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Components of Role Delineation
The need for further progression of professional roles came about as an innovative solution on a worldwide scale to help address “healthcare integration, coordination, continuity, access, and health care sustainability” in order to help delineate different roles in Advanced Practice Nursing (APN) and therefore implement healthcare system reforms (SGNA, 2013). This called for nurses to take on more leadership positions within all health settings and to meet the overwhelming demands from an ever-changing health care system. The nursing profession was called to further prepare to avidly contribute to the modern day objectives and sustainable improvement goals that were being set globally via strategies that exploited human resources for enhanced healthcare delivery. The American Nurses Credentialing Center (ANCC), a division of the American Nursing Association (ANA), conducted a study in 2014 and works to do so on a continual basis to ensure that all work activities, knowledge, and skills are assessed to ensure quality care, improve outcomes, and overall excel in advanced practice nursing. In essence, their findings help to develop and update testing content for the advanced nursing examinations. This is critical since there is insufficient research that specifies the tasks and roles for practice within APNs. Developing an understanding through education or by using an appropriate and reliable tool would help supervisors, managers and administration to properly deploy APNs by clearly defining their role. The list of role delineations based on Nurse Practitioner (NP) competencies, as stated by the National Organization of Nurse Practitioner Faculty (NONPF) and the AACN, are all necessary to ensure safe, quality and effective care in practice. Performing each of these in practice, is essential to being a successful NP.
The National Council of State Boards of Nursing (NCSBN, 2007), denotes that NPs are responsible for first hand delivery of primary and acute care in multiple settings that includes hospitals, community clinics, schools, and others with a list of services that include the diagnosis and treatment of an array of common and acute illnesses and injuries; administering immunizations; performing physical exams; and managing chronic and dangerous symptoms. Among the long list of potential jobs that NPs are qualified to perform, they all require extensive knowledge and preparation on each of the eight competencies that include: Management of Patient Health and Illness Status; NP-Patient Relationship; Teaching-Coaching Function; Professional Role; Negotiating Healthcare Delivery Systems; Monitoring/Ensuring Quality of Healthcare; and Cultural Competence. As a new APN, I will execute each of these outlined roles, by applying my knowledge and methodology learned throughout the program, in conjunction with my professional experience to properly carry out each role as detailed below.
Management of Patient Health and Illness Status
Similar to a primary care or acute care physician, NPs are qualified to provide comprehensive care in both a continuous and critical care setting. To do so safely and adequately, it is essential to concentrate on health promotion and preventative care, chronic disease management, education, and promote follow up/continuously seeking healthcare services. Among these, education and preventative measures are of the utmost importance. Today, nurses are at the forefront for patient interaction, often first at the bedside or to assess patients, and last to discharge or to educate them about treatment options. Helping patients to take a proactive role in their health can prove to be the best approach to overall outcomes and their health improvement. In addition, ensuring their understanding is a critical component of patient care. Providing patients with education that is conscious of their health literacy, language barriers and cultural sensitivity is essential to its impact on the patient. Fully understanding that every encounter with a patient is an opportunity to provide some education and slowly disseminating information is a key strategy to provide a lot of information slowly and build on their knowledge over time. Medication management, diet and physical activity are among the most important topics to cover since they tend to have a significant impact on their health. This helps to establish a relationship with the patient, which can also help to ensure adherence to treatment protocol and enhanced outcomes.
Establishing a relationship with the patient is essential to the outcome of patient’s care. As nurses, NPs already have a strong foundation in compassion, establishing trust and developing a relationship with the patient and their family/caregivers. As NPs, clinical training and education incorporates proficiencies that require health care for the person as a whole and avidly listening to the patients’ needs and concerns. Relationship-centered patient care incorporates collaboration among clinicians, consideration of patient values and needs, and relies heavily on communication in a dynamic approach to reaching patient specified goals (Cooke, 2016). Establishing a relationship with the patient, utilizing team based approach, establishing trust, and ensuring clear and effective communication can help to alleviate the resistance to treatment options that is often caused by fear or ignorance, while also strengthening the NPs ability to relay treatment related information and ensure adherence to medication, follow up care and any other restrictions needed for symptom control and health improvement.
As a NP, one of the many potential ways to impact the future of healthcare is to utilize the education and knowledge from the program to educate or coach others. As the demand for advanced practice and registered nurses continues to grow, so is the call for well-educated and skilled health care providers that demand for clinical mentors and preceptors (Link, 2009). For those that live and work in large cities, finding a qualified preceptor or mentor can be very easy. However, many students find it difficult to do so if living in a more rural or remote location. Online sources now exist to link potential preceptors or mentors with nursing students. I would be interested in helping others to get the mentoring or education needed, and serve as a professional resource throughout their education as well. As a preceptor or coach, the role would require interactions with students to help them develop their knowledge and skills, help them in clarifying their goals to guide them to decide what truly matters most in regards to their professional future, and work to develop fitting coping strategies to be successful (Link, 2009). Serving as an effective mentor requires that the student truly believes in their abilities, establishes trust, creates accountability and responsibility for both parties involved, and forces the mentor to truly hone in on their ability to relay their knowledge and expertise.
The original expectation for the nurse practitioner profession was to serve as an extension of the physician, but that role has since evolved greatly to include a variety of specialties and responsibilities (What Roles Does a Nurse Practitioner Have?, 2018). As a result, the scope of practice has expanded as well. To satisfy the constantly growing expectations, it is essential to ensure that those that are within this role are aware of the capacity of the NP role and to continue to evolve with new opportunities. As part of a national effort to implement patient centered care that is both cost effective and efficient, it is important to provide care; educate patients, legislators, and regulators alike to show how a NP can transform health care delivery. To do so, it is not only important to focus on chronic conditions, but primary care as well through the use of adequate, detailed, and collaborative care coordination and transitional care; focus on prevention and overall wellness; and reduce the incidence of adverse events that are often preventable (IOM, 2011). Improving research and developing interventions that promote health and well-being, rather than treatment after diagnosis; and establishing more opportunities for advocacy alike can help to enhance the perception of the profession and expand its use/scope.
Negotiating HC Delivery Systems
Primary care physicians have the responsibility of maintaining up-to-date knowledge about Medicare, Medicaid, and private insurance carriers as well as understanding standards and restrictions for private pay, billing and coding, and managed care guidelines. As a NP, it is critical to maintain this knowledge as well. Understanding regulations and reimbursement guidelines are essential to a successful practice. Managed care is a complex and increasingly popular system; quickly becoming the most common form on health insurance coverage used in the U.S. Understanding how the system works can affect the results of services rendered and could affect the overall outcomes of patients if mismanaged (Britt, 2001). Literature, conferences, company and government representatives and other resources can help to educate an NP and their colleagues/staff. Keeping up with the latest standards and seeking to understand the different insurance and reimbursement rates will be essential to ensuring appropriate treatment plans to provide the best value for the patient.
Monitoring and Ensuring Quality of Healthcare
Quality and safety have become the focus of healthcare delivery in recent years. The Agency for Healthcare Research and Quality (AHRQ) defines quality health care as, “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Hughes, 2008, pp 1161). The need to ensuring safe patient care delivery has drawn attention to the many factors that contribute to errors, deficiencies, and the overall complexity of health care delivery. As a result, it has been determined that the best way to ensure quality and safety is to utilize process improvement metrics on an ongoing basis. The use of these improvement metrics is often written into protocols for large scale facilities, but must be used on all scales to ensure that every patient is treated in a safe and adequate manner. Using quality improvement metrics helps to diminish the unpredictable factors, challenges, and potential errors that result from controllable variables. AHRQ (2019) offers national quality measures on their website, along with a quality forum that can be used by any healthcare professional to establish measures that are based in scientific research and help to evaluate and implement changes for continually improving the safest and highest quality of care.
Cultural Competence in healthcare is a significant factor in the U.S, especially for those that live in culturally diverse cities. In order to provide culturally competent care, a NP is required to be culturally sensitive and well educated to enhance communication and understanding of the patient’s perspective, values, and needs. Having this knowledge can lead to more effective negotiations, allow for a mutual exchange of information to relay information more effectively, increase the patient’s compliance to treatment or preventative care, and improve the patient-NP relationship (Castro & Ruiz, 2009). This can also have a significant impact on patient satisfaction because they often associate this with being understood and having their wishes and values considered when providing care. Working to have a greater knowledge and better compliance of the population’s culture can provide new ways to ensure greater continuity of care. In addition, seeking out cultural competence training, education, and even having the ability to speak Spanish in a predominantly Hispanic population, can provide an advantage for enhancing communication and relaying the importance of preventative measures and treatment options.
Overall, the use of these role delineations as outlined are essential components to serve the health populations effectively and successfully as a Nurse Practitioner. Throughout our curriculum, we acquired the skills necessary to perform each tasks and ensures that the quality, safety, and other factors needed by our future patients are met and addressed.
- Society of Gastroenterology Nurses and Associates, Inc. (SGNA). (2013). ROLE DELINEATION OF THE ADVANCED PRACTICE REGISTERED NURSE: Gastroenterology Nursing. Retrieved from https://journals.lww.com/gastroenterologynursing/Citation/2013/11000/ROLE_DELINEATION_OF_THE_ADVANCED_PRACTICE.10.aspx
- American Nurses Credentialing Center (ANCC). (2015). 2014 Family Nurse Practitioner
- Role Delineation Study Summary Report. Retrieved from https://www.nursingworld.org/~4ace6c/globalassets/certification/certification-specialty-pages/resources/role-delineation-studies/familynp-rds.pdf
- Sevilla Guerra, S. & Zabalegui, A. (2016). Role delineation study of advanced practice nursing, a cross-sectional study of practice domains and trends in role functions. International Journal of Integrated Care; 16(6):A62. doi: http://doi.org/10.5334/ijic.3014
- Cooke, C. (2016). Relationship-Centered Care and Nurse Practitioners. Society for Participatory Medicine (SPM). Retrieved from https://participatorymedicine.org/2016/relationship-centered-care-and-nurse-practitioners/
- Link, D.G. (2009). The teaching-coaching role of the APN. Journal of Perinatal and Neonatal Nursing. Jul-Sep;23(3):279-83. doi: 10.1097/JPN.0b013e3181b0b8d2.
- What Roles Does a Nurse Practitioner Have? (2018). Nurse Journal.org/, 2. N. Retrieved from https://nursejournal.org/nurse-practitioner/what-does-a-msn-nurse-practitioner-do/
- Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine (IOM). (2011) The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 3, Transforming Practice. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209871/
- Britt, T., MSN. (2001). Managed Care and Managing Risks. Retrieved from http://ana.nursingworld.org/mods/archive/mod312/cerm302.htm
- Hughes, R.G. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Tools and Strategies for Quality Improvement and Patient Safety. Agency for Healthcare Research and Quality (A); Chapter 44. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK2682/
- Castro, A. & Ruiz E. (2009). The effects of nurse practitioner cultural competence on Latina patient satisfaction. Retrieved from https://doi.org/10.1111/j.1745-7599.2009.00406.x
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