The certified psychiatric nurse practitioner: advanced practice psychiatric nursing reclaimed

During the decade of the 1990s, health care reform, market forces, population needs, new knowledge in neuroscience and changes in advanced practice regulation provided the impetus for the development of the role of the psychiatric nurse practitioner. Debate about issues of role, scope of practice, educational preparation, titling, and credentialing for the advanced practice psychiatric nurse (APPN) of the future intensified as the American Nurses Credentialing Center (ANCC) proceeded with its controversial decision to develop a certification examination for the psychiatric nurse practitioner-in advance of consensus among advanced practice psychiatric nurses about those widely debated issues. Ironically, now that the ANCC adult and family psychiatric nurse practitioner (PMHNP) examinations exist, with test content outlines that clearly identify the professional standards and scope of practice relevant to the role of the certified psychiatric nurse practitioner, those contentious issues of role, scope of practice, educational preparation and credentialing (if not titling) seem considerably less thorny. In fact, by credentialing the role of the psychiatric nurse practitioner sooner rather than later, ANCC may have saved advanced practice psychiatric nursing for psychiatric nurses. This article proposes to (1). explain that assertion, (2). clarify what the scope of practice relevant to the newly certified role means in terms of credentialing requirements for existing types of psychiatric nurse practitioner, and (3). identify some of the controversies that linger with the debut of the PMHNP certification examination(s).     

The nature of advanced practice nursing.

In attempting to define "advanced practice," we argue that nursing as such is teleological or goal-directed with those goals being defined by the patient or client in interaction with the nurse. In helping the patient meet identified goals, the nurse requires 2 kinds of knowledge-general and particular. General includes theory (know what/why), pattern recognition (know what), and practical knowledge (know how). Particular (know who) is personal knowledge about the patient. The advanced practice nurse, by virtue of graduate education, is able to move beyond the familiar and experientially learned. He or she makes a deliberate attempt to situate self in a dialectic between general and particular knowledge in such a way that the interplay opens possibilities. Knowing when a particular action would be most helpful is defined as practical wisdom. We argue that a highly developed sense of practical wisdom is the hallmark of advanced practice.     

Acute care nurse practitioner: an advanced practice role for RN first assistants

ACUTE CARE NURSE PRACTITIONERS (ACNPs) are advanced practice RNs who are educationally prepared to provide advanced nursing care to patients with complex acute, critical, and chronic illness.THE EDUCATION of advanced practice nurses should prepare them for the setting in which they practice; ACNPs are well prepared for hospital and specialty practice, particularly if they have experience as RN first assistants (RNFAs).THIS ARTICLE PROVIDES a brief overview of the ACNP opportunity for RNFAs and the importance of additional training for ACNPs without OR experience who may be first assisting. AORN J 87 (June 2008) 1205-1215. © AORN, Inc, 2008.     

The problem of comparing nurse practitioner practice with medical practice

Comparing the practice of nurse practitioners to medical practice began almost 50 years ago and continues to this day. This comparison is curious since the founders of this movement did not indicate that these advanced practice nurses were to be interchangeable with physicians. Nevertheless, substantial literature indicates that nurse practitioners perform equally or better when measured against physician practice standards. This paper compares the ontology and epistemology of both professions and concludes that the philosophical foundations are so different that comparisons are illogical.     

Is heart failure nursing practice at the level of a clinical nurse specialist or advanced nurse practitioner? The Irish experience.

Since 2000 there has been a significant increase of Heart Failure Nursing positions in the Irish health service. The background to these positions has been based on the model established at St. Vincent's University Hospital, Dublin since 1998. Recognition of nursing practice in Ireland has also transformed with the introduction of Clinical Nurse Specialist and Advance Nurse Practitioner positions. To date Clinical Nurse Specialists coordinate and manage heart failure programmes, however it remains to be seen whether current practices are within the scope of practice of these nurses. Advanced Nurse Practitioner is a new position in Irish Nursing from examining guidelines and education this may be the way forward for Heart Failure Nursing in Ireland.     

A conceptual framework for advanced practice: an action research project operationalizing an advanced practitioner/consultant nurse role

• ? A preliminary conceptual framework for an advanced practice/consultant nurse role is presented which links the role to its context and outcomes.
• ? The conceptual framework was developed in the process of analysing data from a 3-year action research study involving the operationalization of an advanced practice/consultant nurse role in a Nursing Development Unit.
• ? The skills and knowledge base of consultancy, underpinned by a strong nursing foundation, augmented by strong leadership and combined with the educator and researcher functions, are presented as the attributes of the advanced practitioner/consultant nurse.
• ? The facilitation of a transformational culture is highlighted as central to the skills and processes used within the role.
• ? Implications for the preparation and accreditation of the advanced practitioner/ consultant nurse are highlighted.