NUR 513 Describe how the role of advanced registered nurse transformed over time

Describe how the role of advanced registered nurse transformed over time. Consider shifts in scope and expectations in the 20th and 21st centuries. In what ways will the advanced registered nurse role and responsibilities continue to evolve and emerge as the American health care system changes?

Transformation of the role of advanced registered nurses over time. 

According to DeNisco & Barker (2021), the advanced registered nurse role has evolved with time to assist the growing needs in the healthcare system. Such functions include Certified Registered Nurse Anesthetist, Clinical Nurse Specialist, Certified Nurse Midwife, and Nurse Practitioners. Since the 1960s, nurse practitioners have helped to supply the paucity of primary care physicians to underprivileged populations in urban and rural settings. Initially, the education process was less than one year; however, as the responsibilities expanded, so did the need for further education (Woodland, Foster, & Robertshaw,2022). Fast forward to the 1990s, and acquiring a master’s degree in nursing became the standard for practice. With the growing trend of increasing comorbidities, aging population, and the predicted physician shortage, the scope of nursing and transition from sole bedside care to more specialized nursing roles is evolving (DeNisco & Barker, 2021).

Shifts in scope and expectations in the 20th and 21st centuries. 

Health care has drastically expanded between the 20th and 21st centuries. Considering the national lifespan of the 21st century has lengthened in comparison to the early 1900s, more specialized services are available to meet individual health needs. For example, nursing in the 20th century was more generalized as one nurse was multifaceted, and primary nursing care and functional nursing care were practiced. However, as the 21st century advanced with complex healthcare needs, nursing has become more specialized. Accor

ding to the International Council of Nurses (ICN), nursing responsibilities include a broad spectrum encompassing varied environments (Woodland, Foster, & Robertshaw,2022).

Ways in which the advanced registered nurse role changes 

Nursing is the most trusted profession in the United States (American Nurses Association, 2022). With trust comes obligations. The current healthcare system is complex and places more demands on healthcare providers, especially nurses. The complex healthcare system includes an aging population, a rise in chronic diseases, emerging infectious diseases, increasing health care costs, and an acute shortage of healthcare providers (DeNisco & Barker, 2021; Vos et al., 2020). The U.S. spends 18% of its GDP on healthcare costs, which is 3.35 trillion (WHO, 2022). The advanced registered nurses’ roles and responsibilities must continue to evolve to meet the challenges of our healthcare system. A unique and highly skilled workforce is necessary to meet these demands. One way to continue to grow is to advance the knowledge. According to the International Council of Nurses (ICN), advanced nurses hold a master’s degree and possess expert knowledge. The role also continues to evolve through expert coaching, research, specialized care, participation in evidence-based practice, nursing standards, the scope of practice, and professional leadership (Chau et al.,2022).

References

Chaum J. P., Lo, S.H., Lam, S.K., Saran, R., & Thompson, D. R. (2022). Critical elements in nursing graduates’ transition to advanced practice roles and their perceived impact on patient care: an exploratory, descriptive study of graduates and their managers’ perception. BMC Nursing, 21(1), 2-7.  https://doi-org.ezproxylocal.library.nova.edu/10.1186/s12912-022-00907-0

DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

Woodland, J., Foster, K., & Robertshaw, D. (2022). Nursing in the 21st century: results of a pilot survey on attitudes towards nurses and nursing. British Journal of Nursing (4). Vol 31.

Vos, T, Lim, S., Abbafati, Abbasi, & Abbasifard, et al., (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. (396). Pg. 204–22. https://doi.org/10.1016/S0140- 6736(20)30925-9

 

World Health Organization (WHO) (2022). https://www.who.int/news/item/12-12-2021-more- than-half-a-billion-people-pushed-or-pushed-further-into-extreme-poverty-due-to-health-care- costs

According to DeNisco and Baker (2021), nursing education has transitioned from an apprentice style of education to one that involves an education built in liberal arts requiring the development of critical thinking abilities. Even the term advanced nursing practice has been shrouded in considerable uncertainty until a watershed seems to have been reached for a definition that indicates master’s-prepared nurses who provide direct clinical care and to include the roles of nurse practitioner (NP), certified nurse–midwife (CNM), certified registered nurse anesthetist (CRNA), and clinical nurse specialist (CNS) (DeNisco & Baker, 2021). The 2010 report by the Institute of Medicine (IOM) that identified the need for nurses to be positioned as vanguards of health care and strongly advocating for allowing advanced practice registered nurses to practice to the full scope of their skills and the removal of barriers to enable forward movement of nurses and the nursing profession paved the way for the advancement of nursing (Stewart, 2021).

The nurse practitioner practice is thought to have emerged in the 1960s taking cue from Lilian Wald’s nurses of the 1800s and was developed to provide primary care underserved population (Stewart, 2021). In 1965, Loretta Ford and Henry Silver formally developed the role of nurse practitioner to advance the nursing profession and to respond to the need for providers in rural, underserved areas (Stewart, 2021). DeNisco and Baker (2021) affirmed that the role evolved out of the unavailability of primary care physicians to take care of pediatric populations with educational preparation changing from the initial 3 to 12 months to the present-day master’s degree as the entry-level education for nurse practitioner specialties.

Formal midwifery training was also necessitated to solve an urgent need to curb high maternal and infant mortality rates which led to the establishment of the first nurse–midwifery school in 1925 by Mary Breckenridge. Today, all nurse–midwifery trainings are college and university level programs which culminate in the DNP degree. The practice of midwifery requires licensed and independent certified nurse–midwives and certified midwives (CMs) who are autonomous primary care providers with prescriptive authority to manage women’s health, that concentrate on pregnancy, childbirth, the postpartum period, care of the newborn, family planning, and gynecologic needs of women (DeNisco & Baker, 2021).

Having evolved more than 150 years ago, nurse anesthetists are another licensed independent practitioners who autonomously deliver care in collaboration with surgeons, dentists, podiatrists, anesthesiologists and other healthcare professionals (DeNisco & Baker, 2021).

DeNisco and Baker (2021) averred that there is a national initiative to improve access to high-quality but cos-effective health care. This directive is bound to necessitate the advent of many new and yet to be conceived roles for nurses. Newly identified nursing roles such as nurse navigators and healthcare coaches, have been instituted and may require advanced degrees and certification. There are thriving care coordination opportunities for nurses throughout the continuum of care (DeNisco & Baker, 2021).

References

DeNisco, S. M., & Baker, A. M. (2021). Advanced Practice Nursing: essential knowledge for the profession (4th ed.). (S. M. DeNisco, Ed.) Burlington, Massachusetts: Jones & Bartlett.

Stewart, J. G. (2021). Advanced Practice Nursing: essential knowledge for the profession. (S. M. DeNisco, Ed.) Burlington, Massachusetts: Jones & Bartlett.

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