Advanced Practice Nursing Scope of Practice for Hospitals, Acute Care/Critical Care, and Ambulatory Care Settings

Abstract

A dvanced practice registered nurses (APRNs), including certified nurse practitioners (CNPs), clinical nurse specialists (CNSs), certified registered nurse anesthetists (CRNAs), and certified nurse midwives (CNMs), represent a growing segment of health care professionals who provide care to patients in various settings. Although opportunities for APRNs are expanding, questions about the specific role components and scope of practice have emerged, especially because APRNs, including CNPs, are assuming greater roles in hospitals, acute and critical care, and ambulatory care settings.The term scope of practice broadly refers to the range of responsibilities that determine the boundaries within which a professional practices. 1 Scope of practice is a term used by state licensing boards for various professions to define the procedures, actions, and processes that are permitted for licensed individuals on the basis of their specific education and experience and their specific demonstrated competency. 2 Education, certification type, licensure, and regulations defined by individual state boards of nursing also shape APRN practice. Yet, variability persists in the degree to which state board of nursing regulations promote APRN practice that is consistent with education, certification, and licensure. The Institute of Medicine's 3 report, The Future of Nursing, highlighted the importance of removing scope-ofpractice barriers to promote the ability of APRNs to practice to the full extent of their education and training.In response to the need to ensure consistency in APRN education and practice, the Consensus Model for APRN Regulation emerged from a national effort to address APRN licensure, accreditation, certification, and education requirements across jurisdictions. The APRN Consensus Model proposes that the requirements for APRNs should be framed in a way that ensures the safety of patients while expanding access to APRN care and promoting a consistent scope of practice. 4

Hiring Appropriate Providers for Different Populations: Acute Care Nurse Practitioners

“…16 Scope of practice for hospital-based nurse practitioners may also include expanded role responsibilities such as education, research, quality review, program development, and administrative activities. 17 In many institutions, scope of practice is positively infl uenced by the ACNP's ability to generate revenue by billing for services, The acute care nurse practitioner role focuses on stabilization of acute problems and prevention and management of complications.…”

“…10 Initially, the work of ACNPs and ACPNPs was focused on critically ill patients, but it has expanded to include the breadth of all critical and acute care services such as care of patients in cardiothoracic surgery, cardiology, and medical, neurosurgical, and surgical intensive care units. 17,19 Other areas of practice for ACNPs and ACPNPs include working on a hospitalist service, in the emergency department, in specialties such as hematology/ oncology, or as part of a trauma team. 17,21 Within these practices are underlying regulations and competencies that outline boundaries or basic premises relative to the population of patients served.…”

“…17,19 Other areas of practice for ACNPs and ACPNPs include working on a hospitalist service, in the emergency department, in specialties such as hematology/ oncology, or as part of a trauma team. 17,21 Within these practices are underlying regulations and competencies that outline boundaries or basic premises relative to the population of patients served. Despite the work environment, a scope of practice defines specific functions of ACNPs relative to the various populations of patients.…”

“…Other outcome measures of the ACNP include improved quality of care, no difference in patients' outcomes with care provided by ACNP versus by fellows, and decreased length of stay. [17][18][19] In a recent survey of pediatric intensive care units, medical directors described ACPNPs as partners who provided supervision of resident physicians, continuity of care, and skill with procedures. 20 As scope of practice has evolved, so has the ACNP role.…”

“…Despite the work environment, a scope of practice defines specific functions of ACNPs relative to the various populations of patients. 17 Job descriptions are typically based on scope of practice for ACNPs, created from models of core competencies and specialty-specific competencies. The core competencies for all nurse practitioners published by NONPF in 2013 reflect expectations for both master's and doctoral level educational preparation, which also provide a basis for role and job expectations.…”