Description of a Nurse in the Expanded Role

APN's

According to the American Association of Colleges of Nursing an Advanced Practice Nurse (APN) is a professional nurse with "specialized knowledge and skills that are applied within a broad range of patient populations in a variety of practice settings" (American Association, 2005).

According to Jennifer Keller an APN who works in the OB/Gyn department, specialized skills include a number of options such as; managing a wide range of health problems using diagnosis after a physical examination. Jennifer sees patients that are normally pregnant, or who are attempting to become pregnant who wish to know or learn the safeguards and practices needed for a successful pregnancy. Keller's expertise has been developed over a number of years and with a constant emphasis on education. She has completed a Masters as required of an Advanced Practice Nurse and continues to attend additional courses and clinics in order to acquire gain further knowledge and sharpen her nursing skills.

A recent study determined that "of all health professionals, nurses spend most of their time with patients and their families" (Dickinson, Clark, Sque, 2008, p. 64) and Jennifer states that is even more true of an APN. Keller states that as an APN her job has even more requirements than those that apply for nurses at other levels.

One of those requirements is to extensively interact with the families as they go through the pregnancy process. Jennifer says that she oftentimes provides assessments for the patients while at the same time she is required to teach the patients how to understand and use what the assessments display.

She also has developed an innate sense of patient problems and much of that sense has been due to her skills in counseling and collaborating with the patients and the doctors with which she works.

One study that confirms Jennifer's words found that a "dose of APN time and contacts make a difference in improving patient outcomes and reducing health care costs" (Brooten, Youngblut, Deatrick, Naylor, York, 2003, p. 74). The study determined that APN's not only need to know about their particular nursing specialty, but must also have condition-specific knowledge about different patient problems, and must also know concerning negotiating systems, communicating and other information about costs, health care programs and how to successfully help the patient complete paperwork and traverse the trail of regulations in today's modern healthcare system.

The current trend in healthcare seems to bode well for APN's, especially in employment and upward mobility. APN's with their advanced educational knowledge and degrees are often counted on to provide more extensive care than other nursing professionals. With the trend in healthcare towards cutting costs and expenses, many times patients will likely seek the services of the APN over the more expensive services of the doctor or physician. Additionally, APN's assist the doctor(s) when the doctors are busy or otherwise occupied.

Another area where APN's are especially important is in the documentation and intervention modes. Many times APN's are required to document all aspects of patient interactions and then intervene according to the analysis of those documentations.

One recent study found that "care logs written by the APN's to document the patient problems and nursing interventions are then content analyzed and coded" (Naylor, Bowles, Brooten, 2000, p. 94). Once the care logs have been analyzed and coded the information is then used to assist the APN's in making interventions with the patients. Jennifer also states that such practices are required of APN's and that most APN's complete them on a regular basis.

Regarding the issue of patient safety, Jennifer states that APN's, because of the massive amount of documentation, the ongoing communication and collaboration, and the knowledge needed of more than just the physical or mental ailments, ensures the viability of the APN and how most of them as individuals, and a group, approach patient safety. Many of the nursing associations include high standards of patient safety including the Association for Ambulatory Behavioral Healthcare (AABH) whose code of ethics states that special care should be taken during the "evaluation and treatment of individuals who are vulnerable and their significant others with the array of programs and services comprising the continuum of ambulatory behavioral healthcare" (AABH, 2011).