Nurse Practitioner
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Nurse Practitioner
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A Navy nurse practitioner assessing a patient
^ "Mid-level health providers: a promising resource to achieve the health Millennium Development Goals" (PDF) . World Health Organization. 2010. Archived from the original (PDF) on 19 Jul 2021 . Retrieved 4 April 2021 .
^ "Mid-Level Practitioners Authorization by State" (PDF) . US Department of Justice. 4 January 2021 . Retrieved 4 April 2021 .
^ Lohr, Robert H.; West, Colin P.; Beliveau, Margaret; Daniels, Paul R.; Nyman, Mark A.; Mundell, William C.; Schwenk, Nina M.; Mandrekar, Jayawant N.; Naessens, James M.; Beckman, Thomas J. (9 Oct 2013). "Comparison of the Quality of Patient Referrals From Physicians, Physician Assistants, and Nurse Practitioners" . Mayo Clinic Proceedings . 88 (11): 1266–1271. doi : 10.1016/j.mayocp.2013.08.013 . PMID 24119364 .
^ Stokowski, RN, MS, Laura A. "APRN Prescribing Law: A State-by-State Summary" . Medscape . Retrieved 25 November 2015 . {{ cite web }} : CS1 maint: multiple names: authors list ( link )
^ "Scope of Practice for Nurse Practitioners" (PDF) . AANP Policy Statements . American Association of Nurse Practitioners . Retrieved 14 November 2017 .
^ "State Practice Environment" .
^ Jump up to: a b "Eligible Nurse Practitioners Questions and Answers" . Department of Health and Aged Care . 11 October 2018 . Retrieved 14 September 2022 . {{ cite web }} : CS1 maint: url-status ( link )
^ Jump up to: a b "Ford, Loretta C." National Women’s Hall of Fame . Retrieved 2019-11-15 .
^ "Historical Perspectives on an Expanded Role for Nursing" . Nursingworld.org . Retrieved 2017-05-10 .
^ "The History of Nurse Practitioners" . Graduatenursingedu.org . Retrieved 2017-05-10 .
^ Jump up to: a b c Dicenso, Abla; Bryant-Lukosius, Denise. "Clinical Nurse Specialists and Nurse Practitioners in Canada: A Decision Support Synthesis" (PDF) . Canadian Health Services Research Foundation. Archived from the original (PDF) on 2012-03-13 . Retrieved 1 June 2019 .
^ "Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners | Occupational Outlook Handbook - Credo Reference" . search.credoreference.com . Retrieved 2022-03-02 .
^ Jump up to: a b "Advanced Practice Nurses | Gale Encyclopedia of Nursing and Allied Health - Credo Reference" . search.credoreference.com . Retrieved 2022-03-28 .
^ "Statement Regarding Nurse PractitionerStudentsandDirect Care Clinical Hours" (PDF) . Nccwebsite.org . Retrieved 30 January 2022 .
^ "Nursing Master's Programs With 100% Admit Rates" . Usnews.com . Retrieved 30 January 2022 .
^ "NP Fact Sheet" . Aanp.org . Retrieved 30 January 2022 .
^ "FNP vs ACNP: What are The Differences? | NurseJournal.org" . Nursejournal.org . 3 June 2020 . Retrieved 30 January 2022 .
^ McCleery, E.; Christensen, V.; Peterson, K.; Humphrey, L.; Helfand, M. (2011). "Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses" . VA Evidence Synthesis Program Evidence Briefs . VA Evidence Synthesis Program Reports. Department of Veterans Affairs (US). PMID 27606392 .
^ Lozada, M. James; Raji, Mukaila A.; Goodwin, James S.; Kuo, Yong-Fang (2020). "Opioid Prescribing by Primary Care Providers: A Cross-Sectional Analysis of Nurse Practitioner, Physician Assistant, and Physician Prescribing Patterns" . Journal of General Internal Medicine . 35 (9): 2584–2592. doi : 10.1007/s11606-020-05823-0 . PMC 7459076 . PMID 32333312 .
^ Hughes, Danny R.; Jiang, Miao; Duszak, Richard (2015). "A Comparison of Diagnostic Imaging Ordering Patterns Between Advanced Practice Clinicians and Primary Care Physicians Following Office-Based Evaluation and Management Visits". JAMA Internal Medicine . 175 (1): 101–107. doi : 10.1001/jamainternmed.2014.6349 . PMID 25419763 .
^ Woo, B. F.; Lee, J. X.; Tam, W. W. (2017). "The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings": A systematic review" . Human Resources for Health . 15 (1): 63. doi : 10.1186/s12960-017-0237-9 . PMC 5594520 . PMID 28893270 .
^ "Nurse Practitioner | Encyclopedia of Women's Health - Credo Reference" . search.credoreference.com . Retrieved 2022-03-28 .
^ "Nurse practitioner standards for practice" . Nursing and Midwifery Board of Australia . 1 March 2021 . Retrieved 14 September 2022 . {{ cite web }} : CS1 maint: url-status ( link )
^ "Nurse Practitioners Career Guide" (PDF) . Australian College of Nurse Practitioners . Retrieved 20 August 2021 .
^ Jump up to: a b Davey, Melissa (16 August 2022). "Nurses are the solution to bulk-billing crisis, says peak body" . The Guardian . Retrieved 14 September 2022 .
^ "Scope of Practice for Nurse Practitioner - College and Association of Registered Nurses of Alberta" (PDF) . College and Association of Registered Nurses of Alberta . 2019 . Retrieved 6 December 2019 .
^ "How to Become an Advanced Practice Nurse in Canada" . Graduatenursingedu.org . Retrieved 2017-05-16 .
^ "Scope of Practice for Nurse Practitioner" (PDF) . College and Association of Registered Nurses of Alberta . December 2019 . Retrieved 6 December 2019 .
^ "Minister for Health publishes Final Evaluation Report which demonstrates the many benefits of Advanced Nursing Practitioners" . Gov.ie . Department of Health (Ireland) .
^ "Changing role of nursing profession" . Sligo Champion . September 26, 2020 – via Independent.ie .
^ Hancock, Jay (2010-04-14). "Jay Hancock's blog: Md. should make nurse practitioners independent" . Weblogs.baltimoresun.com . Retrieved 2011-08-31 .
^ Vestal, Christine (2013-07-19). "Nurse Practitioners Slowly Gain Autonomy" . Kaiser Health News . Retrieved 2019-05-22 .
^ Flanagan, Lyndia (October 1998). "Nurse Practitioners: Growing Competition for Family Physicians?" . Family Practice Management . 5 (9): 34–43. PMID 10187057 .
^ Brown, Deonne J. (October 2007). "Consumer perspectives on nurse practitioners and independent practice" . Journal of the American Academy of Nurse Practitioners . 19 (10): 523–9. doi : 10.1111/j.1745-7599.2007.00261.x . PMID 17897116 . S2CID 9389332 .
^ Kaplan, Louise; Brown, Marie-Annette (March 2004). "Prescriptive Authority and Barriers to NP Practice". Nurse Practitioner . 29 (3): 28–35. doi : 10.1097/00006205-200403000-00004 . PMID 15021500 . S2CID 4001124 . INIST : 15566634 .
^ "Nurse Practitioner State Practice Environment" . American Association of Nurse Practitioners. February 2017 . Retrieved 2017-06-06 .
^ "Registration standard for endorsement for scheduled medicines registered nurses (rural and isolated practice)" . Nursing and Midwifery Board of Australia . 31 March 2010 . Retrieved 20 August 2021 .
^ "Guidelines: For nurses applying for endorsement as a nurse practitioner" . Nursing and Midwifery Board of Australia . Australian Health Practitioner Regulation Agency. 8 August 2019 . Retrieved 20 August 2021 .
^ "ות בריאות העם )אישור תואר מומחה בסיעוד התשע"ד-2" (PDF) . Health.gov.il . Retrieved 30 January 2022 .
^ "Nurse Practitioner Salary | Certified Nurse Midwife | Anesthetist Salaries" . Graduatenursingedu.org . Retrieved 2017-05-16 .
^ Stucky, Christopher H.; Brown, William J.; Stucky, Michelle G. (2020-10-12). "COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority" . Nursing Forum . 56 (1): 222–227. doi : 10.1111/nuf.12515 . ISSN 0029-6473 . PMC 7675696 . PMID 33047352 .
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Look up Nurse practitioner in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Nurse practitioners .
A nurse practitioner ( NP ) is an advanced practice registered nurse and a type of mid-level practitioner . [1] [2] NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex conditions. [3]
The scope of practice for a NP is defined by legal jurisdiction. [4] [5] In 26 states of the US, NPs have full practice authority, while in the remaining 24 states, NPs are required to work under the supervision of a physician . [6] In Australia, the scope of practice is guided by health organisation policy and the individual's competency, while their right to access Medicare rebates requires a Collaborative Practice Aranagement with a medical practitioner . [7]
The present-day concept of advanced practice nursing as a primary care provider was created in the mid-1960s, spurred on by a national shortage of physicians. [8] The first formal graduate certificate program for NPs was created by Henry Silver , a physician, and Loretta Ford , a nurse, in 1965. [8] In 1971, The U.S. Secretary of Health, Education and Welfare, Elliot Richardson, made a formal recommendation in expanding the scope of nursing practice to be able to serve as primary care providers. [9] In 2012, discussions arose between accreditation agencies, national certifying bodies, and state boards of nursing about the possibility of making the Doctor of Nursing Practice (DNP) degree the new minimum standard of education for NP certification and licensure by 2015. [10]
Advanced practice nursing first appeared in the 1990s in Ontario . [11] These nurses practiced in neonatal intensive care units within tertiary care hospitals in collaboration with pediatricians and neonatologists . [11] Although the role of these nurses initially resembled a blended version of clinical nurse specialists and NPs, today the distinction has been more formally established. [11]
Becoming a nurse practitioner requires at least 1.5 years of post-baccalaureate training. [ citation needed ] During their studies, nurse practitioners are required to receive a minimum of 500 hours of clinical training. Upon completion of the graduate program, they must pass the National NP Certification Board Exam, specific to their specialization. After passing this exam, candidates must apply for NP licensure which varies by state regulations. [12] [13] [14]
Although nurse practitioners are required to be licensed as registered nurses prior to obtaining their advanced practice registered nurse certification, there are several programs that combine a nursing undergraduate degree with nurse practitioner training. Other nurse practitioner programs have 100% acceptance rates. [15]
There are many types of nurse practitioner programs in the United States with the vast majority being in the specialty of a family nurse practitioner (FNP). [16] There are also psychiatric, adult geriatric acute care, adult geriatric primary care, pediatric, cardiac, women's health, oncology and neonatal nurse practitioner programs. [ citation needed ] Many of these programs have their pre-clinical or didactic courses taught online with proctored examinations. [ citation needed ] Once the students start their clinical courses they have online material, but are required to perform clinical hours at an approved facility under the guidance of an NP or physician. [ citation needed ] Each clinical course has specific requirements that vary on their program's degree/eligibility for certification. For instance FNPs are required to see patients across the lifespan whereas Adult Geriatric NPs do not see anyone below the age of 13. [17]
A review of studies comparing outcomes of care by NPs and physicians in primary care and urgent care settings were generally comparable, although the strength of the evidence was generally low, with virtually all of the studies sponsored by nursing organizations. [18] A recent study showed nurse practitioners practicing in states with independent prescription authority were more than twenty times more likely to overprescribe opioids than nurse practitioners in prescription-restricted states, the same study identified that both nurse practitioners and Physician Associates were more likely to over-prescribe opioids compared to physicians. [19] Nurse practitioners and physician assistants were also associated with more unnecessary imaging services than primary care physicians , which may have ramifications on care and overall costs. [20]
One systematic review suggests "that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes in emergency and critical care settings". [21]
Nurse practitioners are currently employed in a wide variety of practice settings. These settings include the ambulatory, inpatient, or emergency room of hospitals, health clinics, and office practices whether private or nurse-run. In addition, they serve in schools and college campuses delivering care as well as nursing homes and assisted living facilities. NPs can work alone or under the supervision of a physician in a wide variety of specializations. [13] [22]
In Australia, a nurse practitioner-endorsed registered nurse has an expanded scope of practice, allowing them to practice certain advanced clinical skills within their endorsed field. As a nurse practitioner, they can complete advanced health assessments, diagnose and treat diseases, order diagnostic testing such as imaging and pathology, and prescribe medications and therapeutics. [23]
Nurse practitioners can access Medicare (universal healthcare system) rebates for the services they provide to patients, excluding services provided in public facilities (such as a Queensland Health hospital). [24] Nurse practitioner items on the Medicare Benefits Schedule, however, provide significantly smaller rebates than equivalent items for General Practitioners , leading to a higher out-of-pocket cost to patients. [25] To claim Medicare rebates, the NP must also be in a documented "Collaborative Practice Arrangement" with a medical practitioner and the episode of care approved by a doctor. [7] Prescriptions issued by NPs must also be verified by a medical practitioner to be eligible to be subsidised under the Pharmaceutical Benefits Scheme. [25]
In Canada , an NP is a registered nurse (RN) with a graduate degree in nursing. [ citation needed ] Canada recognizes them in primary care and acute care practice. NPs diagnose illnesses and medical conditions, prescribe Schedule 1 medications, order and interpret diagnostic tests, and perform procedures, within their scope of practice, and may build their own panel of patients at the same level as physicians. [26] Primary care NPs work in places like primary care and community healthcare centers, as well as long-term care institutions. The main focus of primary care NPs includes health promotion, preventative care, diagnosis and treatment of acute and chronic diseases and conditions. Acute care NPs serve a specific population of patients. They generally work in in-patient facilities that include neonatology, nephrology, and cardiology units. [27] There are currently three specialties for nurse practitioners in Canada: family practice, pediatrics, and adult care. NPs who specialize in family practice work at the same level and offer the same services as family physicians with the exclusion of Quebec, where only physicians are allowed to formulate a medical diagnosis. [28]
Ireland's publicly funded healthcare system, the Health Service Executive has the advanced nurse practitioner (ANP) grade. [29] ANPs may prescribe medications. [30]
In the United Kingdom nurse practitioners carry out care at an advanced practice level. They commonly work in primary care (e.g. GP surgeries ) or A&E departments , although they are increasingly being seen in other areas of practice. [ citation needed ]
Because the profession is state-regulated, the scope of practice varies by state. Some states allow NPs to have full practice authority, however, in other states, a written collaborative or supervisory agreement with a physician is legally required for practice. [31] Autonomous practice was introduced in the 1980s, mostly in states facing a physician shortage or that struggled to find enough healthcare providers to work in rural areas . [32] The extent of this collaborative agreement, and the role, duties, responsibilities, nursing treatments, and pharmacologic recommendations again varies widely between states. [33] [34] [35]
NPs can legally examine patients, diagnose illness, prescribe some medications, and provide treatments. [ citation needed ] As of 2022, twenty-six states granted full practice authority to NPs and do not require the supervision or collaboration with a physician. Twenty-four states require NPs to have a written agreement with a physician in order to provide care. Eleven of those states require NPs to be supervised or delegated by a physician, this physician may not be on site. [36]
In Australia, nursing registration including endorsement of a RN as a nurse practitioner is overseen by the Nursing and Midwifery Board of Australia (NMBA) and the Australian Health Practitioner Regulation Agency (AHPRA). [ citation needed ] Registered nurses working in rural and isolated communities can apply for scheduled medicine prescriber endorsement if clinically necessary and trained, and instead become a prescribing registered nurse rather than a nurse practitioner to better meet the need of less-resourced communities. [37] Nurse practitioners are professionally represented by the Australian College of Nurse Practitioners, as well as the Australian College of Nursing. Endorsement as a nurse practitioner in either Australia or New Zealand is recognised by both countries as part of the Trans-Tasman Mutual Recognition Scheme.
For a RN to apply to the NMBA for nurse practitioner endorsement, they must be able to demonstrate they have completed at least 5000 hours (three years, full-time equivalent) at an "advanced nursing practice" level. [ citation needed ] Advanced nursing practice is loosely defined, and not a specific role, but rather a recognised process of higher-level clinical practice within a nurse's existing scope of practice. The RN must also complete an approved nurse practitioner postgraduate master's degree, or demonstrate they have gained qualifications to an equivalent level in advanced health assessment, pharmacology, therapeutics, diagnostics, and research. Nurses applying through the latter pathway must also demonstrate the equivalent training is clinically relevant to the field for which they wish to apply for nurse practitioner endorsement in. [38]
In Canada , the educational standard is a graduate degree in nursing. [ citation needed ] The Can
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