Purpose:
To explore nurses' perceptions and understanding of Advanced Practice Nursing's (APN's) role and influence on agency, practice, position, and outcomes.
Significance:
Advanced Practice Nursing has a long history of responding to societal needs for better healthcare and improving patient outcomes in fiscally responsible ways. However, poor understanding of the APN role can limit access and utilization of this important resource. This can be especially problematic in rural acute care settings where there are few APN role models. This project will explore current nurse perceptions and awareness of the APN role, spheres of influence, and impact on healthcare outcomes.
Methods:
A graduate nursing student used semistructured interviews with nurses working at a hospital located in a rural northwestern state. These interviews were recorded, transcribed, and analyzed for themes.
Results:
The interviews revealed the need for APNs to actively participate in the education of nurses regarding the roles, influences, and outcomes associated with their practice. The participants' level of education and exposure to APNs was directly related to their understanding of advanced nursing practice. The interviews suggest that confusion exists within nursing and healthcare organizations regarding the difference in roles and competencies between the nurse practitioner and clinical nurse specialist. Utilization of the APN in the acute care setting has resulted in increased awareness of differences in role actualization between the nurse practitioner and clinical nurse specialist. The nurse practitioner focuses more on a patient caseload, whereas the clinical nurse specialist expands this focus to include nurses and systems. Advanced Practice Nursing competencies that were best understood by nurses at all levels included patient care, education, leadership, and research. Competencies that were not as well understood include collaborator, consultant, and ethical decision making. The APN in the hospital setting is perceived as influencing patients, nursing, and systems, with the biggest influence identified as promoting best nursing practice. Specific outcomes were not well documented by APNs, but outcomes perceived by nurses include improved patient outcomes and better continuity of care.
Implications for Practice:
Ambiguity about the APN role negatively affects appropriate utilization of the APN in healthcare organizations. Ongoing education is needed to promote understanding of the role of the APN and how APN practice can positively influence outcomes at the patient, nursing, and systems levels. An improved understanding of these roles will promote appropriate utilization of APNs in acute care settings. APN related outcomes should be consistently documented to demonstrate the significant impact of the APN in this and other healthcare settings.