts, consulting other healthcare workers and ensuring the
smooth flow of operations. This is enhanced by proper knowledge of hospital policies and
protocol and training on some of the various issues. The advanced nurse practitioner is involved
in decision making due to their rich skills in management. This is done in collaboration with
other nurses, managers, physicians and hospital administration. Decisionmaking involves critical
thinking, assertiveness, and ability to make rational decisions especially because of the delicate
issues dealt with in the healthcare system.
STANDARDS OF PRACTICE IN AUSTRALIA
According to the Nursing and Midwifery Board of Australia,(2014), the first standard of
practice includes assessing using diagnostic capability. This refers to the ability to demonstrate
knowledge in health sciences, ability to collect data which may help in diagnosis, is able to
prioritize health care needs, assesses comorbidities affecting the person receiving care, can
perform a clinical examination including physical, mental, social and cultural aspects. The nurse
practitioner is able to synthesize history and is able to assess social factors influencing one's
health. A nurse practitioner should make the decision to use diagnostic investigations while
considering cost and efficacy for the person, orders screening and investigations and ensures
proper interpretation of the results. He communicates effectively to the person receiving care the

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results. A nurse practitioner involves developmental factors, pathophysiology and environmental
risks in making a diagnosis, diagnose urgent situations and able to correctly pick a diagnosis
from the differential diagnoses.
The second standard of practice in Australia for nurse practitioners is planning care and
engaging others. This involves exploring different options of care for the client and obtaining
new information affecting the nurse practitioner practice. Provides evidence-based education to
clients regarding their diagnostic information and communicates the diagnosis including the
prognosis. Nurse practitioner plans individual treatment for the client while using extensive
pharmacology and pharmacokinetics at this level of practice. He works together with the client
and chooses within a range the most therapeutic options. A nurse practitioner is involved in
commencing and ceasing medications. He refers clients to agencies and specialists and
collaborates with other healthcare professionals to accept referrals.
The third standard of practice involves prescribing pharmacological and
nonpharmacological interventions. The nurse practitioner conducts his practice in an ethical
manner in regard to the care of the client. He prescribes pharmacological intervention while
performing safe evidence-based invasive and noninvasive interventions. He advises the person
receiving care on the side effects, benefits, interactions of the interventions. A nurse practitioner
works hand in hand with her healthcare professionals and other agencies such as disabled and old
aged. A nurse practitioner practices within the territorial and state legislation governing nurse
practitioner practice. He remains aware of the ever-changing diverse practice of nurse
practitioner.
The fourth standard of practice involves outcomes evaluation of practice. The nurse
practitioner evaluates if the goals set in the plan of care have been accomplished. He plans on

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modifying care or ceasing fro the client in collaboration with other healthcare workers. The nurse
practitioner uses indicators to measure the effectiveness of the strategies put in place. The nurse
practitioner participates in research to meet gaps identified in the healthcare sector while using
research-based innovations in practice to increase productivity and outcomes. The nurse
practitioner acts as an educator and mentor to fellow healthcare workers and promotes the role of
nurse practitioner in professional terms.
STANDARDS OF PRACTICE INTERNATIONALLY
According to the American Nurses’ Association,(2014), the first standard of practice
involves the right qualifications such as masters and doctorate level to practice and be licensed
by the respective body. A nurse practitioner should be able to practice the process of care. This
includes performing an assessment which involves history taking, thorough physical
examination, identifying certain risk factors facing the client and ordering diagnostic
investigations and the ability to interpret the results. There should be a diagnosis made by
analysis and collection of data and ability to make a differential diagnosis from the results of
diagnostic procedures. The nurse practitioner develops a treatment plan by developing a patient
education plan and implementing pharmacological and non-pharmacological interventions. The
nurse practitioners’ plan should be individualized, scientific and consistent with learning
chances. The nurse practitioners should plan for followup for the client to evaluate goal outcome
and criteria.
The nurse practitioner provides education to the patient and to the family regarding the
health status, promotion, and maintenance of health through self-care and consultation of other
healthcare workers. The practitioner ensures optimum healthcare and promoting a safe
environment. He acts as a healthcare team leader in the provision of healthcare while

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collaborating with other health care workers to promote optimum health care. The nurse
practitioner participates in the documentation of care while ensuring the privacy and
confidentiality of these documents. The patient’s advocate is the nurse practitioner by
participating in the health policymaking at national and international levels. The nurse
practitioner participates in continuing education and applies standardized guidelines in their
practice. The role of the practitioner is an educator, mentor, manager, consultant, and researcher.
He participates in research by conducting, disseminating and applying findings in practice
IMPACT OF THE ROLE ON HEALTH CARE SYSTEM
According to Oliver, Pennington, Revelle& Rant,(2014), advanced nurse practitioners
have contributed to decreased hospitalization rates and positive overall outcomes on the health of
the clients. This implies that the practice of nurse practitioners improves the overall healthcare
system. There increased availability of healthcare options amongst highly qualified nurse
practitioners.
A study conducted in Australia, Canada, New Zealand, United Kingdom and United
States(Woo, Lee & San Tam,2017)showed that nurse practitioners strengthen the healthcare
workforce. In the intensive care unit, nurse practitioners ensured continuity of care as they
developed more contact with the environment and patients compared t the physicians. The length
of the patient's hospitalization was shortened while their initiated multidisciplinary rounds
showed proper coordination.
The advanced nurse practitioner role is very important in the Australian setting since it
addresses the gap in the healthcare system. The ration of physicians to the population is
decreased and therefore there is a need to ensure that every citizen has easy access to healthcare.

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Nurse practitioners who have rich expertise in diagnosis, treatment, and referral are involved in
reducing the long waiting hours in hospitals. According to Woods and Murfet(2015), the role of
nurse practitioner in Australia remains underrecognized and underutilized
CONCLUSION
Nurses play an important role in the healthcare system most importantly being the
primary healthcare provider. This provides the opportunity to examine various challenges facing
the clients hence need to further education towards one’s preference. Nurse practitioners are
nurses at an advanced level who provide an opportunity for patients to receive specialized highly
skilled care. The importance of these healthcare professionals can’t be underestimated and there
is a need to provide policies and legislation that favors the practice of the professionals.

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REFERENCES
American Nurses' Association. (2010). Nursing: Scope and standards of
practice. American Nurses Association.
American Nurses Association. Task Force on Standards of Practice for
Primary Health Care Nurse Practitioners, Council of Primary Health
Care Nurse Practitioners (American Nurses Association), & Council of
Primary Health Care Nurse Practitioners (US). (2014). Standards of
practice for the primary health care nurse practitioner. American
Nurses' Association.
American Nurses Association. Task Force on Standards of Practice for
Primary Health Care Nurse Practitioners, Council of Primary Health
Care Nurse Practitioners (American Nurses Association), & Council of
Primary Health Care Nurse Practitioners (US). (2012). Standards of
practice for the primary health care nurse practitioner. American
Nurses' Association.
Carryer, J., Gardner, G., Dunn, S., & Gardner, A. (2013). The core role of the
nurse practitioner: practice, professionalism and clinical leadership.
Journal of Clinical Nursing, 16(10), 1818-1825.
Fitzpatrick, J. J. (2010). The future of nursing: Leading change, advancing
health. Nursing Education Perspectives, 31(6), 347-348.
Furlong, E., & Smith, R. (2013). Advanced nursing practice: policy, education
and role development. Journal of clinical nursing, 14(9), 1059-1066.

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Hoffman, L. A., Tasota, F. J., Zullo, T. G., Scharfenberg, C., & Donahoe, M.
P. (2011). Outcomes of care managed by an acute care nurse
practitioner/attending physician team in a subacute medical intensive
care unit. American Journal of Critical Care, 14(2), 121-130.
Lambert, L. K., & Housden, L. M. (2017). Research Reflection: Nurse
practitioner engagement in research. Canadian Oncology Nursing
Journal/Revue canadienne de soins infirmiers en oncologie, 27(1),
107-110.
Lowe, G., Jennings, N., Tregaskis, P., Kenneally, A., & Bucknall, T. (2018).
Profiling Nurse Practitioner practice patterns at a major urban acute
health service. Collegian, 25(3), 277-283.
McGee, K. S., Relf, M., & Harmon, J. L. (2016). The Development of an HIV
Training Program for Nurse Practitioners. Journal of the Association
of Nurses in AIDS Care, 27(3), 240-245.
Mundinger, M. O., Kane, R. L., Lenz, E. R., Totten, A. M., Tsai, W. Y.,
Cleary, P. D., ... & Shelanski, M. L. (2013). Primary care outcomes in
patients treated by nurse practitioners or physicians: a randomized
trial. Jama, 283(1), 59-68.
Nursing and Midwifery Board of Australia. (2014). Nurse practitioner
standards for practice.

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