Nursing relates to a broad range of professional practices based on the nurse's educational level. Moreover, the professional nursing scope of practice varies and is determined by the level of nursing certification attained – i.e. licensed practical nurse, registered nurse, and advanced practice registered nurse. The purpose of the discussion is to familiarize the advanced practice nursing student with application of philosophical framework in addition to nursing theory into nursing practice. The term Advanced Practice Registered Nurse (APRN) describes any nurse with a post-graduate education who can practice independently without a physician's supervision. A list of APRNs comprises of nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives (American Association of Colleges of Nursing, 2006). The APRN prepared nurse is equipped with the knowledge and clinical skills that include studies of how nurses operate within the complex world of medicine.
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Advanced nursing role examines both theoretical foundations and philosophical frameworks of nursing that are applied in clinical practice. The nursing theory relates to generalized processes applied to nursing practice. Advanced nursing theory is a set of predictive models for how to treat patients, developed through a combination of field observation and scientific testing. A primary role of graduate education is to provide a theoretical framework that helps nursing students how to give care in different settings. Nursing philosophy is a statement that declares a nurse's beliefs, ethics, and values regarding professional nursing and treatment that the nurse applies to patient care. How nursing care is applied, demonstrates a vital philosophical approach to appropriate practice. Because scientific theories and research methods are relatively connected to the philosophical framework, advanced nurses must become cognizant of philosophy that serves as the basis for developing theory and advancing knowledge.
The advanced practice nurse has a responsibility to integrate the philosophical framework into nursing practice by developing a personal philosophy of nursing that benefits their career and the lives of the families and patients receiving care. The personal philosophy of nursing goes beyond day to day practice and is often tied to a theory element that guides the advanced practice nurse's decision in applying abstract view of encountered situations. Because APRNs are often primary care providers at the forefront of providing preventative care to the public, it is vital to apply the professional philosophy of advanced nursing practice by utilizing evidence-based practices that apply to their role.
The Advanced Nursing Role
Nurse practitioner is defined as a clinician that blends clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management (American Association of Nurse Practitioners, 2019). A nurse practitioner can provide a comprehensive perspective and personal touch to health care.
According to the National Organization of Nurse Practitioner Faculties (NONPF) (2017), Nurse Practitioner Core Competencies include Scientific Foundation, Leadership, Quality, Practice Inquiry, Technology, and Information Literacy, Policy, Health Delivery System, Ethics, and Independent Practice. Three competencies that are most meaningful to the doctorate in nursing student's future role in a primary care practice setting are Scientific Foundation, Leadership, and Quality.
Scientific foundation competencies provide a useful frame of reference in which to appreciate the unfolding of nursing as a discipline. A doctorate prepared nurse practitioner is equipped with the ability to apply critical data analysis and evidence-based approaches to improve advanced nursing practice. Appreciation of science can also be noted in the advanced practice nurse's integration of knowledge from the humanities within the context of nursing science. Research, theory and practice knowledge gathered from the science foundation can be applied towards innovative thinking and the introduction of new practice approaches to improve patient outcomes. Admittedly, nursing has been involved in implementation science since its inception and has been influential in important theoretical and empirical work in the field of nursing (Dahnke, & Dreher, 2016) (Zullig, Deschodt, & DeGeest, 2020).
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A doctorate in nursing practice prepared nurse assumes leadership knowledge that allows them to build upon clinical expertise to accommodate innovativeness. The advanced leadership skills help translate evidence into improved practice. According to the NONPF Core Competencies (2017), doctorate prepared nurses can lead practice inquiry whether individually, intra-professionally or inter-professionally. This finding is supported by a peer review research study generated by advanced practice nurses working in collaboration with other stakeholders to improve health care. Campos de Oliveira, Gonçalves de Oliveira, & Misue Matsuda (2018) suggest that advanced practice nurses possess leadership ability to promote health outcomes of a population focus.
Quality Safety Education in Nursing (QSEN) (2012) defines quality improvement as the use of data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and. Safety of health systems (QSEN, 2012). According to the NONPF Core Competencies, quality improvement applies skills in peer review to promote a culture of excellence. Quality improvement evaluates how organizational structure, care processes, financing, marketing, and policy decisions impact the quality of healthcare (NONPF Core Competencies, 2017). The future of nursing practice relies on the knowledge, skills, and attitudes that are necessary to continuously improve the quality of health care systems.
- American Association of Colleges of Nursing (2006). The essentials of doctoral education for advanced nursing practice. Retrieved from http://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf
- American Association of Nurse Practitioners (2019). Nurse practitioner definition: What’s a nurse practitioner? Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner
- Campos de Oliveira, J. L., Gonçalves de Oliveira Toso, B. R., & Misue Matsuda, L. (2018). Advanced practices for care management: Reflections on the Brazilian Nursing. Revista Brasileira de Enfermagem, 71(4), 2060–2065. https://doi.org/10.1590/0034-7167-2017-0115
- Dahnke, M. D., & Dreher, H. M. (2016). Philosophy of science for nursing practice: Concepts and application (2nd ed.). New York, NY: Springer Publishing.
- National Organization of Nurse Practitioner Faculties (2017). Nurse practitioner core competencies content. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf
- Quality Safety Education in Nursing (2012). Graduate QSEN competencies: Quality improvement. Retrieved from https://qsen.org/competencies/graduate-ksas/#quality_improvement
- Zullig, L. L., Deschodt, M., & DeGeest, S. (2020). Embracing implementation science: A paradigm shift for nursing research. Journal of Nursing Scholarship, 52: 3-5. doi:10.1111/jnu.12507
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