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The transition from nurse to advanced practice nurse begins with where a nurse is at the current position. It is important to note that transition does not begin after graduate degree completion. Advanced practice role must include professional writing and presenting because these are both opportunities and responsibilities and are fundamental part of a nurse's identity in their new role. Nurses should not value, practice, and develop these skills while they are in graduate school because in that context it is easy to slide down the slippery slope into a technical conceptualization of the role (Jansen, Michaelene & Zwygart-Stauffacher, 2009).

The transition process should include some notion of connectedness which can be described as the reorientation phase as a final step in transition. Jansen, Michaelene & Zwygart-Stauffacher (2009) indicated that in this phase, connectedness is associated with a redefinition, new meanings, and a new identity of the nurse (p. 269). The neutral phase follows as a bridge to reorientation. The neutral phase step is normally marked by confusion, disequilibrium, and a loss of harmony and familiarity in which the person recognizes that previous expectations or actions no longer work. Jansen, Michaelene & Zwygart-Stauffacher (2009) also noted that in reorientation then nurses in advanced practice redefine themselves as leaders hence in this new identity, publishing and presenting are critical leadership actions nurses should assume.

The nurse who wants to join the advanced practice role should show the ability to blend into system needs in a chaotic time of healthcare change. Zerwekh & Claborn (2010) noted that the nurse who is in transition should learn to keep a positive attitude within the job arena. Also in order to fully fit in the advanced practice role nurses need to promote job security within the system by adding new skills and abilities that help them maintain viability as professionals (Zerwekh & Claborn, 2010). They should also undergo cross training to the emergency room or per-natal areas of the hospital. The movement to advanced nursing practice needs consensus on the definitions with the issues of educational preparation and certification.

Differentiate advanced practice nursing and medical practice

Rostant & Cady (1999) indicated that advanced practice nurses are registered nurses with additional formal education and clinical preparation, resulting in either a certificate or masters degree. One of the differences is that advanced practice requires additional formal education to achieve required advanced status and they should be certified as anesthetist and clinical nurse specialist. On the other hand Corner & Bailey (2001) says that medical practice provides the social system with a means of coping with illness through the adoption of defined and established roles. Medical practice is theorized as playing a part in the maintenance of balance in the social system as a whole. They also exercise a power of legitimating of determining if a sick person is sick enough to be given exemption from normal responsibilities.

The advanced practice of nursing is defined as practice based on the knowledge and skills acquired in a basic nursing education, through licensure as a registered nurse and in graduate education, experience. Rostant & Cady (1999) indicated that "advanced practice nurses make independent decisions in solving complex patient care problems and performing acts of diagnosis and prescription of therapeutic measures" (p. 297). Corner & Bailey (2001) indicated that in a medical practice the practitioners in health care system identifies the sick role as abnormal or deviant, with the sick person potentially motivated to remain formally designated as sick.

Mgma (2006) indicated that the task of the medical practice is to manage the interface between the business of medicine and the practice of medicine. Burchell, Smith & Piland (2002) medical practice requires increased knowledge, fee-for-service payments and the emphasis on quality care and new technology represent important roles of the medical practitioners. McGee & Castledine (2003) indicated that nurses practicing at an advanced level make diagnosis and treatment decisions and at the same time consult medical colleagues in medical practice. McGee & Castledine (2003) also noted that the distinction between the ways in which the two professions practice is based on looking the direct approach of medicine, which focuses on the chief complaint and works through to a diagnosis via history-taking and physical examination.

The advanced nursing approach to treatment is much more concerned with the human response to health and illness and makes a more holistic assessment which includes biological, sociological, psychological, cultural, and family factors. McGee & Castledine (2003) established that "medical practice tends to look at its role too narrowly by simply sifting through symptoms, making a diagnosis, prescribing a treatment and determining medical progress of the patient" (p. 160). Studies indicate that advanced nursing roles are well received by patients because they combine the skills traditionally associated with nursing with those related with medical practice for example physical assessment and diagnosis. McGee & Castledine (2003) also found out that consultations with nurses provide comparable outcomes to those with doctors and high level of patient satisfaction.

Another major difference between a advanced nursing practice and a medical practice is that medical practice at all levels requires their practitioners to work within their sphere of competence besides themselves defining the boundaries of that competence (McGee & Castledine, 2003). Advanced nurse practice on the other hand despite not having full medical training must have those boundaries defined by them. McGee & Castledine (2003) says that "in this context they must be able to satisfy everyone concerned that they have the skills and training to discharge clinical care within those boundaries and determine when there are clinical problems outside their scope and training" (p. 164).

In addition, McGee & Castledine (2003) says that the purpose of advanced nursing roles is to improve patient care. They however obtain support from medical practice through regular scheduled meetings in which patient management and the scope of the practice are discussed. Advanced nursing practice unlike medical practice improves the consistency, continuity, and coordination of patient care. This implies that the advanced nurse practitioner functions independently and autonomously but there is the opportunity for frequent sharing of ideas and knowledge regarding patient care in the two types of practices.    

Describe each of the 5 advanced practice competencies: researcher, consultant, expert clinician, manager/leader, and educator

Expert

Rolfe & Fulbrook (1998) noted that as an expert the advanced nurse practice encompasses both direct and indirect practice. The direct practice involves caring for patients and their families while indirect practice involves working with staff in planning care for their patients and developing practice protocols that were evidence based, supervising staff in guided structured reflection, facilitating refelective primary reviews, and exploring practice issues (Rolfe & Fulbrook, 1998).

Educator

Rolfe & Fulbrook (1998) noted that the educator role of the advanced nurse practice involves a broad view of education, including the development of others, including their teaching skills, providing opportunities for others to learn, establishing staff development culture and developing and facilitating the maintenance of the unit as a learning environment. Besides these skills, knowledge relating to higher education and career development is essential because it helps the staff to gain access to and to progress within the higher education system. Rolfe & Fulbrook (1998) indicated that the educator role helps the practitioner to optimize their higher education experience to benefit practice and to gain credit and recognition for their practice from higher education.

Researcher

The researcher role of the advanced nurse practice involves working tpo come up with research culture and review group which helps others to critique research and explorer its implications in the field. Rolfe & Fulbrook (1998) indicated that as a researcher they determine the effects for the practice of research, updating practices protocols in the light of research and they also facilitate the rationalization of data gathering and its implications. In this context they utilize, interpret, evaluate, and communicate research and its deriving implications. They also test and apply, translate into protocols while supervising research projects and undertaking collaborative research (Rolfe & Fulbrook, 1998).

Consultant

The consultant role of the advanced nurse practice is derived from the roles of nursing practice, practice development, education in practice, educational theory, higher education and the nature of knowledge and theory development in nursing and consultancy skills (Rolfe & Fulbrook, 1998). The expert model consultancy in advanced nurse practice gives advice and guidance while the process model is associated with developing the skills and problem solving activities for others. 

Clinician

Advanced nurse practice should have good clinical skills and judgment to handle any problems that cannot be handled by the staff. McEachen & Keogh (2006) says that advanced nurse practitioners must have some knowledge of the various diagnoses presented by the patient on their unit as well as standard treatment protocols. McEachen & Keogh (2006) established that "advanced nurse practice should provide clinical guidance   o the staff, including when to call on the more expert help from clinical specialist nurses and physicians" (p. 28).

Manager/leader

The advanced nurse as a manager forms a competent team and manages them to carry out the plan for reaching the goal of excellent care for patients and high productivity from staff. McEachen & Keogh (2006) says that as a manager or a leader the practitioner should inspire, mentor and motivate the staff. This implies that the nurse manager must have leadership skills to effectively manage the staff during both times of quite routine and times of chaotic change. They should possess both the leader and manager skills because good nurse managers will be good leaders (McEachen & Keogh, 2006).

Describe a current healthcare need and the impact/solution of advanced practice nursing for that need

One of the current needs in the healthcare is the rising cost of health care in the last few years. Smeltzer et.al, (2009) says that this has led to the use of managed health care and alternative health care delivery systems, including health maintenance organizations and preferred provider organizations. The ever increasing health care costs have a big impact to the low income earners. The high costs of health care have promoted business, labor, and government to assume greater control over the financing and delivery of health care Smeltzer et.al, (2009) says that the costs have resulted to managed care in which advanced nurse practice plays a fundamental role. Managed care includes pre-negotiated payment rates, mandatory precertification, utilization review, limited choice of providers and fixed-price reimbursement.

As a result of this current need, patients return to the community, with more health acre needs many of which are complex. Smeltzer et.al, (2009) thus says that the demand for home based care and community based service is increasing rapidly. Advanced nurse practice is required in such a time because they can perform the diagnosis and treatment of human responses to health and illness. There are three roles of the advanced nurse practitioner which include being the practitioner that is in providing care, teaching, and collaborating. The advanced nurse practice plays an important role in this situation because they co-ordinate health care services to ensure cost-effectiveness, accountability and quality care. The advanced nurse practitioner has the responsibility of meeting the patient's needs and evaluate how effectively they are being delivered in the managed care system.

Through the use of managed care in the health care system, advanced nurse practitioner have helped to decrease costs of care associated with decreased lengths of hospital stays coupled with rapid and frequent inter-unit transfers from specialty to standard care units. Smeltzer et.al, (2009) says that "the advanced nurse practitioner plays the role of managing the care of a caseload of patients and collaborating with nurses and other healthcare personnel who provide care" (p. 804). The advanced nurse practitioner should follow the patient throughout the hospitalization and home after discharge so as to help them reduce the costs associated with health care.

The role of advanced nursing practices has come with the continuing effort to reduce the cost of health care through managed care, and the effort by professional nursing organizations to define more clearly the practice of nursing in reducing health care costs. This means that they have a positive impact in cost effectiveness of health care and its management across a very broad perspective. Smeltzer et.al, (2009) further says that initial care, ambulatory health care, palliative care, and anticipatory guidance are all important in cost reduction in health care. The advanced practice roles enable nurses to function interdependently with other health care professionals in facilitating managed care. The implication is that as the cost of health care continues to increase, advanced practice nurses are expected to continue to increase in terms of scope, responsibility, and recognition.

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