The CNS as an Advance Practice NursePresentation Transcript
Difference between NPs and PAs
Barriers to APNs
The Origin of NPs and PAs
Gaps in the distribution of physicians and services in the rural and inner city .
The cost effectiveness of these two roles, especially when the health care cost is rising.
The patients ’ high satisfaction level with NPs and PAs
In 2006, NPs and PAs have accounted for around one sixth of medical workforce in United States.
NPs vs PAs: Scope of Practice
The supervisory physician is responsible for the PA at all times and must be available for consultation
A nurse practitioner works either independently or as part of a health care team
NPs vs PAs: Education
All Pas and NPs are now graduates of formal, accredited education programs. Most are at the graduate level, providing a master ’ s degree as a standard of education for both NPs and PAs.
The education of PAs students is disease centered, while for NPs students, it also emphasizes psychological and social care.
The NP curriculum follows nursing models of practice and emphasizes health assessment, diagnosis, and treatment, as well as health care maintenance and disease prevention.
NPs vs PAs: Abilities and Limitations
12 states nurse practitioners have no collaboration requirement, 4 states require physician involvement but no written documentation.
11 states and D.C allow for nurse practitioners for independent prescriptive authority
PAs now are licensed in 44 states, but they have to work under the authority of a physician.
Comparison of NPs and PAs (Table from Curren, 2007) Characteristics Nurse Practitioner Physician Assistant Average Age 46.3 years 41.5 years Gender Male (4.1%) Female (95.9%) Male (46.2%) Female(53.8%) Average Years in Practice 9.0 9.5 Number Employed 115,000 50,000 Background All are RNs RN, EMT, Medic, RT, PT Number of US Schools 337 132 Curriculum Focus Health assessment, diagnosis, and treatment Primary care, allopathic, osteopathic Length of Education 12-43 months; mean = 21.5 12-39 months; mean = 25.5 Master’s Degree 72.4% 25.0% Number of Graduates 102,829 52,716 Average Salary $73,620 $69,410 Certification Requirements NCC, AANP, ANCC, NCBPNP PANCE Practice Autonomy Autonomous in most states Physician supervision required in most states Primary Care Practitioners 85% 50%
The barriers to APNs: Public Policy
The ability to be credentialed by health care organizations is very important for APNs to have their own patients, but this credentialing is very difficult in managed care organizations (MCOs)
In many states of United States, physician involvement is required for APN prescription authority.
The barriers to APNs: Role Change
Conflict arose when APNs found that the practice setting did not allow them to practice in a holistic manner that was consistent with the nursing role.
Teaching and counseling is an important part of the APN role and couldn ’ t be ignored
APNs are not physician substitutes, they should offer added difference
Compared with PAs, NPs have more privileges
No need to work under the authority of a physician
There are still barriers to APNs
Limitations on the credentialing and prescription
Sometimes hard to be consistent with the nursing role.
We should be ready to embrace the challenges
Strong demand for APNs because of cost effectiveness and high satisfaction level
The constraints to the practice of APNs are gradually removed by legislation.
Why Washington State Needs Change
What is an Advance Practice Nurse?
Advanced Practice Registered Nurse (APRN) is an umbrella term for four groups of advanced practice nurses.
Clinical Nurse Specialists
All with a Different Focus and Scope of Practice
What is a CNS?
The first APRN
unique body of knowledge and competencies based on education at the graduate level (Mick and Ackerman, 2002)
Advance Practice Nursing Started with Peplau in the 1940’s (Peplau, 1965).
Differentiated from the expertise of other APRN
In 1965 the ANA declare that the that the Title of CNS should only be used by Nurses with a Master’s Degree and higher (ANA, 1965)
CNS Scope and Expertise
Three Main Spheres of Influence
Nurse/Nursing Sphere; and
System/Organizational Sphere (NACNS, 2004).
Specialized Knowledge, Experience, and Education in a specific field, setting, or population.
Prescriptitory rights in field of specialization.
Varies by State
Specific Patient Population
System wide Focus
Focus on Quality of Care Issues
Focus on direct patient care
Referral and consultation to other HCP
Durable Medical Equipment
Pharmacologic when appropriate to Specialty
Protection of Title
Not a protected title in Washington State
Washington Department of Personnel in July, 2007 created a “Class Specification”
Specific “Distinguishing Characteristics”
Specific description of “Typical Work”
Specific “Knowledge and Abilities”
BUT, legal requirements are only a RN
AND, a Master’s Degree is only “Desirable” and “Equivalent education / experience” can substitute
Why Should the Title Be Protected with Educational Requirements
Improve Patient Care
Increased Education Increases Nursing Care (AACN, 2008)
Provide Incentives for Educational Growth
Some States are Offering a $20,000 signing bonus for CNS
Establish Parity with other Professions
PA, Current Pharmacist, Current PTs
Establish Parity with other States
Where is the Title Protected
How is it Protected
Nursing Practice acts
State Nursing Board Changes
Some State second Licensing
Second License Concerns
There are over 40 CNS specialty areas of practice
Only 9 CNS specialty exams exist (NACNS, 2003)
-Adult -Acute and Critical Care
-Adult Mental Health -Pediatric Mental Health
-Home Health -Diabetes Management
If a specialty exam does not exist may have to take a general med/surg exam.
A “New Way”
ANCC New Core CNS Clinical Nurse Specialist Exam (currently under Development)
“ Critical Portfolio”
Examine Experience and Education
Use of other exams
Oncology Certified Nurse
Certified Nurse Operating Room (CNOR)
RN First Assist (RNFA)
Certified Chemotherapy Nurse
Dermatology Nurse Certified (DNC)
CNS Represent a unique role
Different from NP
Different from RN
Title needs legal and regulatory protection
Washington State should implement laws and regulations to protect and recognize the CNS role.
Curren, J. (2007). Professional Issue. Nurse Practitioners and Physician Assistants: Do You Know the Difference? MEDSURG Nursing, 2007 Dec; 16 (6): 404-7.
Plager, KA.; Conger, MM. (2007). Advanced Practice Nursing. Internet Journal of Advanced Nursing Practice, 2007; 9 (1).
McCabe, S.; Burman, ME. (2006). A Tale of Two APNs: Addressing Blurred Practice Boundaries in APN Practice. Perspectives in Psychiatric Care, 2006 Feb; 42 (1): 3-12.
Mick, D. J. and Ackermn, M. H. (2002). Deconstructing the myth of the advanced practice blended role: Support for role divergence. Heart and Lung, 31(6), 393- 398.
American Nurses Association. (1965). Educational Preparation for Nurse Practitiners and Assistants to Nurses: A Position Paper . American Nurses Association. 1965. New York.
Peplau, H. (1965) Specialization in Professional Nursing. Nursing Science , 3, 268-287.
NACNS. (2004). Statement on Clinical Nurse Specialist Practice and Education: Second Edition. National Association of Clinical Nurse Specialist. 2004 Harrisburg, PA.
NACNS. 2003 Testimony to the Federal Trade Commission on Regulatory Credentialing Barriers For Clinical Nurse Specialists (CNS). National Association of Clinical Nurse Specialist. 2004 Harrisburg, PA. http://www.nacns.org/TESTIMONY.pdf. Accessed 7/26/2008.
AACN. (2008)Fact Sheet: The Impact of Education on Nursing Practice American Association of Colleges of Nursing http://www.aacn.nche.edu/Media/pdf/EdImpact.pdf . Updated 6/2/08. Accessed 7/26/08