Advanced Practice Nursing
Advanced practice nursing refers to four classifications of registered nurses with advanced education and experience who perform responsibilities once solely in the realm of physicians: nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists. Most advanced practice nurses hold master's degrees, many prescribe medications, and all began their careers with the decision to become a nurse.
Historically, nurses obtained specialized education through hospital based courses designed to provide knowledge in a specific area, usually obstetric and private-duty nursing. As the sciences advanced, nurses acquired greater knowledge of anatomy, physiology, microbiology, chemistry, pathophysiology, and pharmacology. They also increased their skills and assumed a more active role in client care. Knowledge that was once the sole domain of physicians crossed over to nursing—physical assessment, venipuncture, suturing, ordering diagnostic tests, and administering lifesaving medications under protocol. The more nurses' role expanded, the more specialized they became, requiring changes in standards of practice and formalized education.
Specialty master's nursing education evolved in colleges and universities in the 1940s ad 1950s. Military nurses returning home from World War II facilitated the idea because they often had GI benefits enabling them to return to school for advanced education. Passage of the National Mental Health Act of 1946 provided additional funds for psychiatric nurses, and the first clinical master's program to develop advanced practice psychiatric nurses was developed at Rutgers University in 1954.
The National League for Nurses sponsored a conference in 1952 where attendees agreed to a key issue that still holds today: The purpose of the baccalaureate degree is to prepare nurses as generalists, whereas master's education prepares them as specialists. Nursing envisioned master's education as the foundation for nurses in specialty practice. Early degrees, such as the master's offered at Columbia University in New York, focused on the role of the nurse as educator or administrator. During this time nurses with advanced practice degrees were called nurse clinicians or clinical nurse specialists, and their primary responsibility was to improve client care by acting as a nurse expert in an acute care setting.
The 1960s experienced a shortage and maldistribution of physicians, and in response to this issue, the University of Colorado developed the first nurse practitioner program, one that focused on pediatrics. Within nine years, there were 65 pediatric nurse practitioner programs in the United States, as well as nurse practitioner programs in women's health and family health. However, because there was a lack of graduate degree programs, nurses created short-term certificate programs to develop nurse practitioners. Some required baccalaureate degrees, others did not; some were a few months in length; others were two years; and many had inconsistencies in prerequisites, program length, content, and goals.
Today, most advanced practice nursing education takes place at the graduate level, and the American Nurses Credentialing Center and other professional nursing organizations certify nurses who have obtained the appropriate education and experience. While the majority of advanced practice nurses have master's degrees, this, too, is changing. The new educational standard for 2015, though controversial, will be the Doctor of Nursing Practice, and universities across the nation already have programs in place or in the planning stage to convert to this degree.
The AACN Essentials of Master's Education for Advanced Practice Nursing defines the essential elements of master's education for advanced practice roles in nursing. As outlined in the Essentials document, the advanced practice master's curriculum has three components:
The Graduate Nursing Core contains foundational curriculum essential for all master's students regardless of specialty or functional focus. This content includes: theoretical foundations of nursing practice; research; policy, organization, and financing of healthcare; ethics; professional role development; human diversity, and social issues; and health promotion and disease prevention.
The Advanced Practice Nursing Core contains content essential for providing direct client services at the advanced level. This content includes advanced pathophysiology, advanced health assessment, and advanced pharmacology.
The Specialty Curriculum Content focuses on those didactic and clinical learning experiences identified and defined by the specialty nursing organizations, such as the Core Curriculum for Primary Care Pediatric Nurse Practitioners by the National Association of Pediatric Nurse Practitioners and the Association of Faculties of Pediatric Nurse Practitioners.