Advanced Practice Nursing:
Emphasizing Common Roles
Edition 2
Joan M. Stanley, PhD, RN, CRNP
Director of Education Policy
American Association of Colleges of Nursing
Washington, DC
F.A. Davis Company • Philadelphia
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Library of Congress Cataloging-in-Publication Data
Advanced practice nursing : emphasizing common roles / [edited by] Joan M. Stanley.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8036-1229-X (hardcover : alk. paper)
1. Nurse practitioners. 2. Midwives. 3. Nurse anesthetists.
[DNLM: 1. Nurse Clinicians. 2. Nurse Practitioners. 3. Nurse Midwives. WY 128 A2445 2005] I.
Stanley, Joan M.
RT82.8.A37 2005
610.73′06′92—dc22
2004001938
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Contents
Foreward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIX
CHAPTER 1
The Evolution of Advanced Practice in Nursing . . . . . . . . . . . . . . . . . . . . . . . .1
Pauline Komnenich, PhD, RN
Certified Nurse Midwives, 4
Nurse Anesthetists, 14
Clinical Nurse Specialists, 22
Nurse Practitioners, 27
Joining Forces: Role Parameters and Concerns, 33
CHAPTER 2
Advanced Practice Nursing in the Current Sociopolitical Environment . . . . .46
Lucille A. Joel, EdD, RN, FAAN
The American People and Their Health, 48
The Health Care Delivery System: Origins of Change, 54
Dominant Trends in American Health Care, 55
The Advanced Practice Nurse and the Emergent Delivery System, 56
Barriers to Advanced Nursing Practice, 57
Summary, 66
CHAPTER 3
The American Health Care System: Implications for Advanced
Practice Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Mary Knudtson, MSN, NP
The American Health Care System, 72
Financing Health Care, 74
The Evolution of Managed Care, 88
Implications for Advanced Practice Nursing, 90
CHAPTER 4
Selected Theories and Models for Advanced Practice Nursing . . . . . . . . . . . .93
Michelle Walsh, PhD, RN, CPNP, Linda A. Bernhard, PhD, RN
Theories of Leadership, 96
Theories of Change, 102
Models of Health Promotion, 107
Models of Advanced Practice Nursing, 113
Summary, 119
CHAPTER 5
Primary Care and Advanced Practice Nursing: Past, Present,
and Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Catherine L. Gilliss, DNSc, RN, FAAN, Linda Lindsey Davis, PhD, RN
Health Care in the Twentieth Century, 124
Health Care in the Twenty-First Century, 124
The Nature of Primary Care, 125
Primary Care Providers in the Twenty-First Century, 131
Policy Issues Influencing Advanced Practice in Emerging Primary
Care Systems, 137
Summary, 142
CHAPTER 6
Advanced Practice Nurses in Non-Primary Care Roles: The Evolution
of Specialty and Acute Care Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Dennis J. Cheek, PhD, RN, FAHA, Karol S. Harshaw-Ellis, MSN, RN, A/GNP, ACNP-CS
Advanced Practice Nursing Roots in Acute Care, 148
Evolution of NPs in Neonatal and Acute Care, 149
Hospitalist/Acute Care Nurse Practitioner Model, 152
Non-Primary Care Roles: Growing Specialties, 154
Summary, 155
CHAPTER 7
Formulation and Approval of Credentialing and Clinical Privileges . . . . . . .158
Geraldine “Polly” Bednash, PhD, RN, FAAN, Judy Honig, EdD, CPNP, Linda Gibbs, BSN, RN, MBA
Regulation: Professional and Public, 160
Professional Certification for APNs, 169
Clinical Practice and Institutional Privileges, 174
Summary, 183
CHAPTER 8
Reimbursement for Expanded Professional Nursing Practice Services . . . . .187
Michael J. Kremer, DNSc, CRNA, FAAN, Margaret Faut-Callahan, DNSc, CRNA, FAAN
The Economic System, 191
Criteria for an Economic System in Relation to Health Care, 191
Types of Economic Systems, 192
Market Competition, 194
Disequilibrium, 196
Supplier-Induced Demand, 197
The Effects of Changes in Price, Supply, and Demand for Health Care, 199
Cost Considerations in Provision of Care and Reimbursement for Physicians and APNs, 201
Key Terms in Finance and Reimbursement, 210
Reimbursement for Specific APN Groups, 214
Summary, 223
CHAPTER 9
Marketing the Role: Formulating, Articulating, and Negotiating
Advanced Practice Nursing Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Christine E. Burke, PhD, CNM
The Traditional Marketing Approach: The 4 Ps, 228
Knowledge of Personal Values, Professional Skills, and Practical Necessities, 230
Knowledge of Practice Regulations, 232
Knowledge of Existing Services, 232
Knowledge of Clients’ Health Care Needs and Desires, 233
Knowledge of the Target Population’s Understanding of the Role and Scope
of Practice of the APN, 234
Knowledge of the Utilization and Cost-Effectiveness of and Satisfaction with
APN Services, 234
Knowledge of Specific Marketing Elements, 235
Communication Skills, 237
Evaluation of Job Opportunities, 246
Close of the Deal, 248
Mentors and Career Advancement, 250
Summary, 252
CHAPTER 10
Caring for a Diverse Population: Ensuring Cultural Competency
in Advanced Practice Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Pier Angeli Broadnax, PhD, RN
Diversity, 258
Commonly Used Culture-Related Terms, 259
Principles of Cultural Competency, 260
Cultural Assessment Models, 261
Healthy People 2010, 264
Culturally Sensitive Life Events, 264
Summary, 273
CHAPTER 11
Clinical Research in the Advanced Practice Role . . . . . . . . . . . . . . . . . . . . . .277
Julie Reed Erickson, PhD, RN, FAAN, Christine Sheehy, PhD, RN
APNs as Consumers of Research, 282
APNs as Researchers, 293
Summary, 297
CHAPTER 12
Publishing Scholarly Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Suzanne Hall Johnson, MN, RN,C, CNS
Avoiding the “School Paper” Style Rejection, 307
Adapting the Thesis Style for Publication, 313
Summary, 320
CHAPTER 13
Legal and Ethical Aspects of Advanced Practice Nursing . . . . . . . . . . . . . . .322
Linda Callahan, PhD, CRNA, Mary Jeannette Mannino, JD, CRNA
Nurse Practice Acts, 324
Professional Negligence (Malpractice), 327
Malpractice Insurance, 331
The Patient and the APN, 332
Professional Ethics, 332
CHAPTER 14
Advanced Practice Nursing and Global Health . . . . . . . . . . . . . . . . . . . . . . . .351
Katherine Crabtree, DNSc, FAAN, APRN, BC, Anita Hunter, PhD, RN, CNS, CPNP
Global Health Challenges, 354
Globalization of Advanced Practice Nursing, 355
Education Competencies for NP Practice in the U.S. and Abroad, 357
Advanced Practice Nursing in Other Developed Nations, 361
Advanced Practice in Developing Nations, 364
Ethics and Spiritual and Cultural Competence in a Global Environment, 367
Opportunities for Advanced Practice Outside the United States, 367
Preparing APNs with a Global Perspective, 369
Summary, 371
CHAPTER 15
Advanced Practice Nursing and Health Policy . . . . . . . . . . . . . . . . . . . . . . . .374
Eileen T. O’Grady, PhD, RN, NP
Tensions Among Health Care Costs, Quality, and Access, 376
The American Health Policy Process, 379
The APN Health Policy Agenda, 384
APN Political Competence, 388
Important Health Policy Websites, 392
CHAPTER 16
Creating Excellence in Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .395
Marla J. Weston, MS, RN, Vicki L. Buchda, MS, RN, Debra Bergstrom, MS, RN, FNP
Attributes of Excellence, 398
Summary, 409
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413
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