Thursday August 28th 2014

Opportunities, challenges, and solutions for APRNs

The five new articles in the May 2014 OJIN topic APRN Roles: Opportunities and Challenges for Practice and Education discuss a variety of aspects related to practice and education in a rapidly changing health care environment.

The topic begins with Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign by Debra Hain, PhD, GNP-BC, and Laureen Fleck, PhD, FNP-BC, CDE, FAANP. As health care reform evolves, nurse practitioners (NPs) will play key roles in improving health outcomes of diverse populations. According to the Institute of Medicine (IOM) 2010 report, The Future of Nursing, nurses should be leading change and advancing health by caring for populations within complex health care systems. Despite the IOM recommendations, many barriers exist preventing NPs from practicing to the fullest extent of their education and training. This article discusses some of these barriers and provides suggestions for possible ways to decrease the barriers.

Clinical nurse specialists (CNSs) are well-positioned to participate in the transformation of health care, as outlined by the IOM and called upon by the Affordable Care Act (ACA) of 2010. CNSs exercise their expertise through population-based care across three spheres of influence (patient/family, nurses/other professionals, systems). Janet Foster, PhD, APRN, CNS, CCRN, and Sonya Flanders, MSN, RN, ACNS-BC, CCRN, will discuss how challenges during the educational process as well as implementation in practice can be barriers to optimization of the role, denying the public full benefit from the potential of CNSs. This article, Challenges in Clinical Nurse Specialist Education and Practice, highlights some of the issues and provides solutions for mitigating these difficulties.

Debra Malina, DNSc, MBA, CRNA, ARNP, and Janice Izlar, DNAP, CRNA, discuss challenges faced by certified registered nurse anesthetists (CRNAs) in their article titled, Education and Practice Barriers for CRNAs.  CRNAs have historically experienced the most vigorous and organized resistance from outside entities to their right to practice to the full scope of their education and experience. The IOM’s Future of Nursing report added fuel to the fire that has been glowing for decades. Opposition to allowing nurse anesthetists to practice to the full scope of their education and training is not evident solely in the clinical arena; it is a pervasive challenge in the educational milieu as well.

Midwifery clinical practice and education has changed significantly since Mary Breckinridge first introduced nurse-midwives to the United States in 1925. In the article, Midwifery Practice and Education: Current Challenges and Opportunities, Deborah Walker, DNSc, CNM, FAAN, FACNM; Barbara Lannen, MSN, CNM; and Debra Rossie, MS, CNM, discuss current challenges in midwifery clinical practice and education and proposes possible solutions. Midwifery clinical challenges include restrictive legislation and business-related barriers, including but not limited to, physician supervision restrictions, prescriptive authority, out-of-hospital birth legislation and third-party reimbursement. Educational challenges highlighted include the current health care climate’s influence on midwifery education, the contribution of clinical sites and preceptors.

Ruth Kleinpell, PhD, RN, ACNP, FAAN, FAANP, and colleagues offer a global perspective in their article, Addressing Issues Impacting Advanced Nursing Practice Worldwide. Advanced practice nursing roles are developing globally, and opportunities for advanced practice registered nurses (APRNs) are expanding due to the need for expert nursing care at an advanced level of practice. Addressing barriers to APRN practice worldwide and ensuring that APRNs are able to practice to the full extent of their education and training can help to promote optimal role fulfillment as well as assessment of the impact of the APRN role.

— Andrea Warner Stidham is the assistant editor for OJIN.

Read these articles in OJIN at

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