The term ‘history” is broad in meaning. Within that broad framework archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.
So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties.
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For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.
Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).
Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.
By Day 3
Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues’ posts on two different days and provide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
The role of the mid-level practitioner varies based on their scope of practice, and this can differ state by state. Certified Registered Nurse Practitioners (CRNP) and Certified Nurse Midwives (CNM) are recognized roles as Advanced Practice Registered Nurses (APRN) (ANA, 2021). Nurse Practitioners (NP) select a population focus, with specialty tracks guiding the type of care they will deliver within the community. In the United States, a CNM graduates from a nurse-midwifery program with a goal to promote health and provide care to all women throughout their lifespan (Zhou and Lu, 2018). A Physician Assistant’s education entails a comprehensive approach to general medicine, formed under a medical model that is designed to complement medical doctors (AAPA, 2021). When looking at the utilization of costs for complex patients, as a primary care provider (PCP), NPs and PAs were associated with lower healthcare costs and less use of acute care services; however, there can be different clinical approaches to management that may stem from their educational models (Morgan et al., 2019). Following evidence-based practice is imperative regardless of the approach to the treatment and plan of care.
Observing these different roles can provide insight and impact the practice of a Family Nurse Practitioner (FNP) student. Educational backgrounds and practical experience can provide an excellent learning platform. Nurse Practitioners are often primary care providers, and in states with independent practice, this is often promoted within the healthcare organization (Poghosyan et al., 2017). Specialties, such as a preceptorship with a CNM, can provide an excellent opportunity to hone women’s health skills, such as contraception counseling, preventative care including PAP smears, clinical breast exams, prenatal and postpartum care. Learning from a PA can provide greater insight into general medicine. Every encounter offers a learning opportunity, and each preceptor can teach you something if you keep an open mind and are willing to learn.
American Academy of Physician Assistants (AAPA). (2021). How are Pas different from nurse practitioners (NPs)? https://www.aapa.org/what-is-a-pa/
American Nurses Association (ANA) (2021). Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, acknowledgment of specialty nursing standards of practice, and affirmation of focused practice competencies. https://www.nursingworld.org/~49d755/globalassets/practiceandpolicy/scope-of-practice/3sc-booklet-2021-june.pdf
Morgan, P., Smith, V., Berkowitz, T., Edelman, D., VanHoutven, C., Woolson, S., Hendrix, C., Everett, C., White, B., Jackson, G. (2019). Primary care: impact of physicians, nurse practitioners, ad physician assistants on utilization and costs for complex patients. Health Affairs, 38(6), 733–739. https://pubmed.ncbi.nlm.nih.gov/31866788/
Poghosyan, L., Liu, J., & Norful, A. A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. International journal of nursing studies, 74, 1–7. https://doi.org/10.1016/j.ijnurstu.2017.05.004
Zhou, N., & Lu, H. (2018). A review and comparison of midwifery management and education in five representative countries. International journal of nursing sciences, 5(1), 10–14. https://doi.org/10.1016/j.ijnss.2017.12.007
There are several specialized roles that an Advanced Practice Nurse (APRN) can select for clinical practice. When it comes to women’s health, there are 3 roles to choose from which include Certified Professional Midwife/CPM, Certified Nurse Midwife/CNM, or a Certified Midwife. Each of these roles can provide women with holistic services (Winter et al., 2020).
The scope of practice for each discipline is designated in the APRN’s practicing state (Yang, 2020). The role of the Certified Professional Mid-Wife (CPM) is unique because the APRN must have experience in the field. In addition, the nurse is certified by a midwifery credentialing agency (Marzalik, Feltham, Jefferson, & Pekin, 2018). If you work as a CPM, you could be in a position of providing services to patients in their homes until her child is born.
A Certified Nurse Midwife or CNM is also an APRN’s who graduates with at least with a master’s level degree from a school with an approved Nurse-Midwife nursing program (Marzalik, Feltham, Jefferson, & Pekin, 2018). The candidate must pass the national Certified Nurse Midwife Examination and maintain continuing education credits required by his/her State
Licensure Organization. As a CNM, you can work in various venues such as hospitals, birthcenters, OB/GYN practices and/or health clinics while providing care throughout a patient’s lifespan.
The credentials to become a Certified Midwives are somewhat different due to the fact that the certification can be achieved by a person who does not have a nursing background. Then the candidate will need a graduate level degree which is certified by the American Midwifery Certification Board. With this delegation, you could provide services to patients from adolescent to menopause in either a hospital, health clinics, OB/GYN office, homes and/or a birth center (Marzalik, Feltham, Jefferson, & Pekin, 2018).
Regardless of the medical specialty practice the Advanced Practice Registered Nurse achieves, the goal of care remains the same. The APRN must ensure that each patient is counseled on health promotion, and that health determinants to care are minimized, and make sure the patient receives quality of care by putting the patient first. Additionally, it is important that the patient has an opportunity to ask sensitive questions during her examination.
American Nurses Association (ANA). (n.d.). View the code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of ethics-for-nurses/
Marzalik, P. R., Feltham, K. J., Jefferson, K., Pekin, K. (2018). Midwifery education in the U.S. Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife, Midwifery, (60), 9-12. https://doi.org/10.1016/j.midw.2018.01.020
Winter, S., Chapman, S. A., Chan, G. K., Duderstadt, K., & Spetz, J. (2020). Nurse Practitioner role and practice environment in primary and in nonprimary care in California. Medical Care Research and Review. https://doi.org/10.1177/1077558720942706
Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2020). State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review. Medical Care Research and Review https://doi.org/10.1177/1077558719901216
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