2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page ii i Advanced Practice NURSING EMPHASIZING COMMON ROLES 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page i 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page ii Edition 3 Advanced Practice NURSING EMPHASIZING COMMON ROLES Joan M. Stanley, PhD, RN, CRNP, FAAN Senior Director of Education Policy American Association of Colleges of Nursing Washington, DC 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page iii F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2011 by F. A. Davis Company All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne Patzek DaCunha, RN, MSN Developmental Editor: Barbara Tchabovsky Director of Content Development: Darlene D. Pedersen Project Editor: Tyler R. Baber Manager of Art and Design: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treat- ments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with profes- sional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new informa- tion regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Advanced practice nursing : emphasizing common roles / [edited by] Joan M. Stanley. — Ed. 3. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8036-2207-4 (pbk. : alk. paper) 1. Nurse practitioners—United States. 2. Midwives—United States. 3. Nurse anesthetists—United States I. Stanley, Joan M. (Joan Marlene), 1949- [DNLM: 1. Advanced Practice Nursing. WY 128 A2445 2011] RT82.8.A37 2011 610.7306’92—dc22 2010013948 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transac- tional Reporting Service is: 8036-2207/11 0 + $.25. 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page iv This book is dedicated to all of the APRNs who have worked tirelessly for the past five decades to bring us to where we are today! 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page v 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page vi vii F O R E W O R D The current healthcare reform debate in Congress and across the nation raises the possibility of major changes in the emphasis and structure of our healthcare system. Regardless of the im- mediate outcome, concerns about cost, quality, access, effectiveness of interventions, prioritiz- ing prevention, and workforce inadequacy are likely to persist and provoke transformations far beyond the legislative horizon. Once Pandora’s Box is open, it is impossible to shut again. In this context, the contribution of nursing to the quality of care and patient outcomes—and especially the contribution of advanced practice registered nurses (APRNs)—is attaining growing recognition. APRNs are seen increasingly as a promising, long-overlooked source of solutions to the shortage of primary care physicians and the inadequate management of chronic diseases. The potential for nurse practitioners and other APRNs to influence the form and substance of healthcare delivery has never been so manifest. New models of care and new practice structures are being proposed that harness the knowledge and skills of APRNs. This book, now in its third edition, provides an in-depth understanding of the past, pres- ent, and future of advanced practice nursing and why APRNs are poised to lead the recon- ceptualization of health care and assume greater prominence in its delivery. The authors ably describe current issues and trends faced by APRNs, their historical antecedents, and the ma- jor policy implications of practice, education, and regulatory developments. Although each of the four APRN roles—certified nurse-midwife, certified registered nurse anesthetist, clinical nurse specialist, certified nurse practitioner—has evolved along a different path, collectively they have changed nursing education and the way care is delivered. APRNs continue to lead changes in practice and in the healthcare system. The chapters in this book cover a wide range of topics, from microsystems thinking, prac- tice inquiry, intra- and interprofessional education, and ethics to credentialing, reimburse- ment, and marketing. The implications of pay for performance and retail clinics are detailed, as are issues related to scope of practice. The description of recent education/practice devel- opments, such as the Doctor of Nursing Practice degree and the Consensus Model for APRN Regulation, documents the evolution of APRNs and provides a vision for the future of ad- vanced practice nursing. Each chapter presents perspectives on issues relevant to current APRN practice, education, certification, and licensure. A valuable part of each chapter is the suggested exercises. Think- ing through the questions will give APRNs and others a chance to explore issues from a per- spective they may not have considered. In addition, new to this third edition is a complemen- tary instructor online resource that provides suggestions for teaching the content, a selection of PowerPoint slides for classroom use, and additional learning exercises for faculty to help them integrate this content into the APRN curriculum and learning experiences. Also, pro- vided online for students are additional learning exercises and useful Web links. This book will be a valuable resource for students, faculty, practicing APRNs, health sys- tems that employ APRNs, policy makers, and certifying organizations. Janet D. Allan, PhD, RN, NP, FAAN Dean and Professor The University of Maryland School of Nursing 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page vii 2207_FM-i-xxxiii:2207_FM-i-xxxiii.qxd 05/10/10 4:02 PM Page viii