The role of the nurse practitioner (NP) represents a unique blend of nursing and medical functions. Few studies exist that address the nursing component of the NP role and no literature is available to document the extent to which nurse practitioners utilize nursing diagnoses in their clinical practice. Thus, the author reports findings of a study that sought to describe the use of nursing diagnosis in current NP practice and to identify advantages and barriers to the use of nursing diagnoses by NPs. Fifteen percent of nurses surveyed used nursing diagnoses in their practice. The diagnoses most commonly used reflected attention to clients' lifestyles and daily living problems.As our country's interest in reforming almost all aspects of our healthcare system increases, the role of the nurse practitioner (NP) is also increasing. While the practice, outcomes, and cost-effectiveness of NPs as primary care providers have been studied extensively little is known about the degree to which NPs find nursing diagnoses useful in their work. The author presents research findings on the current use of nursing diagnosis in NP practice. The purpose of the research was: (a) to idenhfy the independent nursing role of the Np, and (b) to describe the advantages and barriers to the use of nursing diagnosis in NP practice.
The Nurse PractitionerThe concept of the nurse practitioner as a primary care provider was introduced in 1965. Although physician shortages and geographic maldistribution of physicians were not the reasons for the development of the role, these factors provided an excellent opportunity for its implementation (Pearson, 1985). Initial use of NPs to cover for physician shortages contributed to the identification of the NP as a substitute medical provider.Initially, the socialization of nurses into the primary care role emphasized a medical model orientation. The majority of educational programs were certificate programs directed and staffed by physicians (Sultz et al., 1983). Physicians were the role models, the teachers, and the persons who controlled the rewards and sanctions of those learning the primary care role. Role socialization (Hardy & Conway 1988;Meleis, 1975) incorporates role modeling, transmission of knowledge and values, acquisition of language, and learning new skills. Nursing behaviors were not reinforced, and many NPs avoided role conflict by idenhfymg with and valuing the medical rather than the nursing aspects of their new role.In addition, third party payment for services has most often been granted to NPs under the auspices of the