Advanced practice within nursing (APN) plays a big role in the future frontier for practices in the nursing field and its professional development. This mode of practice helps people view the field of nursing and the world in general in a different way, since it enables the public to question the current practices in nursing, it enables the creation of new knowledge in nursing, and helps in the improvement of delivery of services in the nursing field and other health care services. Hence, the continuous development and evaluation of advanced practice within nursing is of great significance to the nursing profession and the society at large.
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In this paper, nursing roles and their developments are critically analyzed in order to understand the development and the concept of danced practice within nursing in the U.K and how it might be taken to the next level and serve the society better. Furthermore the implementation and evaluation of the APN are also described. A precise and collective effort ought to be established to ensure that professionals in the nursing field and the expertise is recognized and enhanced. Clinical supervision has in mental and psychiatric nursing has shown some improvement due to the development of practices within nursing. Education in practices within nursing and leadership roles evolution, only offers a temporary solution to the issue of advanced practices within nursing.
Advance practice nursing involves a variety of roles within which a nurse is expected to perform at a higher level of hi/her profession. In the U.K one has no difficulties in identifying the roles of an APN, since there are different tittles established for such nurses. However, there is always confusion where the same title is given to different nurses performing different roles with varied intentions. The competencies in roles which involve domains of APN which are related to practices in clinics, research, education, professional development and organizational leadership are proper indicators of the APN roles compared to job titles (Gibson & Hooker, 2004). There is an agreement that, for APN roles to flourish there is need for graduate education collated with practice experience in the U.K, with such a combination the nursing sector will improve and patients will be well catered for.
There has been progress in the development of APN roles in the United Kingdom and this has been accelerated by some environmental factors. Other factors which have influenced the development of advance practice within nursing include local condition, health care system within the country, culture, APN community, the nursing experts or profession and the government.
The development, demand and acceptability of APN roles in U.K have been due to the values of the society, needs of the society for nursing and expectations of the society. For example there has been a wide acceptance of women in the workforce. The health care system in the U.K has influenced the development of APN roles through the variations of the demand and supply of care providers, economic pressures within the country thus affecting health care services and new trends in nursing practice (Hamric et al, 2000). Furthermore, the increased competition within health care providers and other players for better health services and care has also affected the development of APN roles.
The U.K government has played a significant role in developing and promoting APN roles in the country. The government has done these through allocating of funds to the program and coming up with crucial policies that enable the smooth running and implementation of the ideas and programs in health care delivery (Della, 2004). One such policy that has enabled the development of APN roles is where the government restricted working hours of some junior doctors and the improvement of primary health care and other health care services such as palliative care, which necessitated the introduction and implementation of new APN roles in different settings and capacities.
Though the development of advance practice within nursing in the U.K has been tremendous, the lack of proper definition of goals lead to the need of continuous assessment and follows up by the government. Some organizations come up with new APN role but they lack proper objectivity since they are not well defined. Research has shown that, many organizations do not consider the needs of the society in the local health care setting, so as to clearly define some of the roles of APN and how government priorities would be achieved in such a setting to improve health care within a certain society. Through ambiguous settings, APN roles are guided by expectations of stakeholders such as health care providers, nurses, managers, hence resulting to wide disparities on the interpretation and use of the roles of APN. This situation has caused crisis in the health care sector for example role conflict, acceptance of the APN roles by some stake holders and role overload. Moreover there is involvement of inexperienced people in the introduction of new APN roles thus leading to misinterpretation, titling, scope of practice, funding, under use of some roles and reporting systems. These are some of the hindrances that have been encountered in the development of APN roles in the health care system in the U.K. Houngblut (2002) stated that,
“Cognizance must be taken of the challenges for the development of advanced nursing practice and it is important that the challenges are explored and discussed. The developments in advanced nursing practice have taken place in response to contemporary healthcare delivery and the changes that have taken place have altered the way health care is perceived and delivered. These changes are welcome. However, APNs must ensure and demonstrate that outcomes are improved and that the needs of clients are met” (pg 78).
Another impediment that is mainly experienced in the development of advance practice in nursing is that nurses in the U.K have long not been valued. The valuing of expertise in nursing should be done in ways such as formalizing the advance practice roles. A nurse specialist is one of such roles that should be formalized. These are the people who are supposed to have expertise in the nursing field, are responsible of developing expert practices and specialist know how. Many of the nurses in these fields feel unsupported and lack role models. Therefore, the government and other stake holders should show some solidarity with nurses in order to provide better care services to patients (McGee, & Castledine, 2003).
The impact of APN
There have been substantial changes in the relationship between nurses and patients, over last few years since the inception of advanced practices in nursing in the U.K. The nation has supported the renewed efforts to establish a well organized nursing system in the country thus improving the services being provided by the nurses and the entire health care system. Clinical efficiency, quality services and proper governance in the nursing sector are some of the main strands of the government interest and drive to come up and modernize a proper nursing system. As a result of these efforts the patient-nurse relationship has improved tremendously (Ball & Cox, 2003). The development of new roles of nurses and also some postgraduate courses which have been supported by the government in the U.K has helped many nurses understand the concept of being a nurse and being good one in that matter. Nurses are now developing the character of holding patients’ hands and attending to them properly, thus developing the relationship between nurses and patients.
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The extended roles of the nurses through advanced practices within nurses have helped in the relationship of nurses and patients. Such extended roles include drug prescription and other areas which have been traditionally delegated to other health professionals. These roles have increased the contact between patients and nurses and hence developing a good relationship. Classification of what a nurse is required to do and education provision and other frame-works are necessary in ensuring the safety of all concerned parties. However, it is important not to confuse these extended roles in nursing to those of expertise in nursing (Marsden et al, 2003). A survey done by Allen, evaluated 78 opinions of nurses involved in psychiatry in the U.K about their opinions on the extended roles of nurses and advanced practice and found out that, many of the nurses believed that such extended roles should not only be in medical tasks but should also be extended to other humanistic nursing roles. If there are such extended roles of nurses in the country, the nursing field will be more responsible and efficient.
Current state and the future of APN
The future of advance practice within nursing is closely attached to the future of the entire nursing field and to the needs, events and changes within the society and its environs.
Science and technology is one of the factors that have directly affected APN in U.K. The work of nursing and the entire health care system is squarely based on knowledge and technology has made it easier in acquiring of knowledge in many aspects. The knowledge required to guide and instill nursing practice is sourced from various areas including nursing research which mostly involves the use of the modern technology. If nursing education and other practices are to stay relevant in the constantly changing environment, they must also change with time (Bryant-Lukosius, 2004). With the current trend, nurses need to make educated guesses; they should turn problems to answers and learn how to be comfortable with ambiguity.
Specific challenges related to health continue to change every time. This signifies that, how nurses and other health practitioners respond to such challenges must also change with the trend. Health needs depends various aspects such as environment, demographic trends and epidemics. A country such as the U.K is expecting to see more growth in the number of elderly people in the coming future. Some nursing undergraduate programs within the U.K do not have enough theoretical content nor clinical exposure or experience with the elderly people. This shows that there is a serious challenge in the learning institutions to provide a curriculum which involves elderly patients, in the future. Whyte (2000) noted that,
“Educators need to comprehend the role that APNs will play in healthcare delivery in the next decade and beyond. APNs are required to exercise higher levels of judgment and decision-making in the clinical setting. Appropriate preparation, education and demonstrated competence to practice are integral to the success of the role of the APN in the designated area of practice. It is proposed that for the successful preparation of APNs, an innovative curriculum design is needed, where content is delivered within an interdisciplinary framework” (pg 23).
The current demographic trends and other special health needs, indicate that the government needs to come up with an appropriate policy and other organized actions that must be taken by nurses so as to meet the needs of the society. Training has to be established in institutions and also the specialization of personnel in all levels in order to give directions of the changes that research in nursing must take.
The development of advanced practice roles and opportunities through post graduate education can only enrich nursing practices. Education, regulating and defining the scope of nursing practices is very vital however, it is insufficient it is not the only thing needed to advance nursing practices as it is evident in the U.K. There must be equal opportunities being offered to nurses in developing their expertise in nursing practice (Bamford & Gibson, 2000). Supervision is one of the key tools that help nurses develop their expertise in practice and therefore it should be emphasized in the health care policy.
Many institutions and organizations which are committed in advancing nursing practices will be in future rewarded in different ways and means. While value is added to nurse through education, safe environment is created and people are able to be competent enough to handle patients with care. Advanced practice within nursing also cements the relationship between patients and nurses, hence patients are able to relate well with nurses.
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