Abstract
The nurse practitioner (NPs) role evolved historically from changes in the demand for and supply of physicians and primary health care services. Beginning in the 1965, programs were developed and offered specifically to educate and train NPs based on specialization which includes family nurse practitioner. The transition from another nursing role to a family NP role depends on how similar and different those two roles are. It is also depends on individual strengths and weaknesses as these relate to the new role and how effective strategies are in improving the latter. Career progression to the NP role requires envisioning the setting of one’s practice, the target patient population, and the practice environment as well. Educational and clinical preparation is also indispensable to achieve the necessary competencies in enacting the family NP role. To ensure that the role transition is realistic and time bound, one should create a timeline for attaining the necessary competencies and licensure and certification requirements.
Description of the Role
My visionary role is to become a family practice nurse practitioner. The role of nurse practitioner (NP) primarily evolved out of physician shortages. Despite an increase in the ratio of physician per 100,000 persons from 150 in 1950 to 163 in 1969, rapid advances in medicine enticed many physicians to specialize leading to a disproportionate ratio of 3 specialists for every generalist (Dunn, 1997). At the same time, the demand for health care increased with the expansion of Medicare and Medicaid to low-income women and their children, seniors, and persons with disabilities (O’Brien, 2003). These trends pushed nurses to expand their role into primary care provider at a similar quality but more affordable cost. Additional training and education for the NP role was paramount and the first program was initiated by Loretta Ford and Henry Silver, both physicians, in 1965 (O’Brien, 2003). Thereafter, the role was legitimized by the American Nurses Association and branched out into specializations including certified nurse anesthetist, pediatric NP, and family NP with their respective academic curricula and continuing education programs. The first program for the latter opened in 1971 and guidelines for curriculum planning were published in 1980 (AANP, 2014).
The significant increase in the number of NPs by 1985 led to the formation of the American Academy of Nurse Practitioners and later the American College of Nurse Practitioners in 1995 (AANP, 2014). These organizations became the vehicle through which NPs influenced national policy such as in the area of federal appropriations for NP education and nurse-managed clinics to increase the availability of primary care. The two organizations merged in 2013 forming the American Association of Nurse Practitioners (AANP). Recent trends again include an acute physician shortage especially in the field of primary care as statistics show that fewer than 10% of physicians are in primary care (Hoppel, 2010). The recent Medicaid expansion to low-income adults, the mandate to reduce the uninsured population, and the emphasis of the ACA health reforms on primary care is expected to increase primary care visits from 15.07 million to 24.26 million per year by 2019 (Hofer, Abraham & Moscovice, 2011). That nearly 7,000 primary care physicians would be needed to fill this demand but 70% of NPs are already in primary care again highlights the important role of NPs. The Institute of Medicine recommended that NPs be allowed to practice within the full extent of their training and education to fill the gap in primary care (Hain & Fleck, 2014).
I have practiced as a registered nurse for a decade, two years of which was in a medical-surgical telemetry unit and eight years up to the present in an operating room as a circulating nurse. I am also working in a plastic surgeon’s office in the area of pre- and postoperative care. Despite the differences in practice between perioperative nursing and primary care/family NP, I believe my past and present experiences will benefit my transition. Perioperative nursing employs holistic and patient-centered care as the nurse advocates for the patient and his or her family’s involvement in decision-making in regards to treatment and care (Selimen & Andsoy, 2011). Cultural beliefs such as in the area of pain behavior and responses as well as diet are also considered. Preventive interventions and health promotion are employed to reduce the likelihood of complications and ensure the return of the patient to the highest level of functioning possible. To achieve these goals, the perioperative nurse collaborates with other disciplines and coordinates team care.
Family NPs also employ holistic and patient-centered care but in a much broader setting and patient population. Thus, my current role responsibilities will change when transitioning into this role. While I currently work with adults, I will be assessing children, adolescents, adults, and older adults as a family NP. It is beyond my current scope of practice to order diagnostic tests or diagnose medical conditions, but I will be performing these tasks in my visionary role. As an RN, I perform nursing interventions but cannot prescribe treatments. However, I will be permitted to perform the latter as a family NP. I am also currently not allowed to perform minor surgeries, but an NP can suture minor lacerations or excise benign lesions. Moreover, I will be working with individuals in various states of health including well patients and those with acute and chronic illnesses.
My strengths include a strong commitment to learning, communication and collaboration skills, leadership, use of technology, educating, counseling, and cultural sensitivity. My weaknesses include performing research, dealing with financial matters, quality improvement, and policy advocacy. I will address my weaknesses through education and training, learning through self-reflection, joining the AANP, expanding my professional network, participating in conferences, and finding a mentor. As a family NP, I will be collaborating with the physician, registered dietician, and physical therapist as in perioperative nursing. In addition, however, I will also be working with the medical technologist, radiologist, and sonographer. The rationale is that I am permitted to order laboratory and other diagnostic tests and thus will need to communicate with these professionals. In addition, I may also need to work with psychologists and psychiatrists when the need to refer patients for diagnosis and interventions in relation to mental health, behavioral, or developmental problems arises.
Organizational Structure
I would like to work in a primary care physician’s private practice clinic in my community in Miami. As defined by current Florida law, the physician will supervise and delegate my prescribing authority and the treatment and management of patients will be of a collaborative nature (AAPN, 2014). I will be providing care to a culturally and socially diverse population, about 70% of whom is Hispanic and about 19% of whom is African American (US Census Bureau, 2012), and most likely a significant number of low-income families because there is a large inner-city neighborhood. Ethnic minorities and low-income individuals often present with acute and advanced illness because of barriers to care that create vulnerability and disparity. The lack of culturally-congruent and affordable care and inadequate proficiency in the English language are some of the barriers that need to be overcome (Derose, Gresenz & Ringel, 2011).
Education, Competencies, and Experience
In Florida, licensure as an NP requires having a license as a registered nurse, attaining graduate degree, and fulfilling national certification requirements (AANP, 2014). According to the Florida Nurse Practice Act, graduation from a master’s degree program for the purpose of acquiring specialized practitioner knowledge and skills is required of those who wish to become NPs (Florida BON, 2007). With the recommendation that all RNs should achieve a baccalaureate degree, my facility has encouraged its RNs with an associate degree to pursue a BSN. At the same time, having a BSN is an admission requirement for admission in a master’s degree program (FAU, 2012). I have an ADN and am currently in a BSN program. Following graduation, I plan to apply for the Florida Atlantic University’s Family Nurse Practitioner (Primary Care) Track.
The family NP curriculum consists of 43 credit hours on a part-time basis with most courses taken online. Clinical practice for a minimum of 600 hours in the second year of the program is also required for the attainment of the required competencies (FAU, 2012). These can be arranged in local health departments, private practices, community-based clinics, outpatient clinics in a hospital, and other primary care settings. The required competencies include the management of selected medical problems; ordering occupational or physical therapy; managing patients with chronic but stable disease; establishing, diagnosing, and recommending treatment for behavioral problems; initiating, monitoring, or altering therapies for acute but uncomplicated conditions; and health promotion and disease prevention (Florida BON, 2007; FAU, 2012). Knowledge in the theoretical foundation of the family NP role, nursing research, evidence-based practice, leadership, finance, and policy must also be demonstrated.
After graduation from the family NP program, I can sit for certification examination for family nurse practitioner either by the AANP or the American Nurses Credentialing Center (ANCC). Because certification is national, it can cross state lines although transferring to another state will require obtaining a license in that state and adhering to that state’s practice environment for NPs. If I wish to obtain a separate license for dispensing medications, except controlled substances which only physicians can dispense, I will need to file an application with the Board of Nursing (Florida BON, 2014). Malpractice insurance is also a requirement for clinical practice. Family NP certification is valid for 5 years and recertification requires proof of at least 75 hours of continuing education and 1,000 hours of clinical practice to ensure continuing competency (AANP, 2014).
My future NP practice will be within the legal framework of the Nurse Practice Act or Chapter 464 of the Florida Statutes and Chapter 64B9-4 of the rules of the Florida Administrative Code pertaining to NPs (Florida BON, 2007). These laws mandate that NP practice should be governed by a protocol developed jointly by the Board of Nursing and Board of Medicine. The standards require general supervision of an NP by a licensed physician. A written protocol should contain the name, address, certificate number and license number of the NP and physician, respectively (Florida BON, 2007). The practice locations where the protocol is applicable must also be included. The collaborative practice agreement, on the other hand, must describe the duties of the family NP, the duties of the physician, the areas of management for which the family NP is responsible for, a procedure for determining whether a condition requires specific consultation with the physician rather than the NP, and the conduct of annual reviews of the protocol (Florida BON, 2007). The protocol is filed with the Florida Department of Health. Family NPs must adhere with the protocol. The code of ethics of nursing also remains applicable.
Regarding my timeline, I will finish my BSN in ___ years. The Master of Science curriculum and clinical practice hours will take between 2-3 years to finish because I will take it on a part-time basis. I will also review for the certification exams and then sit for it which will take around 3 or 4 months. I will then apply for licensure with the BON. There is no standard length of time for processing, but I will assume it will take 6 months to one year. As such, it will take approximately 3-4 years following my baccalaureate degree before I am able to achieve my visionary role.
References
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U.S. Census Bureau (2012). Miami (city), Florida. Retrieved from http://quickfacts.census.gov/qfd/states/12/1245000.html
