Role and Scope of Nursing Practice

Personal Philosophy and Framework

Professional nurses are expected by the public to demonstrate professional competencies throughout their career. According to Bickford, Marion and Gazaway (2015), a registered nurse is personally accountable and responsible for maintaining professional competence. It is the responsibility of a nurse to shape and guide all the processes that assure nurse competence. Minimal competence standards are defined by regulatory agencies to protect the public. The employer is accountable and responsible for providing a conducive environment for competent practice. Competence assurance is the shared responsibility of the regulatory agencies, credentialing and certification entities, professional organizations, individual nurses, and other key stakeholders. 

As a practicing nurse, it is my responsibility to maintain professional competence by shaping and guiding all the processes that assures nursing competencies while removing barriers that constrain this practice. O’Grady (2017) explains that in the framework of nursing competency, a lifelong process will be required. Competence will occur due to a continual reassessment of competence and identification of needs for additional skills, knowledge, integrative learning experiences, and personal growth. As a practicing nurse, it is important to evaluate competence through self-assessment by using tools that capture subjective and objective data about the knowledge base of an individual and their actual performance. 

Professional Components and Educational Requirements in Arizona

Educational institutions offering APN program in Arizona for CNS and RNP roles ensure that the programs contain some of the highlighted factors. The programs should be affiliated or offered with an accredited college or university under A.R.S & 32-1644 (Bickford, Marion, & Gazaway, 2015). For new programs, the university or college should at least have – as defined in R-19-101 – one supplementary nationally accredited nursing program, or else provide a substantial evidence of its ability to achieve national APRN program accreditation for all graduates. All students should have a license of practicing as RN in clinical practice state. In comparison to California, the requirements of Arizona are similar to that of California as both states require registered nurses to be competent by consistently demonstrating the ability to transfer scientific knowledge from physical, biological, and social sciences. 

Boards Application Process, Arizona’ State Regulation, and APRN Issues in Arizona

On the AzNA Policy Committee, there are 25 members chaired by Denise Link, Ph.D., NP, FAAN, FAANP. The responsibility of the committee is reviewing the bill as presented in the course of legislative sessions. The legislative session of 2017 began on January 9 and was adjourned at the end of April. The APRN 2017 full practice Authority Legislation in Arizona was last updated on April 18, 2017 (ANA, 2017). The legislation was titled “pro-nurse, pro-patient legislation” with a responsibility of improving accessibility and affordability of care and improving patient care.

Currently in Arizona, the Arizona Nurse Association applauds the approval of SB 1336 Arizona Legislature’s bipartisan. They have designed the legislation to expand the accessibility of patients to care, streamline anti-competitive and unnecessary regulation and help in recruiting more physicians and surgeons to Arizona communities. The SB 1336 which is broadly supported by the Arizona health care leaders bipartisan coalition updates state law that governs Certified Registered Nurse Anesthetists (CRNAs) while addressing century-old regulations that have handcuffed health care professionals for years (Napolitano, & Ridenour, 2014). In Arizona, CRNAs play a crucial role in providing affordable, safe, and quality care. 

APN Roles and Prescriptive Privileges and Impact on Client Care

Advanced practice nursing includes nursing interventions which influence the outcome of health care, including the development and implementation of health policy, administration of health care and nursing organizations, management of population and individual care, and direct care of clients. NCBI (2011) explains that it is the role of all APNs to provide safety and quality health care to all clients. They should collaborate with other health professionals in providing care to patients. According to ANA (2010), APNs and physicians should be in a collaborative or supervisory relationship with one another. It is essential that the APNs practice to the full extent of their training and education. 

Within the healthcare workforce, nursing remains the most versatile occupation. Due to this versatility, the APN facilitates relief and palliative care, expands the capacity of a nation’s primary care, and increases accessibility of care to the rural residents and the poor, and increases the greater availability of focused consultation and specialty care. According to the NCBI (2011), the APNs are responsible for the provision of quality care to clients. They are therefore crucial in the reduction of infection rates, prevention of medication errors and facilitation of the transition of patients from hospital to home.

Difference between Prescriptive Authority, Credentialing, and Clinical Privileges

Credentialing, prescriptive authority and clinical privileges are in one way or another connected. Credentialing involves the process that health care organizations use in validating clinical experience, professional licensure, and preparation for specialty care. Every health care professional including APNs should have some form of credentialing before they are given specific patient care privileges or before a healthcare system hires them. On the other hand, a clinical privilege is a process that APNs are granted with the authorization of providing specific patient care services. Privileging certifies that the nurse receiving the clinical privileges is skilled in the provision of patient care services that agree with the standard of care of the facility offering the privilege. 

Prescription authority privileges given to nurses does not require them to collaborate with other physicians. According to Stokowski (2016), prescriptive authority or independent prescribing is the capability of APRNs to prescribe with no limitations, controlled or legend drugs, durable medical goods, adjunct health/medical services, devices, and other supplies and equipment. The three concepts – prescriptive authority, credentialing, and clinical privileges – are inter-related as they all involve authority given to nurses by regulatory bodies. However, each concept has a different mandate in the provision of care, and they are all essential in providing quality and safe care.

Global Development of the Advanced Practice Nurse Roles

The APN’s role began in the United States and has evolved over time across the globe. Savrin (2009) holds that in the USA, the advanced practice role consists of a variety of distinct groups’ nurse aesthetic, nurse midwife, clinical nurse specialist, and the nurse practitioner. The roles in the United States are grouped as they were developed; starting with the nurse aesthetic and the latest being the nurse practitioner. Currently, according to Savrin (2009), the majority of countries have well established APN programs where an estimated 70% of health facilities have some form of advanced practice. Some countries like Australia and Canada have adopted the APN model in the USA to fit in their local environments. However, in comparison to the US and these countries, Hong Kong took a different path where it developed a clinical ladder system for APNs. They have organized the career ladder without a clear direction of clinical career and professional progression and development. 

References

ANA. (2010). ANA Standards of Professional Nursing Practice (2nd ed.). Silver Spring: Nursesbooks.org.

ANA. (2017). Nurses Care for Arizona. Arizona Nurse’s Association. Retrieved from http://www.aznurse.org/

Bickford, C., Marion, L., & Gazaway, S. (2015). Nursing: Scope and Standards of Practice (3rd ed.).

Napolitano, J., & Ridenour, J. (2014). Arizona State Board of Nursing. Retrieved from https://www.azbn.gov/documents/discipline/Laws%20and%20Rules%20-%2032-1664.pdf

NCBI. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academy Of Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK209871/

O’Grady., E. (2017). Chapter 43Advanced Practice Registered Nurses: The Impact on Patient Safety and Quality. Patient Safety And Quality: An Evidence-Based Handbook For Nurses.. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2641/

Savrin, C. (2009). Growth and Development of the Nurse Practitioner Role Around the Globe. Journal Of Pediatric Health Care, 23(5), 310-314. http://dx.doi.org/10.1016/j.pedhc.2008.10.005

Stokowski, L. (2016). APRN Prescribing Law: A State-by-State Summary. Medscape. Retrieved from http://www.medscape.com/viewarticle/440315