Evolution of APN


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History and evolution of advanced practice nursing

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Evolution of APN

  1. 1. Evolution of Advanced Practice Nursing (APN) S Spencer
  2. 2. Nursing History Video <ul><li>http://www.youtube.com/watch?v=Noaqf- </li></ul><ul><li>JE3UI </li></ul>
  3. 3. Nursing Care Florence Nightingale, 1855 The Granger Collection, N. Y. 1952, A child receiving TB vaccine at a school in Bulacam UNICEF/ICEF-2539 Surgery Perioperative nurses Robert Llewellyn Corbis Physicians & nurses examine children with clef palate & lip at the Xion Jingxi Hospital China Photos/Getty Images 1960’s-Establishment of Medicare & Medicaid programs-> ↑ demand for geriatric nursing Pediatric nurses care for infants, children, and adolescents/Sean Justice—The Image Bank/Getty Images U.S. Army Nurse Corps recruitment poster from World War II/National Library of Medicine, Bethesda, Md.
  4. 4. Nurse Anesthetist <ul><li>Stock Photo - Nurse Anesthetist in Operating Room </li></ul><ul><li>42-16080493 Corbis Royalty Free Photograph </li></ul>
  5. 5. Nurse Anesthetist (CRNA) TIMELINE 1800s 1910-30s 1940s 1950s 1970-1990s ♦ Traced to Catholic sisters administering chloroform during civil war ♦ After civil war, graduate nurses used as Nurse Anesthetists ♦ 6 mo Nurse Anesthetist program ♦ Alice Magnaw, mother of anesthesia ♦ Nurse anesthetists’ right to administer analgesic by physicians questioned ♦ #s’ ↑ during WWI ♦ Great Depression era, physicians & nurses anesthetists compete for same jobs ♦ WWII defined anesthesia as a medical specialty ♦ Anesthesiologists became board certified ♦ Certified as CRNAs ♦ Role expand due to physician shortage in military ♦↑ #s of males choosing Anesthesiologist & CRNA positions ♦↑ demand because of the Korea & Vietnam War ♦ Building credibility & defending practice ♦ CRNAs could bill for services ♦ ↓ financial support ♦ ↑ physician pressure ♦ Overcome barriers to reimbursement ♦ Master degree required
  6. 6. Nurse Midwife
  7. 7. Nurse Midwife (NM) Timeline 1600s 1900s 1950s 1970s 1990s ♦ Nurse midwives brought to US with the slave trade & European immigration ♦ Well respected during this period ♦ Nurse midwives blamed for high maternal & infant mortality ♦ Established schools for midwifery ♦ ↓ usage in urban areas & ↑ usage in poor & European communities ♦ ↑ demand because of high birth rate & post war ♦ Hospitals opened its doors to midwives ♦ ↑ # of master degree programs ♦ Among 1st to advocate graduate education ♦ ↑ demand ♦ shortage of OB physicians ♦↑ funding ♦ Physicians supported certified NM ♦ Medical team continues to supervise their practice ♦ ↑ demand ♦ Role expanded ♦ Recognized by every state ♦ Granted prescriptive privileges & 3rd party reimbursement ♦ Master degree preferred but not required
  8. 8. Clinical Nurse Specialist
  9. 9. Clinical Nurse Specialist (CRNA) Timeline 1900-30s 1940-1950s 1960-70s 1980s 1990s ♦ Specializa-tion in nursing began (anesthesia, TB, lab, OR, dietetics, public health, and psychiatric ) ♦ ↑ demand for psychiatric nurses ♦ ↑ funding because soldiers returned from WWII with medical problems ♦ CNS role development ♦↑ # s of CNSs ♦ Defined as expert practitioners & change agents, ♦ Master prepared ♦ Early 80s, represented 42% of APN ♦ Late 80s, ↓ #s of CNS due to cost constraints ♦ Role shift from clinical to education ♦ Considered clinical expert & should not be doing patient care ♦↓ employment opportunities ♦ ↓ master level enrollment because of ↑NP, intro of acute care nurse practitioners, & hospitals’ financial challenges ♦ A # of CNS also prepared & worked as NP
  10. 10. Nurse Practitioner
  11. 11. Nurse Practitioner (NP) Timeline 1800-1960s 1970s 1980s 1990s 21 st Century ♦ Psychiatric Nursing 1 st specialty ♦ Nurse clinician defined as nurse with advance knowledge ♦ NPs not afforded the same status as cardiac CNS (can not diagnose & treat) ♦ ↑ demand due to physicians specialization ♦ NP operated & prescribe medication under the direction of the physician ♦ NP role perceived as enticing nurses to switch to medical side ♦ Supported by physicians ♦ Confronted with ↑ resistance by organized medicine ♦ Conflict between NPs & CNS by ANA ♦ AMA opposed any attempt to empower non physicians ♦ NPs fight for prescriptive authority & reimbursement ♦ Assumed multiple roles ♦ Master degree required ♦ Gained prescriptive authority for narcotics prescription ♦ ↑ demand ♦ Multiple groups developed to represent PN ( ANCC, AANP, etc.) ♦ Battle over prescriptive authority ♦ Full recognition by insurers & health care organizations ♦ Doctorate NP (DNP) degree proposed by AACN to standardize the practice
  12. 12. Physician Assistant
  13. 13. Physician Assistant (PA) Timeline 1900s 1920s 1960s 1990s Current ♦ 1903, state licensure registration ♦ Goldmark study resulted in the establishment of collegiate nursing vs. hospital based schools ♦ Curriculum founded on nursing education ♦ Missed opportunity for professional nursing (slow to respond) ♦ PA role developed ♦ C ollege degree not required ♦ PAs worked under the director of a license preceptor ♦ Created tension with the role of NP ♦ T rained according to the medical model . ♦ Degree requirement varies (associate, baccalaureate, or master)
  14. 14. Conclusion <ul><li>A brief synopsis of the history of ANP reveals several themes: </li></ul><ul><li>Throughout the century, APNs have been permitted to provide care to the underserved poor communities and in rural areas. </li></ul><ul><li>significant resistance from organized medicine occurred whenever nursing care competes with physicians’ reimbursement. </li></ul><ul><li>  Documentation of outcomes of practice continues to be critical to the survival of APN practice. </li></ul><ul><li>  Efforts of national professional organizations, national certification, and the move toward graduate education requirement for advanced practice have been critical in establishing the credibility of APN. </li></ul><ul><li>  Intra-professional and inter-professional resistance to expanding the boundaries of the nursing discipline continue to recur. </li></ul><ul><li>  Societal forces (i.e. wars, economic climate, and health care policies) have influenced APN history. </li></ul>
  15. 15. Reference <ul><li>Brucker, M. C. & Reedy, N. J. (2000). Nurse Midwifery: Yesterday, Today, and Tomorrow. MCN, The American Journal of Maternal/Child Nursing . November/December 25(6), 322. </li></ul><ul><li>Hamric, A. B., Spross, J. A. & Hanson, C. M. (Eds.), Advanced practice nursing: An integrated approach. (3 rd ed.). Elsevier Saunders. St. Louis MO.  </li></ul><ul><li>Hodson, D. M. (1998). The evolving role of the nurse practitioner in </li></ul><ul><li>surgery. Retrieved June 5, 2005 from </li></ul><ul><li>http://findarticles.com/p/articles/mi_m0FSL/is_n5_v67/ai_20601099/pg_2/ </li></ul><ul><li>Kristi, H. K. The history and evolution of the APN role: The impact on </li></ul><ul><li>healthcare. Retrieved July, 27, 2009 from: </li></ul><ul><li>http://dynamicnursingeducation.com/class.php?class_id=86&pid=18 </li></ul><ul><li>Northouse, P. G. (2003). Leadership theory and practice. (3rd ed.). </li></ul><ul><li>Sage Publications, Thousand Oaks, CA. </li></ul><ul><li>Nursing. In Encyclopedia Britannica online encyclopedia. Retrieved August 2, 2009, from </li></ul><ul><li>http://www.britannica.com/EBchecked/topic-art/422718/11075/Stephen-Girard-lithograph-by-A-Newsam-after-a-portrait-by%20on%20August%202 </li></ul>