Introduction
Advanced practice nurses (APNs) refer to those who possess the required advanced training from accredited institutions as well as certification; often inclusive of a doctorate or master’s degree in the field of nursing (Miranda et al., 2019). They are part of a group of healthcare providers that is described as advanced practice providers (APPs) and are often referred to as advanced practice registered nurses (APRNs); APPs are often inclusive of both APNs and physician assistants (PAs). Due to the supplementary training that is necessitated for individuals to become APNs, they are often afforded the liberty to practice within a clinical setting or organization with a higher level of independence and responsibility for patient safety. They may be certified to attend to patients without physician supervision, request diagnostic tests for patients, subsequently make diagnoses as well as generally make crucial medical decisions regarding the care of patients. It is critical to note that APNs are nurses at their core, their additional training adding on the base of knowledge that they already possess to specialize their expertise.
This paper will attempt to perform an in-depth analysis of the regulations that apply to APNs’ practice and compare their roles between the states of New Jersey and Illinois with regards to the facets of board certifications and renewal, collaborative agreements with involved parties, and perspective authority. This comparison is because every state accords unique authorization to their nurses for what they can and cannot perform, consequently possessing their licensure protocols. In this regard, the paper will also analyze the various restrictions that apply to APRNs in each state, the hospital privileges that they are granted, their nursing compacts, and finally the differences in palliative end-of-life care. APN practice is based on a firm foundation of expert nursing skills, values, and ethics which coupled with the rapidly rising number of nurses make it one of the areas in healthcare delivery that was identified as being paramount to the attainment of universal healthcare coverage.
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Description and Comparison of Roles
As highlighted earlier, APNs and the roles they perform are subject to regulations that are unique in every state. In the state of New Jersey, they are inclusive of nurse practitioners (NPs) as well as clinical nurse specialists (CNSs). The former are providers of primary care whose scope of practice involves the diagnosing and subsequent management of both chronic and episodic illnesses. They can request and infer diagnostic tests for patients as well as prescribe drugs and other treatment formalities to them; in essence, nurse practitioners offer care with an emphasis on the promotion of general patient health and prevention of diseases (Joel, 2017). They traditionally operated in ambulatory settings but recent developments are seeing them shift to care provision in acute care settings as well. Clinical nurse specialists on the other hand are staples in acute care settings and specialize in the coordination in addition to the provision of education concerning complex conditions such as diabetes, oncology, and cardiology to patients and their families as well as other staff members. CNSs with a specialty in psychiatric care often independently provide psychotherapy to patients in nurse-based settings. Others with additional post-masters level; training in pharmacology and pathophysiology are allowed to provide primary care.
In addition to this, APNs in the state of New Jersey are also allowed to practice in the areas of pediatrics, psychiatric mental healthcare, women’s health, nursing anesthesia, acute care as well as other fields in which they possess the required expertise and accreditation. When their patients’ conditions are beyond their scope of knowledge, APNs may seek consultation from more qualified healthcare providers to increase their ability in delivering care, refer them to specialists when completely overwhelmed, and even apply team-based care when it is benefitting for the cost, quality, and effectiveness of healthcare. With regards to the prescription of medication, APNs in New Jersey do so without the supervision of superiors but are required to own a joint protocol collaborative agreement (JP) especially for the prescription of controlled substances to patients. This is a compulsory practice agreement that was legislated in the year 1992 when APNs were awarded the authority to independently prescribe medication and mandates a yearly review of patient charts without their knowledge or that of physicians.
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