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Core Competency in Advanced Practice Nurses and their Roles

Introduction

Advanced Nursing Practice is a profession, which demands a lot of competencies. These core competencies are deemed foundational to the practice of nursing. Nurses along their duty of work define core competency as the unswerving demonstration of operating values. A core competency can be merged with professionalism in the manner in which nurses relate to other professionals to meet optimal health outcomes for patients. Also, core competency in nursing includes accountability. It will demand nonstop learning and professional engagement (DeNisco & Barker, 2013). The APRN movement has developed exponentially by employing professionals in almost every sector. As presented in the American Nurse Association Code of Ethics for Nursing, the paper seeks to analyze the core competency of an Advanced Practice Nurse. The paper will also examine the findings of rules, policies, and regulations as well as the pros and cons of the APRN based on the interview.

In the interview, the respondents included two certified nurse-midwife (CNM), a certified registered nurse anesthetist, a clinical officer, and a nurse practitioner. The above professionals were chosen because Advanced Practice Registered Nursing is broad with different objects under the healthcare system. Each profession offers direct care for patients, population management care, and assistance in the implementation of healthcare policies. The interview focused on direct clinical practice with the core competency of any of APRN’s role. To achieve accuracy, I set general questions irrespective of specialization of the respondents. Since APRN is based on the registered nursing skills, the interview is set to develop deeper knowledge, wider synthesis of data, and more significant autonomy in APRN (DeNisco & Barker, 2013).

APRN Core Competency Research Interview Schedule

Phase 1: Warm up

At this point, I will the opportunity to establish a rapport between respondents and me. Activities include asking for the respondents’ names, occupations, relevant profile information and the reasons for choosing them to participate in the interview.

Phase 2: Explore discussion points

The objective of the interview is communicated to the respondent. However, the respondents are familiar with types of question they are likely to be asked. Since there are four respondents from different fields of nursing, the interview will take two hours thereby allowing thirty minutes for each interviewee.

Phase 3: Core discussion

The main body of the interview will consist of generated questions and the record of answers. The transition should be convenient for preparing the respondent for participation throughout the entire interview session.

Phase 4: Summarizing

The closing part involves extending thanks to the respondents by appreciating their cooperation and availability. For my part, I will be summarizing the information gathered from the interview. It is also essential to review the data obtained at every stage to enhance clarity and reliability. The aim is to maintain the already established rapport.

The interview questions seek to evaluate whether nurses observe all competencies based on AACN principles. According to AACN, nurses ought to conduct their roles while observing the laws of altruism, caring, ethics, excellence, quality competency, and scientific principles.

Interview Questions

1. In your professional practice, are you concerned about the welfare of patients? 2. What are the key duties and responsibilities demanded from your position by APRN? 3. Has APRN set a framework of policies and regulations that ensures nurses perform roles observing their competencies? 4. What advantages and disadvantages are attached to predetermined competency policies and regulations in your roles? 5. Upon making the decision concerning health care, does it reflect autonomy and respect and observe patients’ right? 6. How do you reflect and display integrity in agreement with the accepted code of nursing? 7. How does APRN’s member observe social justice in order to extend the fair treatment of patients irrespective of economic status, race, ethnicity, sexual orientation, or disability? 8. Do you showcase complex and unconventional leadership roles to initiate and guide change? 9. Do you incorporate knowledge from the humanities and sciences into the context of nursing science? 10. With respect to quality, does it promote the culture of excellence with the aid of peer review? 11. Do you apply the knowledge of investigative clinical techniques to improve healthcare results?

Analysis of the Findings

Roles of Nurses with Regard to AACN Core Competencies

There are three primary tasks expected from an APRN member as a practicing baccalaureate nurse. These roles include providers of health care, leaders, designers of care, managers, and, finally, experts. Firstly, as providers of health care, nurses act as trainers and advocates. (Bartolone, 2008). All members of APRN are supposed to create partnerships with patients in order for contribution in determining healthcare decisions to be carried out. On the other hand, patient advocacy is a stamp enforced in professionals nursing roles. It calls for nurses to offer health care with high competency and quality. It is also useful for evaluating care results and availing leadership directions for improving care (Bartolone, 2008).

From the interview, it was clear that nurses are often subject to multiple ethical dilemmas, which often occurs in the workplace. These difficulties create significant challenges that propel nurses to make wise decisions within stipulated moral frameworks. Moreover, nurses are aware that establishing the health status of a patient in line with the individual’s values is vital for generating the framework for strategizing, implementing, and reviewing the outcomes of care.

Secondly, nurses as managers, leaders, and designers of care, are inclined to create substantial knowledge and authority to delegate duties to other medical personnel. Additionally, in the management and leadership positions, nurses are obliged to supervise and evaluate the performance of these personnel. When nurses are set to operate interdependently and autonomously, they become accountable for their professional practices and images (Hamric, Hanson, Tracy, & O’Grady, 2014). Accountability also covers the outcomes of their delegated duties and it does not matter whether the task was delegated or not. In a health care team, nurses become automatic members that can perform complex treatments and services. In summary, it is the responsibility of nurses to introduce a unique blend of knowledge, decision-making, and technical skills in the healthcare industry.

Finally, APRNs have to become members of the nursing profession. They ought to advocate their patients and their profession. Being a member of a profession implies the creation of an image of a nurse in terms of professional identity and accountability. Nurses are expected to act with the utmost professionalism by displaying well-delineated and broad knowledge in practice. Moreover, this profession expects members to present profound reasoning, decisive clinical judgment, skills assessment, and communication. Most importantly, a member of APRN has to practice an accepted code of standards by following the stipulated set of ethical values. All nurses are committed to nonstop learning since their discipline is dynamic. Therefore, only constant updates will guarantee quality health care for all patients (Bartolone, 2008).

Policies and Regulation

All interviewee responses concerning policies and regulations made this interview unique. Healthcare systems are general and applicable to all practitioners in the industry because they aim at the same objective. The policies tend to include financial and regulatory systems which influence the healthcare system, either directly or indirectly. According to the findings, these policies indicate the manner in which the healthcare system responds to national and global issues of affordability, equality, accessibility and social justice in the provision of healthcare. Additionally, health care policies are essential for the interpretation and analysis of safety and quality during the actual practice of nursing (National Council of State Boards of Nursing, 2015).

Nursing policies and regulations help distinguish between the nursing practice and nursing training and clearly define the scope and roles of these two parties. From the interview findings, healthcare policies are known to be developed and altered over time based on the influence of the healthcare fraternity (National Council of State Boards of Nursing, 2015).

According to the Nurse Practice Act, nurses need to abide by all the stipulated and listed regulations. Despite varying interpretations of the Nurse Practice Act among the states in the United States, at least all Act covers the most important regulation. First, the Authority and power structure of the nursing board provides distinctive governance for the practice of nursing and the enforcement of the law. Advanced Practice Nurses APRN right has to practice nursing, and the responsibility to the healthcare system safety is balanced by the NPA (National Council of State Boards of Nursing, 2015).

The second policy is the standard scope of nursing practice. Standards have been set to guide a patient-centered healthcare plan as well as a comprehensive assessment of a patient. Additionally, standards have been set for decision-making expected from nurses, critical and creative thinking, and delegation of nursing intervention with respect to patient’s advocacy (National Council of State Boards of Nursing, 2015).

Thirdly, educational program standards are set for the pre-licensed nursing education program. These standards comprise of credentials, curriculum specifics, and faculty. Additionally, if one contemplates withdrawal from the educational program and later wishes to continue, the standard provides procedures to be followed and met. Importantly, the standards outline requirements expected from the evidenced-based clinical judgment as well as prerequisite skills in clinical management and ethical practices of nursing (National Council of State Boards of Nursing, 2015).

Finally, there are stipulated healthcare policies to guide title and licensure. Due to the reported incidence over the increase in the use of tile nurse by the unlicensed quarks, NPA has set measures to protect these titles from being misused. The title “nurse” is only reserved for those who have met required educational and legal qualifications that allow to practice nursing and permit the public to consult them (National Council of State Boards of Nursing, 2015).

Pros of Nursing Roles

Core competencies enable nurses to perform their duties of healthcare delivery with excellence. A certified nurse-midwife has double education in nursing and midwifery. Observing the value of altruism, expecting women develop confidence regarding their welfare. However, the core competency creates accountability in the professional practice for a Nurse Anesthetist (NA). NA specialists can undertake roles independently, but they are still held accountable for their sole professional practices (Schneider & Whitehead, 2012).

Another advantage of the nurse’s roles is the ability of practitioners to make an independent professional decision using their competencies and licensure. In addition, under the AACN competency guide, when Nurse Anesthetics collaborate with surgeons, dentists, and anesthesiologists in providing anesthetic to a patient, it is not considered as a medically delegated act, but as a practice of nursing (Bartolone, 2008).

However, technological information and literary competency have helped to incorporate suitable knowledge in order to improve anesthetic operations. For example, improvement in anesthetic agents, applied technology, and multimodal pain management stipulated in the policies and regulatory guidelines of anesthesiology have greatly helped reduce accidents of anesthesia-related cases.

Under the leadership competency, clinical nurses can provide clinical and professional leadership in their daily operations. A Clinical Nurse Specialist tends to deal with direct clinical practices, because the sickness may either be cardiovascular disease or something related to pediatrics. Additionally, the leadership competency assists to foster the collaboration with health care fraternity and applies policies thereby enhancing ethical decision-making and improving health care (DeNisco & Barker, 2013).

Core competencies seem to play a massive role for Nursing Practitioners (NPs) because they provide a broad range of services to patients. NPs stick to the guidance of health delivery competencies to cut down the risk related to patients and providers at the individual and system levels. By implementing healthcare knowledge of practices and compound systems, NPs provide healthcare awareness, clinical counseling with an emphasis on healthcare maintenance, and prevention of chronic diseases.

Lastly, peer reviews play significant roles in guiding NPs and other members of APRN to refer patients to other professionals with similar skills, abilities, and knowledge for the evaluation. Peer review falls under quality competencies and is mainly insisted on by APRN operations in order to enhance the culture of transcendent performance (Hamric et al., 2014). However, peer review enables variation in health care practice, which can provide uniform solutions. The interview with the Nurse Practitioner revealed that relying on peer review during inquiries permits dissemination of shreds of evidence that allows using several modalities.

Cons of Nursing Roles

As much as the interviewees had their roles and responsibilities as professionals, they reviewed challenges faced in the practice from the personal point of view. The interviewees acknowledged that their roles were hampered by the decline of quality that had plagued the healthcare delivery system. The quality deprivation is based on the overuse, underuse, and misuse of healthcare resources.

For the nurses to perform their roles effectively, they have to maintain, support, provide safety, equality and ensure patients’ rights. However, these aims are not always met today.

Another disadvantage is that the roles of nurses are improving steadily, but have not yet reached the ideal standards due to misguidance and mismanagement of the financial sector. According to the interviewees, the values of their roles end up being not truly patient-centered. The blame is on the system because it is characterized by delays that hamper practitioners from achieving objectivity in their performance. Constant delays are likely to compromise the healthcare outcome, and this is a serious issue that concerns individual lives hence contradicting the core competency of human dignity (Hall, Moore, & Barnsteiner, 2008).

Conclusion

APRN core competencies adherence has established robust quality and standard care for the citizens of the United States. Each member of APRN is well conversant with the policies and regulations stipulated in the Nurse Practice Act. Nurses know their roles and the degree of professionalism expected from them. The interview was mainly focused on the level at which nurses are adhering to the recognized core competencies of the practice. The findings have revealed that nurses are trying their best, but the healthcare leadership is letting their effort down. Based on the three primary roles of nurses, the system has bestowed a lot of pressure and substantial support upon them. The roles of nurses record some disadvantages which signal complacency in the healthcare system. Luckily, APRN has managed to integrate members into a unified team so that quality can be achieved in patient health care irrespective of practitioner’s specifications.

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