The Role Of The RN/APRN In Policy Evaluation Essay

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?The Role Of The RN/APRN In Policy Evaluation Essa

In this Discussion, you will reflect on the role of professional nurses in policy evaluation.

To Prepare:

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.
Review the Resources and reflect on the role of professional nurses in policy evaluation.
By Day 3 of Week 9
Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.The Role Of The RN/APRN In Policy Evaluation Essay

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

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In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?The Role Of The RN/APRN In Policy Evaluation Essay

In this Discussion, you will reflect on the role of professional nurses in policy evaluation.

To Prepare:

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.

Below is previous discussion on used last week for policy making.The Role Of The RN/APRN In Policy Evaluation Essay

Different opportunities exist for Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs) to take part in decision making as well as advocacy in healthcare institution (Burke, 2016). Healthcare organizations have developed various structures that ensure nurses take part in decision making, especially decisions made along their professional path. For example, American Association of Colleges of Nursing (AACN) focuses on helping the nurses understand the interaction between nursing and policy formulation in healthcare institution (Abood, 2007). AACN developed “Essentials” document that guides the RNs and APRNs on the best way to take part in policy development along their professional line. Nurses have also been allowed to take part in policy development through the developmental framework that allows for collaborative policy work (Burke, 2016). Notably, nurses from various regions are encouraged to work together in a manner that seeks to improve health service and outcomes.

The opportunities that are available to the nurses may result in various challenges. The structure of organizations that allow nurses to take part in development of policies poses a challenge since the RNs and APRNs might not have access to such organizations (Burke, 2016). The policies of such organizations might not also work for doctors from different jurisdictions. The concept of collaborative policy work poses a challenge since the nurses might not be able to work together The Role Of The RN/APRN In Policy Evaluation Essay

Advanced Practice Nursing, as discussed in this paper,
refers to enhanced and expanded healthcare services and interventions provided by nurses who, in an
advanced capacity, influence clinical healthcare outcomes and provide direct healthcare services to individuals, families and communities (CNA 2019; Hamric
& Tracy 2019). An Advanced Practice Nurse (APN) is
one who has acquired, through additional education,
the expert knowledge base, complex decision-making
skills and clinical competencies for expanded nursing
practice, the characteristics of which are shaped by the
context in which they are credentialed to practice (ICN
2008a). The Clinical Nurse Specialist (CNS)1
and Nurse
Practitioner (NP) are two types of APNs most frequently
identified internationally (APRN 2008; Begley 2010;
Carryer et al 2018; CNA 2019; Finnish Nurses
Association 2016; Maier et al. 2017, Miranda Neto
et al. 2018).
This guidance paper begins by providing overarching
assumptions of Advanced Practice Nursing. In addition,
core elements of the CNS and NP are presented in
Chapters Two and Three, together with ICN’s positions
on these nursing roles. In order to facilitate dialogue to
distinguish two types of APNs (CNSs and NPs), practice characteristics of the CNS and NP are presented
and differentiated in Chapter 4. Country exemplars provided in the Appendices depict the diversity of CNS and
NP practice.
1.2 Assumptions about Advanced Practice Nursing
The following assumptions represent the nurse who is
prepared at an advanced educational level and then
achieves recognition as an APN (CNS or NP). These
statements provide a foundation for the APN and a
source for international consideration when trying to
understand Advanced Practice Nursing, regardless of
work setting or focus of practice. All APNs:
• are practitioners of nursing, providing safe
and competent patient care
• have their foundation in nursing education
• have roles or levels of practice which require formal
education beyond the preparation of the generalist2
nurse (minimum required entry level
is a master’s degree)The Role Of The RN/APRN In Policy Evaluation Essay
• have roles or levels of practice with increased levels
of competency and capability that are measurable,
beyond that of a generalist nurse
• have acquired the ability to explain and apply
the theoretical, empirical, ethical, legal, care
giving, and professional development required
for Advanced Practice Nursing
• have defined APN competencies and standards
which are periodically reviewed for maintaining
currency in practice, and
• are influenced by the global, social, political,
economic and technological milieu.
(Adapted from ICN 2008a)
The degree and range of judgement, skill, knowledge,
responsibility, autonomy and accountability broadens
and takes on an additionally extensive range between
the preparation of a generalist nurse and that of the
APN. This added breadth and further in-depth practice is achieved through experience in clinical practice,
additional education, and a master’s degree or beyond.
However, the core of the APN remains based within the
context of nursing and nursing principles (Adapted from
ICN 2008a).
Results from research conducted in Australia found that
nurses in the field of Advanced Practice Nursing exhibit
patterns of practice that are different from other nurses
(Gardner et al, 2015). Using an Advanced Practice
Role Delineation tool based on the Strong Model of
Advanced Practice, findings demonstrate the capacity to clearly delineate and define Advanced Practice
Nursing (Gardner et al, 2017). The significance of this
research suggests that, from a healthcare workforce
perspective, it is possible to measure the level of nursing practice identified as Advanced Practice Nursing
and to more clearly identify these roles and positions. The Role Of The RN/APRN In Policy Evaluation Essay
GUIDELINES ON ADVANCED PRACTICE NURSING 2020
10

1.3 Advanced Practice Nursing Characteristics
Role characteristics can be viewed as features that
make Advanced Practice Nursing and the APN recognisable. Descriptions of the domains of education,
practice, research, leadership and professional regulation provide guidance when making a clear distinction
between advanced versus generalist nursing practice.
While the core of APN practice is based on advanced
nursing education and knowledge, an overlap of expertise may occur with other healthcare professionals. The
breadth and depth of autonomy associated with the
APN often arises within a broader and more extensive
range in community-based services such as primary
healthcare, ambulatory services and out-of-hospital settings. The degree of autonomy may evolve or expand
over time as the concept of Advanced Practice Nursing
gains recognition.
The following sections provide guidelines for identifying
Advanced Practice Nursing:
Educational preparation
• Educational preparation beyond that of a generalist
or specialised nurse education at a minimum
requirement of a full master’s degree programme
(master’s level modules taken as detached courses
do not meet this requirement). It is acknowledged
that, for some countries, the requirement of a
master’s degree may be an aspirational goal
as they strive to achieve this standard. Transitional
programmes and bridging courses can be defined
to progress to this standard.
• Formal recognition of educational programmes
preparing nurses specifically for Advanced
Practice Nursing (CNS or NP) (e.g. accreditation,
approval or authorisation by governmental
or nongovernmental agencies).
• A formal system of credentialing linked to defined
educational qualifications.
• Even though some countries require clinical
experience for a nurse to enter an APN education
programme, no evidence was found to support
this requirement.The Role Of The RN/APRN In Policy Evaluation Essay
Nature of practice
• A designated role or level of nursing that
has its focus on the provision of care, illness
prevention and cure based on direct and indirect
healthcare services at an advanced level,
including rehabilitative care and chronic disease
management. This is beyond the scope of practice
of a generalist or specialised nurse (see Section 2.3
for definitions of direct and indirect care).
• The capability to manage full episodes of care
and complex healthcare problems including hard
to reach, vulnerable and at-risk populations.
• The ability to integrate research (evidence informed
practice), education, leadership and clinical
management.
• Extended and broader range of autonomy (varies
by country context and clinical setting).
• Case-management (manages own case load
at an advanced level).
• Advanced assessment, judgement, decision-making
and diagnostic reasoning skills.
• Recognised advanced clinical competencies,
beyond the competencies of a generalist
or specialised nurse.
• The ability to provide support and/or consultant
services to other healthcare professionals
emphasising professional collaboration.
• Plans, coordinates, implements and evaluates
actions to enhance healthcare services
at an advanced level.
• Recognised first point of contact for clients
and families (commonly, but not exclusively,
in primary healthcare settings).
Regulatory mechanisms – Country specific
professional regulation and policies underpinning
APN practice:
• Authority to diagnose
• Authority to prescribe medications
• Authority to order diagnostic testing and therapeutic
treatments
• Authority to refer clients/patients to other services
and/or professionals
• Authority to admit and discharge clients/patients
to hospital and other services
• Officially recognised title(s) for nurses working
as APNs The Role Of The RN/APRN In Policy Evaluation Essay
• Legislation to confer and protect the title(s)
(e.g. Clinical Nurse Specialist, Nurse Practitioner)
• Legislation and policies from an authoritative
entity or some form of regulatory mechanism
explicit to APNs (e.g. certification, credentialing
or authorisation specific to country context)
(Adapted from ICN, 2008a)
The assumptions and characteristics for Advanced
Practice Nursing are viewed as inclusive and flexible
to take into consideration variations in healthcare systems, regulatory mechanisms and nursing education in
individual countries. Over the years, Advanced Practice
Nursing and nursing globally have matured with the APN
seen as a clinical expert, with characteristics of the role
crosscutting other themes that include understanding
and influencing the issues of governance, policy development and clinical leadership (AANP 2015; CNA 2019;
Scottish Government 2008; NCNZ 2017a). Promotion
of leadership competencies and integration of research
knowledge and skills have increasingly become core
elements of education and role development along
with advanced clinical expertise. In the United Kingdom
(UK), all four countries use a four-pillars coordinated
approach encompassing clinical practice, leadership,
education and research. Clinical practice is viewed as
the main pillar to develop when faced with funding and
human resource issues (personal communication K.
Maclaine, March 2019).
10
Chapter One: Advanced Practice Nursing
11
1.4 Country Issues that Shape Development of Advanced Practice Nursing
The fundamental level of nursing practice and access
to an adequate level of nursing education that exists
in a country shapes the potential for introducing and
developing Advanced Practice Nursing. Launching an
Advanced Practice Nursing initiative is influenced by the
professional status of nursing in the country and its ability
to introduce a new role or level of nursing. The prominence and maturity of nursing can be assessed by the
presence of other nursing specialties, levels of nursing
education, policies specific to nurses, extent of nursing
research and nursing leadership (Schober 2016).
It is acknowledged that in countries where generalised
nursing education is progressing and the country context is considering development of a master’s degree
education for Advanced Practice Nursing, that transition
programmes or bridging courses can be developed to
prepare generalist or specialised nurses for CNS or NP
roles. Transition curricula have the potential for filling in
educational gaps as nursing education in the country
evolves toward the master’s degree requirement.The Role Of The RN/APRN In Policy Evaluation Essay
In addition, it is recognised that there are countries that
have clear career tracks or career ladders and grading
(e.g. banding) systems in place for nursing role titles,
descriptions, credentials, hiring practices and policies.
These grading systems or level of roles will impact on
implementation of the APN (CNS or NP) as the grading
system stipulates a certain level of education and years
of experience at each level, including roles at advanced
levels. Such a grading system is likely to ensure that
nurses working in a specific grade perform at a more
consistent level since they would be viewed to have
similar education and experience. Protected role titles
with clear credentialing requirements help ensure consistent role implementation at the desired level.
Most importantly, these guidelines emphasise that the
APN is fundamentally a nursing role, built on nursing
principles aiming to provide the optimal capacity to
enhance and maximise comprehensive healthcare
services. The APN is not seen as in competition with
other healthcare professionals, nor is the adoption of
the domains of other healthcare providers viewed as
the core of APN practice.
Chioma
GUIDELINES ON ADVANCED PRACTICE NURSING 2020
12
CHAPTER TWO
THE CLINICAL NURSE SPECIALIST (CNS)3
The Clinical Nurse Specialist (CNS) is one commonly identified category of Advanced Practice Nursing (APRN &
NCSBN 2008; Barton & Allan 2015; CNA 2019; Maier et al. 2017; Tracy & O’Grady 2019). This section describes
the historical background of the CNS, defines the role and explains how a scope of practice and education provide the foundation for the CNS. In addition, credentialing and regulatory mechanisms are defined as well as their
importance in establishing the identity and professional standard for CNSs.
2.1 ICN Position on the Clinical Nurse Specialist
3 It is acknowledged there are countries with Clinical Nurse Consultants (CNC) whose practice is viewed to be consistent with CNS practice
(Bryant-Lukosius & Wong, 2019; Carryer et al. 2018; Gardner et al. 2013; Gardner et al. 2016). The use of CNC is country specific and at times
used interchangeably with CNS, however, this guidance paper focuses on identifying the CNS.The Role Of The RN/APRN In Policy Evaluation Essay
The CNS is a nurse who has completed a master’s
degree programme specific to CNS practice. The CNS
provides healthcare services based on advanced specialised expertise when caring for complex and vulnerable patients or populations. In addition, nurses in this
capacity provide education and support for interdisciplinary staff and facilitate change and innovation in
healthcare systems. The emphasis of practice is on
advanced specialised nursing care and a systems
approach using a combination of the provision of direct
and indirect clinical services (see Section 2.3 for definitions of direct and indirect care). This profile of the CNS
is based on current evidence of the successful presence of the role in some countries; however, often the
CNS role is present but invisible in settings where these
nurses provide a valuable service. Further research is
needed to clearly identify the diversity of the settings
and countries where the CNS practices.
As healthcare reform worldwide continues to gain
momentum, there will be opportunities for nurses in
CNS practice to meet the unmet needs of varied populations and diverse healthcare settings. Crucial to taking
advantage of these possibilities is the need to improve
understanding of the CNS in the Advanced Practice
Nursing context. In order to grasp an increased appreciation and comprehension of the CNS, the requirement
for title protection, graduate education (minimum master’s degree), and an identifiable scope of practice as
part of a credentialing process, is seen as optimal.
2.2 Background of the Clinical Nurse Specialist
The expanded role of nursing associated with a CNS
is not a recent phenomenon. The term ‘specialist’
emerged in the United States (USA) in the 19th and
early 20th Centuries as more postgraduate courses in
specific areas of nursing practice became available
(Barton & East 2015; Cockerham & Keeling 2014;
Keeling & Bigbee 2005). The origin of the CNS emerged
from an identified need for specialty practices (Chan &
Cartwright 2014). Psychiatric Clinical Nurse Specialists
along with nurse anesthetists and nurse midwives led
the way. The growth of hospitals in the 1940s as well
as the development of medical specialties and technologies further stimulated the evolution of the CNS.
These nurses were considered to practice at a higher
degree of specialisation than that already present in
nursing and are viewed as the originators of the current
CNS role. Even though there has been an evolution of
role development internationally over the years, CNS
origins were seen to lie comfortably within the traditionally understood domain of nursing practice and thus the
CNS was able to progress unopposed (Barton & East
2015).The Role Of The RN/APRN In Policy Evaluation Essay
Similarly, in Canada, CNSs first emerged in the 1970s
as provision of healthcare services grew more complex. The concept of the role was to provide clinical
consultation, guidance and leadership to nursing staff
managing complex and specialised healthcare in order
to improve the quality of care and to promote evidenceinformed practice. CNSs were focused on complex patient
care and healthcare systems issues which required
improvements. The result of the CNS presence was
measurable positive outcomes for the populations they
cared for (CNA 2019).
The following reasons for the conception of the CNS
role were proposed by Chan and Cartwright (2014: 359):
• Provide direct care to patients with complex
diseases or conditions
• Improve patient care by developing the clinical skills
and judgement of staff nurses
• Retain nurses who are experts in clinical practice
The CNS role has developed over time, becoming
more flexible and responsive to population healthcare
needs and healthcare environments. For example, in
Sub-Saharan Africa, the CNS is well developed, particularly in the progress made in HIV management and
prevention for these vulnerable populations (personal
communication, March 2019, B. Sibanda). The fundamental strength of the CNS role is in providing complex
specialty care while improving the quality of healthcare
delivery through a systems approach. The multifaceted
CNS profile, in addition to direct patient care in a clinical specialty, includes indirect care through education, research and support of other nurses as well as
healthcare staff, provides leadership to specialty practice programme development and facilitates change
and innovation in healthcare systems (Lewandowski &
Adamle 2009).The Role Of The RN/APRN In Policy Evaluation Essay
12
Chapter Two: The Clinical Nurse Specialist (CNS)
13
2.3 Description of the Clinical Nurse Specialist
The CNS is a nurse with advanced nursing knowledge
and skills, educated beyond the level of a generalist
or specialised nurse, in making complex decisions in
a clinical specialty and utilising a systems approach to
influence optimal care in healthcare organisations.
While CNSs were originally introduced in hospitals
(Delamaire & LaFortune 2010), the role has evolved
to provide specialised care for patients with complex and chronic conditions in outpatient, emergency
department, home, community and long-term care
settings (Bryant-Lukosius & Wong 2019; Kirkpatrick
et al. 2013). Commonly, the provision of healthcare
services by a CNS includes the combination of direct
and indirect healthcare services (refer to Section 2.3)
based on nursing principles and a systems perspective
(CNA 2014; NACNS 2004; NCNM 2007). It is acknowledged that indirect services of the CNS are highly valued along with direct clinical care and should be taken
into consideration when defining scope of practice.
Although nurses who practice in various specialties
(e.g. intensive care unit, theatre/surgery, palliative care,
wound care, neonatal, gerontology) may consider themselves at times to be specialised nurses, the designated
CNS has a broader and extended range of accountability and responsibility for improvements in the healthcare
delivery system, including an advanced level clinical
specialty focus. Based on postgraduate education at
a minimum of a master’s or doctoral degree, the CNS
acquires additional in-depth knowledge, critical thinking
and decision-making skills that provide the foundation
for an advanced level of practice and decision making. The Role Of The RN/APRN In Policy Evaluation Essay