Advanced Practice Nursing: Essential Knowledge for the Profession

Description:

Advanced Practice Nursing: Essential Knowledge for the Profession, Fifth Edition is a core advanced practice text used in both Master’s Level and DNP programs. This bestselling textbook is framed around the AACN’s Master’s Essentials as well as the Essentials for Doctoral Education featuring the most up-to-date content on each set of Essentials. Throughout the Fifth Edition the authors address the rapid changes in the health care environment with a special focus on health care finance, electronic health records, quality and safety as well as emerging roles for the advanced practice nurse. Patient care in the context of the advanced nursing role is also discussed.

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INTRODUCTION

Advanced practice nursing education has been rapidly evolving over the past 2 decades, with much attention given to the unique differences between advance practice nursing and the four traditional advanced practice roles—that is, certified registered nurse anesthetists (CRNAs), certified nurse–midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs)—as direct care providers. The fifth edition of this book was conceived in response to several new national initiatives, including the evolution and continued growth of the doctor of nursing practice (DNP) degree. The following position papers and task force recommendations were taken into account when selecting new content for this textbook:

The Essentials: Core Competencies for Professional Nursing Education (American Association of Colleges of Nursing [AACN], 2021)

Defining Scholarship for Academic Nursing Task Force Consensus Position Statement (AACN, 2018)

The NONPF Statement in Support of Telehealth in NP Education (National Organization of Nurse Practitioner Faculties [NONPF], 2018)

Nurse Practitioner Role Core Competencies (NONPF), 2022

Diversity, Inclusion, and Equity in Academic Nursing AACN Position Statement (AACN, 2017b)

Common Advanced Practice Registered Nurse Doctoral-Level Competencies (AACN, 2017a)

Advancing Healthcare Transformation: A New Era for Academic Nursing (AACN, 2016)

The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations Report from the Task Force on the Implementation of the DNP (AACN, 2015b)

Re-envisioning the Clinical Education of Advanced Practice Registered Nurses (AACN, 2015a)

These initiatives address the rapid changes in the healthcare arena and the need for advanced practice nurses to be responsive to a complex health system with an aging population with complex comorbid health conditions at the core. These changes are all encompassing and, in most circumstances, a long time coming. Reforms include the move from volume-based to value-based care, from process to a focus on quality and outcomes, from episodic care to life span care, and from acute care to prevention and population health. Given changes in higher education, student desires, and the aforementioned changes in the healthcare systems, a competency-based educational approach has been endorsed to prepare the nursing workforce for the future decade. On April 6, 2021, AACN-affiliated academic deans across the country endorsed The Essentials: Core Competencies for Professional Nursing Education, which delineates competency expectations for graduates of baccalaureate and graduate nursing programs. This historic and bold move will transform how nurses are educated for both entry-level and advanced roles (AACN, 2021). These “new essentials” are not intended to replace advanced practice core competencies for master’s or doctorally prepared advanced practice registered nurses (APRNs) or nurse practitioner role core competencies (NONPF) but to provide a framework for contemporary advanced nursing practice across each of the previously mentioned APRN roles. Competency-based nursing education is a focused approach putting the individual student at the center of learning. The intent is for entry-level and advanced practice students to work at their own pace and reflect on their performance and the attainment of competencies required for practice. As academic and clinical partnerships continue to intensify, so does the intricacy of healthcare services. Advanced practice nurses are expected to engage in a high level of teamwork that is both intra- and interprofessional in nature. This calls for advanced practice nurses to participate in clinical scholarly activities to enhance best clinical practices and influence health policy and advocacy while educating the next generation of clinicians, scholars, and leaders regardless of the setting and focus of care.

Content on business planning and economics, quality improvement, and the use of metrics to drive clinical decisions have been incorporated. Advanced practice nurses must have a broad overview of how big data, including cost, healthcare outcomes, and patient and provider satisfaction, facilitates decisions and affects outcomes in all arenas. The impending shortage of primary care providers, new healthcare reform legislation, the focus on patient safety, and cost-effective high-quality care have provided curricular guidance to master’s and doctoral programs preparing advanced practice nurses. Given national gains in full independent practice, more NPs are opening their own businesses; thus, entrepreneurship is a trend that will continue to grow and is addressed in this textbook. Given the COVID-19 pandemic, an increased demand for telehealth is another major trend in advanced practice nursing. In April 2020, the number of telehealth visits was 78 times higher than in February 2020. Currently, the use of telehealth is 38 times higher than before the pandemic. Advanced practice nurses need to understand best practice for conducting telehealth visits as well as reimbursement guidelines for telehealth.

Although diversity, equity, and inclusion are not new, it is imperative that governing bodies and healthcare leaders support healthcare systems to reflect communities they serve and, most important, bring equality into healthcare access and delivery. Promoting the racial and ethnic diversity of the nursing workforce will aid in employee engagement and attract new talent.

New to this edition, the content of this textbook has been cross-referenced with the Essentials: Core Competencies for Professional Nursing Education (AACN, 2021). The task force that developed the “new essentials” built their work on the strong foundation of nursing as a practice discipline, the underpinnings of a liberal education, and principles of competency-based education. The Essentials, as the framework for preparing nursing’s future workforce, intentionally reflect on and integrate nursing concepts as a discipline. This document was finalized with the input from practice partners and other professionals with the goal of bridging the gap between education and practice. Stakeholders including faculty, students, employers, patients, and families, expect all nursing graduates to complete their educational programs with measurable skills and knowledge. The “new essentials” clearly delineate 8 core nursing concepts, 10 major domains, and competencies representing the essence of professional nursing practice.

In addition, in July 2022, the National Organization of Nurse Practitioner Faculties (NONPF) released the revised Nurse Practitioner Role Core Competencies, replacing the prior NP core competencies (2017). They are written to be measured and evaluated at the clinical doctoral level. These competencies are for entry to practice for all nurse practitioners regardless of population focus as the competencies are essential behaviors of all NPs.