Worldwide, a lot of people have no insurance coverage or uninsured (Chalfin & Fein, 1994). As the government and politicians in different countries continues the debate over unique dynamic of health care, there are still shortage of physicians and other registered practitioners. Here comes the importance of a nurse practitioners especially in the fields of neonatal, pediatric, general medicine and obstetric. Nurse practitioners have proved their ability in providing care such as children, women, migrant workers, the homeless and the workplaces such as schools, work sites and health departments.
The nurse practitioner (NPS) is a registered nurse with advanced preparation, graduation from a nurse practitioner program, and successful completion of the licensing exam (Wikapedia 2009). They provide client outcomes that are as good as physicians' outcomes Nurse practitioners (NPs) provide primary health care services to consumers. Nursing care services provided by NPs include assessing client health using a holistic framework, identifying medical and nursing diagnoses, planning and prescribing treatments managing health care regimens for individuals, families, and communities, promoting wellness, preventing illness and injury, and managing acute and chronic health conditions. NPs carved out a distinct difference in practice from the medical model by using a holistic approach to care based on nursing theory As recognition grew, mostly related to the reduced cost of primary care and positive health outcomes for clients (Wikipedia, Nurse practitioner, 2009).
Nurse Practitioners - Scope of Practice
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Today, more than 95,000 NPs practice in a variety of settings. Frequently, the health care system defines NP practice according to clients served, including pediatric NP, family NP, adult NP, and geriatric NP. Before qualifying for direct third-party reimbursement, NPs must obtain certification. Several bodies offer certification examinations, including the American Nurses Credentialing Center, the American Academy of Nurse Practitioners and Nurses, the National Certification Board of Pediatric Nurse Practitioners, and the National Certification Corporation. Most NPs are required to renew certification every 5 years. This process requires documented practice and evidence of continuing education. Within their relatively short existence, NPs have earned the respect of clients and other health team members. Recent research has demonstrated the effectiveness of NPs in primary care, health promotion, decreasing hospitalization rates, and client satisfaction (Bureau of Labor Statistics, 2007).
Nurse practitioners' education and licensing
There are three basic educational paths to registered nursing to become nurse practitioners. They are a bachelor's degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the profession by completing one of these programmes. Nurse practitioners then should take licensing examination in order to obtain a nursing license. Further training or education can qualify nurse practitioners to work in specialty areas. (Hampson, Gillian D. 2006) The three major educational paths to registered nursing are a bachelor's of science degree in nursing (BSN), an associate degree in nursing, and a diploma. Associate degree in nursing educates nurses in the community college setting. Nurses usually take 2 years of coursework that focus on the technical aspects of professional nursing. Diploma programs provide nursing education in primarily the hospital setting. Diploma nursing students attend school for 3 years and take courses focused on professional nursing. Diploma nursing programs emphasize the scientific aspects of nursing practice; provide more hours of clinical instruction than other programs, and graduate nurses adept at following policies and procedures rather than relying on theory to meet clinical practice demands. A bachelor's of science degree in nursing (BSN) educate students in university settings. A bachelor's of science degree in nursing (BSN) may be traditional or accelerated in nature. In a bachelor's of science degree in nursing (BSN) student receives a well-rounded education over 4 years. Courses in nursing may be integrated with other fields of study. a bachelor's of science degree in nursing (BSN), nursing majors frequently take the same courses as other health profession majors. (Hood, L.J, Leddy, S.K, 2006)
After completing the education program, the nurse must be licensed by the state in which he or she plans to practice. The State Boards of Nursing regulate nurse practitioners and each state has its own licensing and certification criteria. In general, the criteria include completion of a nursing program and clinical experience. Because state board requirements differ, nurse practitioners may have to fulfill additional requirements, such as certification by the American Nurses Credentialing Center (ANCC) or a specialty nursing organization. The license period varies by state; some require lasting two years re-licensing, others require occurring every three years. (womenshealthchannel, 2007)
Characteristics of Nurse practitioners
Always on Time
Marked to Standard
Nurse practitioners have a standardized education for entry into the profession. Like many other professions nurse practitioner requires from members to have intelligence, deep personal commitment, mutually shared values, and specialized skill to make autonomous decisions to serve society. A nurse practitioner should have these have authority to control its work, should possess exclusively unique body of knowledge, extensive period of format training , specialized competence, control over work performance, service to society, self-regulation, credentialing systems to certify competence, legal reinforcement of professional standards, ethical practice, creation of a collegial subculture, Intrinsic reward and public acceptance in order to be classified as one.
The nurse practitioner does use a specialized knowledge base, has autonomy and control over his work, requires specialized competence, regulates himself, possesses a collegial subculture, and has public acceptance.( Hampson, Gillian D. 2006)
Intellectual Characteristics of Nurse practitioners
Nurses make decisions that affect clients' lives, nurse practitioners must have the intellectual capability to master scientific concepts, understand the impact of self on others, use this information in clinical practice, and understand potential consequences for alternative actions. Nurse practitioners possess a body of knowledge on which professional practice is based, a specialized education to transmit this body of knowledge to others and the ability to use the knowledge in critical and creative thinking. (Hood, L.J & Leddy S.K, 2006)
The roles of nurse practitioners
Nurse practitioners use 31 different competencies as they engage in clinical practice. They are shorten into the following seven domains upon which nurse practitioners roles are based on “The helping role” which provides the foundation for the roles of caregiver (provider of direct client care, colleague, helpful team member and client advocate the person looking out for the client's best interest. (Hunt. R, 2001). “The teaching-coaching function” which provides the foundation for the roles of teacher (provider of education and information) and counselor (one who provides emotional support and encouragement). “The diagnostic and patient monitoring function” which provides the foundation for the caregiver, and critical thinker (someone who uses complex thought processes) roles. “Effective management of rapidly changing situations” which provides the foundation for the caregiver, change agent (person who initiates and guides the change process) and coordinator (person who manages, leads and verifies that things get done) roles. “Administration and monitoring of therapeutic interventions and regimens” will provide the foundation for the caregiver and change agent roles. “Monitoring of and ensuring the quality of health care practices” provides the foundation for the roles of coordinators, client advocates, and change agents. And lastly, “Organizational and work role competencies” provides the foundation for the client advocate, change agent, and coordinator roles.( Michaelene, P; Jansen, M; Zwygart, M. 2006)
The role of nurse Practitioners development from social political perspective
Nurse practitioners have a history of political activism. Nurse practitioners participate in public policy formation in a variety of ways. During the women's suffrage movement of the early 1900s, the American Nurses Association joined forces with other women's groups to work successfully in attaining the right for women to vote. Once they are successful in affecting public policy by providing input, some nurse practitioners progress to higher levels of political activism. Feldman and Lewenson (2000) identify how being involved in politics and the political process fits with the goals of professional nursing to benefit society. The public perceives nurses as being trustworthy and credible. Nurse practitioners advocate for large groups of clients when they use their specialized knowledge of wellness, health, illness, and delivery of health services to influence policy makers to create new and fund public health programs. Nurse practitioners also have well-refined communication and assessment skills that enhance the ability to determine what types of health programs are needed. Because of the ability to understand nursing and health-related research, nurses can present strong cases based on solid evidence to document needs for new programs and to continue present ones. 9Ameican College of Physicians, 2008)
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Politically active Nurse practitioners frequently use nursing process to guide their thinking for public policy development and evaluation. Because laws govern professional nursing practice, Nurse practitioners have a stake in public policy legislation and enforcement. Legislators pass laws and provide funding for health care programs, access, professional education, and research. Nurse practitioners might react to proposed legislation by writing their elected officials to influence their action during the legislative process. Some Nurse practitioners engage in proactive political action by proposing legislation, persuading an elected official in the legislature to introduce a bill, devising public relations campaigns around their proposal, lobbying to get the bill passed by both houses of Congress, and influencing the head of the executive branch to sign it. Nurse practitioners participate in national, state, and local legislative efforts. A national or statewide effort to pass legislation requires the participation of many for success. However, once legislation becomes law, some nurses continue to work with state or federal agencies responsible for devising the regulations to implement the law. (American College of Physicians, 2008)
In 1996, Cohen, Mason, Kovner, Leavitt, Pulcini, and Sochaiski outlined four stages of political activism in nursing that still apply today. The first stage is buying in- which nurse practitioners become aware of the importance of political activism to attain professional goals, and they use the political system to have input into public policy development. Secondly, regarding Self-interest-wherein Nurse practitioners continue to use the political system to the sole advance of intra professional agendas. Thirdly is about Political sophistication where Nurse practitioners engage in complex political activity, such as building coalitions and running for political office. And lastly is leading the way-where Nurse practitioners serve as influential persons by holding key govern-mental positions and in the process select the course for public policy changes. (Hood, L.J & Leddy, S.K. 2006)
Pediatric nurse practitioner knowledge, abilities, characteristics and responsibilities
Pediatric nurse practitioners deliver care to newborns, infants, toddlers, pre-scholars, school-aged children, adolescents, and young adults. The pediatric nurse practitioner is a specialist in the care of children from birth through young adult with an in-depth knowledge and experience in pediatric primary health care including well childcare prevention and management of common pediatric illnesses. This care supports health of children within their family, community, and environment. (Crabtree, M. Katherine; Stanley, Joan; Werner, Kathryn E.; Schmid, Emily, 2002) Upon graduation or entry into practice, the pediatric nurse practitioner should demonstrate good abilities in the following:
Health promotion, health protection, disease prevention, and treatment
The pediatric nurse practitioner is a provider of direct health care services. The pediatric nurse practitioner synthesizes scientific and contemporary clinical knowledge for the assessment and management of both health and illness states as following:
Assessment of health status
These qualifications describe the role of the pediatric nurse practitioner in assessing all aspects of the patient's health status, including for purposes of health promotion, health protection, and disease prevention. The pediatric nurse practitioner should obtain and document a relevant health history for children. The pediatric nurse practitioner should perform age-appropriate screening for developmental and behavioral concerns, such as speech development, learning disabilities, and behavioral and mental health concerns. The pediatric nurse practitioner assesses the child's developmental status based on developmental theories recognizing the individual differences in temperament, reactions to selected developmental tasks and situational crises, and coping styles and strategies. The pediatric nurse practitioner should identify and analyze factors that affect the child's growth and development. The pediatric nurse practitioner assess for evidence of child abuse and neglect and the effects of violence on the child. The pediatric nurse practitioner analyzes the family system to identify factors that influence the health of the child and adolescent. The pediatric nurse practitioner should assess patient's and family's knowledge and behavior regarding leading health indicators.
Diagnosis of health status
The pediatric nurse practitioner should differentiate between normal and abnormal development in relation to physiological, cognitive, and social behavior of the child. The pediatric nurse practitioner should identify, natural history, developmental considerations, pathogenesis, and clinical events of common disease processes in children. The pediatric nurse practitioner should order and interpret age and situation appropriate screening, labs, and other diagnostic tests. The pediatric nurse practitioner should cooperate in the diagnosis of children with special health needs and disabilities.
Plan of care and implementation of treatment
The pediatric nurse practitioner should have abilities to promote healthy nutritional practices, including promotion and management of breastfeeding, national nutritional programs, and nutritional intake considering food preferences and avoidance of food sensitivities. The pediatric nurse practitioner should provide interventions to modify behavior associated with health risks. The pediatric nurse practitioner should refer children with developmental disabilities. The pediatric nurse practitioner should link health objectives into individual educational plans. The pediatric nurse practitioner should assist the child in coping with developmental behaviors. The pediatric nurse practitioner should evaluate health maintenance and health promotion services for the child and family by including teaching, counseling, and advising. The pediatric nurse practitioner should help in planning for transition to adult health care. (Margaret G. Marks, 1998)
Nurse practitioner-patient relationship
The pediatric nurse practitioner should adapt the nurse practitioner-patient relationship to the changing nature of the child's cognitive and Psycho-social developments. The pediatric nurse practitioner should communicate effectively with children and family members.
The pediatric nurse practitioner should provide expectant guidance that is age or developmentally appropriate. The pediatric nurse practitioner should advise regarding and support effective parenting. The pediatric nurse practitioner should help the child in taking responsibility for self-care and healthy behavior in agreement with age and developmental cure.
The pediatric nurse practitioner should serve as an advocate for the child and the family, especially in giving services to provide for the health, safety, and protection of the child. The pediatric nurse practitioner should know the importance of sharing in professional and community organizations that affect on the health of children. The pediatric nurse practitioner should understand his or her role in primary and specialty health care to other health care providers. The pediatric nurse practitioner should serve as a source in the shape and development of pediatric community health services. (Hennery H., Bernstein, 2005)
Managing and negotiating health care delivery systems
The pediatric nurse practitioner should have information regarding state and federal programs for child and family health care.
Monitoring and ensuring the quality of health care practice
The pediatric nurse practitioner should monitor public matters that affect on presenting health services for children and their families.
The pediatric nurse practitioner should recognize the influence of cultural differences on child health practices, and parenting.
The future of health care providence needed various teams of health care workers that collaborate to provide patient-centered care. To perform well in multidisciplinary teams in an understanding of the distinctive roles, skills and values of all team workers. Nurse practitioners should be well qualified and skillful to get along with these teams. In future, nurse practitioners need a broad based education, assertiveness skills, technical competence and the ability to deal with rapid change. However, research and technology may provide the instrument nurses require for defining professional nursing, demonstrating that professional nursing care affects client care outcomes, and marketing professional nursing to the public. Nurse practitioners will be in need for extra skills and abilities to develop healthcare.