Role of Family Nurse Practitioner

Introduction

Nurse Practitioners (NP) play a vital role in the delivery of primary care in the United States. This is especially considering the fact that 89% of the population of NPs are actively involved in primary care provision. There is a lot of evidence to demonstrate that the primary care’s cost effectiveness and high quality are attributed to the NPs (Buppert, 2012). Therefore, there has been a growing interest in the field by students of various nursing disciplines to take part in primary care dilemma solution.

The scope of practice for NP includes blending medical and nursing services to groups, families and individuals. NPs are involved in the diagnoses and management of chronic and acute conditions as well as emphasizing disease prevention and health promotion initiatives. Some of the services include conducting, interpreting and ordering laboratory and diagnostic tests, non-pharmacologic therapies and pharmacologic agents’ prescription as well as provision of guidance and services. They practice both independently and in collaboration with the rest of the professionals involved in health care provision.

As a process of preparation, the NPs undergo through a rigorous academic training journey in different academic levels like graduate, master’s or doctoral. Some of these academic programs include clinical and didactic courses that are designed to offer graduates with clinical care and specialized knowledge competencies. As professional members, the NPs are responsible for the advancement of the NP roles, specification of professional competencies and standards and making sure that all these are accomplished.

Almost the entire population of the NPs is prepared in the focus of primary care such as family, pediatric, adult, women’s health and gerontological health.

However, the family nurse practitioner (FNP) focus is the most predominant category. However, irrespective of their population focus the primary care NPs are trained and ready to accomplish the primary care objectives across different settings such ongoing chronic and acute conditions management, care coordination and health promotion as well as first contact care provision for conditions that are undifferentiated. The last few years witnessed the rapid growth in the number of students who are enrolling and graduating in NPs programs (Grossman & O’Brien, 2010). This points to a greater future ahead where many NPs will be prepared to handle family health.

Practice Focus Justification

Family nurse practitioners forms the largest NPs proportion in the United States. By 2016, more than 55% of the 220,000 licensed nurse practitioners worked under the family health field. There is a lot of evidence that the NPs provide quality and cost-effective health services and thrive in those states that assure them of full practice. However, the NPs are still fighting for their professional autonomy, which they argue, do not correspond to their level of preparation and training. In some states, the diagnosis and treatment for patients are entirely performed by the physicians while the NPs are only allowed to do the periphery cares that limits their engagements professionally. Few states however have collaborative professional practices between physicians and family nurse practitioners. Best services are achieved if there are collaborative services among all health care professionals.

By definition, scope of practice implies a set of actions, processes, and procedures that a nurse practitioner is lawfully permitted to undertake. Apparently, scope of practice changes from one state to the other but is always governed by the relevant laws in those states. Nurse practitioners are independent and licensed practitioners who are mandated to practice in long term, ambulatory and acute care units as providers of specialty and primary care. They diagnose, manage, assess, and treat chronic and episodic illnesses. Besides, they are also specialists in disease prevention and health promotion (Zaumeyer, 2003). Moreover, the nurse practitioners also conduct, interpret, order, and supervise laboratory and diagnostic tests, prescribe both nonpharmacologic agents and pharmacologic agents in addition to counselling and teaching patients and their families on various care initiatives.

A NP and a physician have similar scopes of practices. However, they are quite different when it comes to registered nurse (RN) who is registered to carry out nursing diagnostic and implement treatment like in health education. On the other hand, NP implements such treatments as diagnostic imaging, invasive procedures, and prescription medication. Nonetheless, both the RNs and NPs are allowed and trained to carry out independent practices despite the differences in their scope of practice.

Independent practice is one of the core mandates of NPs. It refers to an ability of the NP to offer care and treatment without direct supervision from a doctor. Therefore, an NP from independent practice granted states can diagnose, treat, and assess a patient just as a physician could have done it. It is important to note that all NPs are trained to offer care to patients without being supervised by physicians. Nonetheless, in some states, the NPs are required to pay physicians if they supervise their works. This implies that different states have different degrees of independence. Consequently, it has a remained a contentious topic among national organizations that represent both the physicians and the NPs.

Various degrees of independence among different states can be categorized under full practice, reduced practice, and restricted practice. The full practice is entirely independent while the reduced practice is partially independent. On its part, the restricted practice is not independent at all. The NPs in full practice can provide full care to patients without the involvement of physicians. Meanwhile, those in the states of reduced practice can provide care to patients but would require the involvement of physicians to some level. These levels of involvement include meeting some patients as well as discussing patient cases with the nurses (Cash & Glass, 2011). Conversely, states with restricted practice laws prevent NPs from offering care to patients despite being educated to do so. Instead, there must be a supervisory agreement between the doctors in charge and the NPs. Incidentally, this is a very costly exercise.

Evaluation of the Professional Image of NPs

Since the year 1999, the nurses in the United States have often topped the list of eleven professions with the highest ethical standards and honesty, according to the Gallop poll. They have always been ranked higher than the clergy, the medical doctors and law enforcement officers. One of the most outstanding features of the NPs profession is their uniforms, which some pundits have argued that do not evoke immediate respects and recognition as does the white coat worn by the physicians. Today, it is becoming difficult to tell who a NPs is from a group of health care professionals.

Nurse practitioners have long been identified by their standardized uniforms since the year 1836. Although the stark white outfits professionally worn by the NPs did not have any direct impact on how they provided primary care to their patients, they made them stand out and completely communicated an unambiguous role about the wearer. The outfits were impressive and demonstrated their professionalism. However, this situation would later change in the 1970s when major changes were introduced to the nursing professional outlook, which affected their uniforms (Way, Jones, Baskerville, & Busing, 2001). Some of the cultural changes responsible for this change of events included the liberation of women and sexual orientation. From there things started getting more colorful and casual.

The white attire that was worn from head to toe and the starched caps were abandoned from scrubs of different patterns and colors that depicts different characters including those in cartoons. The scrubs were deemed to revolutionize the professional image of the NPs. It was argued that they were practical and evolutionary advancements to their professional image. However, the same could not be said of the wide variations of NPs uniforms that characterized their workplaces. Ultimately, they confused the patients even more. It subsequently gave rise to a debate of whether the NPs’ professional image genuinely portrayed the knowledge, compassion and level of expertise that nurses ought to possess (Cash & Glass, 2011). Indeed, the image portrayed by the nurses should elevate their professionalism sense and emphasize their sense of commitment and care for their patients.

Some scholars have argued that a standardized uniform color and style among the NPs is a clear demonstration of the increased perception of recognition and professionalism of the NPs among their patients and their families. However, this can be misleading as it proves that the NPs uniforms is an issue of patient safety, which apparently is not the case since a patient can as well receive a false information from assistive personnel who is not licensed to deliver the same. While it is true that patients need to know who their NPs are, and they can easily do that if they wear the right uniform, it is also true that assistance can come from other health care professionals like a care technician for instance. This means that the idea of a uniform as a professional image depiction is defeated in this case.

Proper distinction of health care staff duties in patient care is captured under the Nurse Title Protection legislation, which was enacted in March 2015 across 38 states to among other things avoid misrepresentation of persons unlicensed and uneducated to practice nursing as well as ensure the provision of quality and safety of patient care. This legislation helps to restore the NPs’ professional image as it prohibits persons who are not licensed as nurse from using the title. By reserving the NPs title for only those persons who have genuinely met the licensing and educational standards of a nurse, the public can adequately distinguish a nurse practitioner who is licensed from other providers of health care. This is appositive trend that also boosts the NPs’ professional image and can be better achieved if the uniform style of the NPs is standardized.

Research by different professional organizations such as the PAH Professional Image Council (PIC) have established that the identity and awareness of the hospital staff by patients and their interdisciplinary collaboration are at the cornerstone of achieving effective, quality and safe health care as well as patient outcomes that are positive. Nonetheless, a substantial number of patients have also confessed that patterned and brightly colored scrubs confuse them in their attempts to distinguish the NPs from other health care staff (Zaumeyer, 2003). Indeed, some are not even aware if the health care professional caring for them is a NP or not.

The attire and color worn by a NPs sends vital messages to a patient about the quality and skills that the nurse would dispense to the given patient. In fact, it is more effective than the identification badge worn by nurses in identifying the NP. On the contrary, the badge is mostly difficult to read by patients, some of which must be very close to it. This is a further indication that the professional image of a NPs goes beyond a neck tag. While many nurses prefer a certain kind of bright colored attire for their professional image, patients do not have any preference as long as the NPs’ nurses do not affect their care delivery. All that the patients need are attires that make the NPs comfortable and flexible in executing their duties as care givers.

Standardizing the professional image on the NPs is however a contentious issue as some nurses feel that somebody is dictating their individualities. This is a very big challenge since most nurses feel that their profession is isolated for discrimination. But it is vital that the NPs understand that nursing is more than a profession, it is a calling (Buppert, 2012). Hence, one should elevate his or her thinking beyond the profession tag and desist from the mentality of ‘being victimized’ and in its place embrace a model of patient centeredness.

Conclusion

Nurse Practitioners (NP) play a vital role in the delivery of primary care in the United States. The scope of practice for NP includes blending medical and nursing services to groups, families and individuals. They are involved in the diagnoses and management of chronic and acute conditions as well as emphasizing disease prevention and health promotion initiatives. However, the professional images depicted by the NPs matters a lot when it comes to primary care deliver. When the NPs professional image is standardized, a nurse gets a sense of pride in his or her profession. This makes them feel acknowledged and appreciated for their education and knowledge. Additionally, patients also get it easy to identify their nurses while in the hospital. This initiative can inspire other hospital departments such as radiology, respiratory, escort and laboratory services especially if successful to understand that standard color uniform boosts professional image.

References

  1. Buppert, C. (2012). Nurse practitioner’s business practice and legal guide. Sudbury, MA: Jones & Bartlett Learning.
  2. Cash, J. C., & Glass, C. A. (2011). Family practice guidelines. New York: Springer.
  3. Grossman, S., & O’Brien, M. B. (2010). How to run your nurse practitioner business: a guide for success. New York: Springer Pub. Co.
  4. Way, D., Jones, L., Baskerville, B., & Busing, N. (2001). Primary health care services provided by nurse practitioners and family physicians in shared practice. CMAJ, 165(9), 1210–1214.
  5. Zaumeyer, C. R. (2003). How to start an independent practice: the nurse practitioner’s guide to success. Philadelphia, Penns.: F.A. Davis.
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