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How come we arent considered APN's?

Has 25 years experience. Specializes in CCU, OR.

Looking under the "specialty key" here at AN, I've noticed that APN's are only CRNA's, NP's, or Nurse-midwives. If we go to school so we can teach and help create the next generations of nursing students, why aren't we Advanced Practice Nurses? If we have to go and get an MSN or a PhD or the new title DNSc(or whatever it is), how come we aren't APNs, too?

There have been discussions of this here before. The term "advanced practice" has always referred to advanced clinical practice, above and beyond the generalist RN scope of practice, which is why it has been reserved for the four "advanced practice" roles of CRNA, CNS, CNM, and NP. It's not about how much education one has, it's about the clinical role.

Heogog53

Has 25 years experience. Specializes in CCU, OR.

Hmmm. I understand a part of that, however, don't nursing educators and nursing faculty do clinical care as well as teach in the class room? My nursing school instructors most certainly taught us clinical skills and were on the floor to make sure that we did our assignments correctly.

The nurse educators who taught my Critical Care course spent two months with us in the classroom and then the next four months with us in class and on the floor. The same was true of my OR training program.

Most of my nursing instructors worked clinically on the side, as well, to make sure that they were up to date on all sorts of things.....

So if nurse educators aren't clinical instructors all the time, then they can't be APN's. Seems rather sad to me....almost like a neither fish nor fowl argument.

Hmmm. I understand a part of that, however, don't nursing educators and nursing faculty do clinical care as well as teach in the class room?

Can one make medical diagnoses and prescribe? If not, one is a straight RN. The teaching is important but it does not confer an advanced clinical scope.

Hmmm. I understand a part of that, however, don't nursing educators and nursing faculty do clinical care as well as teach in the class room? My nursing school instructors most certainly taught us clinical skills and were on the floor to make sure that we did our assignments correctly.

The nurse educators who taught my Critical Care course spent two months with us in the classroom and then the next four months with us in class and on the floor. The same was true of my OR training program.

Most of my nursing instructors worked clinically on the side, as well, to make sure that they were up to date on all sorts of things.....

So if nurse educators aren't clinical instructors all the time, then they can't be APN's. Seems rather sad to me....almost like a neither fish nor fowl argument.

Can one make medical diagnoses and prescribe? If not, one is a straight RN. The teaching is important but it does not confer an advanced clinical scope.

Exactly -- most clinical teaching is not advanced clinical practice. Teaching someone clinical practice within the generalist RN scope of practice is not advanced practice -- it's generalist RN practice.

Heogog53

Has 25 years experience. Specializes in CCU, OR.

Vicky, thank you for that link. There are indeed a plethora of issues surrounding being an APN that I wasn't aware of. What I do know is that Master's prepared nurses ought to be recognized as Advanced Practice Nurses, because they have gotten an ADVANCED DEGREE. I think nurse educators of all levels should be recognized for what they do, whether they teach CNA's, MA's, LPN's, BSN's or----even the few Diploma nurse programs that still exist.

I do think that it's weird that the local university is looking for a BSN prepared nurse as a clinical educator, but the local ECPI and community colleges are looking for MSN's OR MD's to teach nurse's aides or medical assistants. Strikes me as backwards. What do you think?

Anyway, thank you for the informative thread. My nursing instructors worked hard at preparing us to be not just competent nurses, but intellectually curious and aware nurses.....at a Diploma program.....

Vicky, thank you for that link. There are indeed a plethora of issues surrounding being an APN that I wasn't aware of. What I do know is that Master's prepared nurses ought to be recognized as Advanced Practice Nurses, because they have gotten an ADVANCED DEGREE.

Again, not to be argumentative or disrespectful, but it's about advanced practice, not an advanced degree. There are lots of graduate degree concentrations in nursing that don't make you an advanced practice nurse.

BTW, I am a diploma grad also, and got a much better nursing education in my diploma program than I did in the BSN completion program I completed later on (to be able to go to grad school).

Heogog53

Has 25 years experience. Specializes in CCU, OR.

Let me apologize. It's been a long day and while I get the point, I think I've become a victim of the OH-MY-GOD-I-HAVE-TO-BE-CERTIFIED- IN AT- LEAST-3-THINGS -TO FEEL-IMPORTANT......syndrome....sorry.

Actually, I do think that it's getting pretty tough to get a job as a nurse these days. All the advertisements around here read

RN wanted

graduation from an accredited school, an active nursing license and a year of experience----and then go into the job requirements...which then state the following;

RN wanted

-must have BSN

-must have at least 2 years of experience in xyz

-must be certified in _______ or_______

-blaah blaah blaah

I understand the differentiation between the APNs- and there are apparently much I am not the slightest bit aware of, in terms of the requirements to legally qualify as such.

One last comment. After I graduated from my Diploma Program(and yes, they were wonderful weren't they?), if circumstances had gone my way, after my 2 years in CCU, I could have gotten a one year Certificate in Anesthesia---just imagine, without my BA, I could have done a total of four years of education, two years of critical care experience- and ended up as a grandfathered APN. Whoosh!

I recognize that for me to have fulfilled my dream of becoming a CRNA, I'd have had to go back to school to finish a BSN as well as more time to take all the old science courses again- and some new ones, too, before even attempting to get into school.....oh yah, I forgot and two years of critical care experience. Sigh. Real life does odd things to one's dreams.

Thanks for being polite and it's obvious I need to go to bed.

Helga

Teresag_CNS

Has 34 years experience. Specializes in ICU, trauma, gerontology, wounds.

Can one make medical diagnoses and prescribe? If not, one is a straight RN. The teaching is important but it does not confer an advanced clinical scope.

Actually, that's not quite true. Clinical nurse specialists do not make medical diagnoses and only a few prescribe, but we are APNs. I chose to be a CNS specifically because I didn't want to be a "minor physician," which I do not think is the right way to advance in one's nursing career. Practicing medicine is not practicing nursing.

Actually, that's not quite true. Clinical nurse specialists do not make medical diagnoses and only a few prescribe, but we are APNs. I chose to be a CNS specifically because I didn't want to be a "minor physician," which I do not think is the right way to advance in one's nursing career. Practicing medicine is not practicing nursing.

Thanks. I was thinking more of nurse practitioners, but you certainly make a valid point.

I chose to be a CNS specifically because I didn't want to be a "minor physician," which I do not think is the right way to advance in one's nursing career. Practicing medicine is not practicing nursing.

I am another "old school" CNS who feels exactly the same way. I practice advanced nursing, not "medicine lite."

Heogog53

Has 25 years experience. Specializes in CCU, OR.

I'd like to give a sincere round of applause to the CNS's who state that they want to be ADVANCED PRACTICE NURSES, not med lite....

I gave thought to becoming a PA, rather than an NP. I looked into both, but it seemed to me that a PA generally makes more money than an NP- have no idea why. I'd think that an NP who HAS TO HAVE an RN already, just to start with, would be considered the better prepared.

Perhaps, however, I wasn't looking at it properly; once again, PA's started out as MALE(this is a biased view, based on my experience, so please take no offense) and therefore got more $$$$.

I would also like to say to the APN's that I do hold y'all in considerable esteem. I've spent most of my career as an OR nurse, and have watched the very best CRNA take better care of most patients than a boatload of senior residents and attendings. While most of the attendings and CRNA's at my facility have a very collegial relationship, while most attendings are more than willing to teach a CRNA new skills, or supervise those who've attained a certain mastery and now need to be "checked off" formally, there are a few crapheads out there on both sides of the anesthesia machine.

At one time in my life, I considered moving up to L and D. However, at that time, the term 'nurse-midwife' was enough to send MD's into a rage!!! Then doula's came to be recognized(amazingly enough) and somehow the fight to kill off the NM's started to moderate. Once again, my bias- and in a different state.

It took me quite awhile to figure out what a CNS was. None I knew was familiar with the term, but then, CNS's don't show up in OR's often. I thought about becoming a CNS in Pain Management until someone I spoke with about the whole idea of what to pursue to be useful in pain management was to be a CRNA- period. That was discouraging.

Now this may be a form of heresy, but in the olden and much more olden days, there were women known as healers, who knew some very practical pharmacology and general curative practices. Healers, in this country and many others, were exclusively WOMEN. I think most nurses are healers of some sort- why else did we get started in the first place? As to making diagnoses, etc----I've met some awesome nurse diagnosticians who weren't even NP's(not sure they existed at the time). Sometimes I wonder why we are so limited in our scope of practice when we have the example of a field medic or a MASH unit surg tech who does stuff that would be a huge violation of scope of practice in the civilian world? The best surg tech I ever met was a guy who served in a MASH unit in Vietnam- he could open, tie, suture, repair vascular tears/bleeders, amputate, close with the best of the surgeons- and frequently did when the unit was busy.

So why can't a nurse with enough skills be both a nurse and a diagnostician? What is wrong with that concept at all? As a mere RN, I unfortunately accurately diagnosed several members of my family's medical issues- and was correct every time. It's sad to be able to have to turn to one parent and report the bad news about the other.

T'any rate, I do salute those APN clinical specialists. There are so many people contributing to patient care on so many levels.

Thanks to all those who patiently explained the how's and why's.

Actually, that's not quite true. Clinical nurse specialists do not make medical diagnoses and only a few prescribe, but we are APNs. I chose to be a CNS specifically because I didn't want to be a "minor physician," which I do not think is the right way to advance in one's nursing career. Practicing medicine is not practicing nursing.

I am another "old school" CNS who feels exactly the same way. I practice advanced nursing, not "medicine lite."

Actually, I should have added/clarified a month ago :) that, as a psych CNS, I do diagnose and treat psychiatric disorders -- just not with medication (I can diagnose legally, but I don't have (and don't want!) prescriptive authority -- the focus of my graduate education was as a psychotherapist).

cnburton

Has 22 years experience. Specializes in ICU,PACU, M/S, Tele & ED.

There are many more nurse educators who do not continue to practice nursing in the clinical setting as staff nurses than those who do. I teach part time as adjunct clinical faculty for a community college and there are 2 out of 8 that still work in nursing just in my section. Many of the nursing educators have not worked in several years and that is what is needed....clinically competent nurse educators. I think the advanced practice nurse title should still count for the advanced degree....not for the setting you work in.

There are many more nurse educators who do not continue to practice nursing in the clinical setting as staff nurses than those who do. I teach part time as adjunct clinical faculty for a community college and there are 2 out of 8 that still work in nursing just in my section. Many of the nursing educators have not worked in several years and that is what is needed....clinically competent nurse educators. I think the advanced practice nurse title should still count for the advanced degree....not for the setting you work in.

And are those nurse educators who aren't practicing as staff nurses practicing in some advanced (clinical) practice role?? If they're not practicing clinically at all, generalist level or advanced practice level, how would it possibly improve the situation (or possibly be legitimate) to give them "advanced practice" status (or, at least, the title)?? What are these educators doing that is outside the scope of generalist nursing practice?

It's not about the degree or the setting; it's about the scope/role of the individual's clinical practice.

Edited by elkpark

cnburton

Has 22 years experience. Specializes in ICU,PACU, M/S, Tele & ED.

Why is that the criteria? Why isn't getting an " advanced" degree enough? I am taking Advanced pharmacology and Advanced patho to teach it and explain it to many others and that requires advanced training and practice. Just because I won't prescribe , I am paying for the degree and putting in the hard work to attain it, I feel I deserve the title.

Why is that the criteria? Why isn't getting an " advanced" degree enough? I am taking Advanced pharmacology and Advanced patho to teach it and explain it to many others and that requires advanced training and practice. Just because I won't prescribe , I am paying for the degree and putting in the hard work to attain it, I feel I deserve the title.

Because it's advanced practice, not advanced education. There are kazillions of US nurses who have MSNs or PhDs who aren't advanced practice nurses, because they're not educated, certified, and practicing in an area of advanced clinical practice. I can't tell you "why" that is the criteria, but there is long-standing and widespread consensus across the US, within and outside the nursing community, on what constitutes advanced practice nursing. If you want to undertake a campaign to change that, I certainly encourage you to do so.

"advanced practice nurse

n. Abbr. APN

A licensed registered nurse who has completed graduate training as a clinical nurse specialist, nurse anesthetist, nurse-midwife, or nurse practitioner."

The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

"advanced practice nurse (APN),

a registered nurse having education beyond the basic nursing education and certified by a nationally recognized professional organization in a nursing specialty, or meeting other criteria established by a Board of Nursing. The Board of Nursing establishes rules specifying which professional nursing organization certifications can be recognized for advanced practice nurses and sets requirements of education, training, and experience. Designations recognized as advanced practice nursing include certified nurse-midwife, certified registered nurse anesthetist, clinical nurse specialist, nurse practitioner."

Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

(both from advanced practice nurse - definition of advanced practice nurse in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.)

"Prepared typically in master's-degree programs, APNs are advanced registered nurses who include four categories of providers:

1) nurse practitioners who deliver front-line primary and acute care in community clinics, schools, hospitals, and other settings, and perform such services as diagnosing and treating common acute illnesses and injuries, providing immunizations, conducting physical exams, and managing high blood pressure, diabetes, and other chronic problems;

2) certified nurse-midwives, who provide prenatal and gynecological care to normal healthy women, deliver babies in hospitals, private homes, and birthing centers, and continue with follow-up postpartum care;

3) clinical nurse specialists, who provide care in a range of specialty areas, such as cardiac, oncology, neonatal, pediatric, and obstetric/gynecological nursing; and

4) certified registered nurse anesthetists, who administer more than 65 percent of all anesthetics given to patients each year and are the sole providers of anesthesia in approximately one-third of U.S. hospitals."

http://www.aacn.nche.edu/Media/Backgrounders/apnursng.htm

"PREAMBLE

The registered nurse practicing as an advanced practice nurse (APN) builds on the foundation and core values of the nursing domain. The APN practices autonomously to design, implement, and evaluate patient-specific and population-based programs of nursing care. The APN practices in many roles and arenas. The purpose of this document is to define the role of the perioperative advanced practice nurse.

POSITION STATEMENT

The perioperative APN is, first and foremost, a registered professional nurse who is competent in the use of specialized perioperative nursing knowledge and skills in the care of patients and families undergoing operative and other invasive procedures. The APN possesses a minimum of a master's degree in nursing, concentrated in a recognized area of advanced clinical nursing practice (ie, nurse practitioner [NP], clinical nurse specialist [CNS], certified registered nurse anesthetist [CRNA], or certified nurse-midwife [CNM]), which forms the foundation for an advanced practice role.

A hallmark of the APN's skills are the autonomy and expertise in diagnosing and treating complex responses of clients (ie, patient, family, community) to actual and potential health problems ..."

Position_Advanced Practice Nurse

"... The APN is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including, but not limited to, homes, hospitals, institutions, offices, industry, schools, community agencies, public and private clinics, and private practice. The APN acts independently and/or in collaboration with other health care professionals to deliver health care services (Texas Nurse Practice Act, Section 221).5 APNs conduct comprehensive health assessments aimed at health promotion and disease prevention. They also diagnose and manage common acute illnesses, with referral as appropriate, and manage stable chronic conditions in a variety of settings. APNs titles include Nurse Practitioner, Clinical Nurse Specialist, Certified Nurse Midwife, and Certified Nurse Anesthetist. Independent practitioners are capable of solo practice with clinically competent skills and are legally approved to provide a defined set of services without assistance or supervision of another professional. 6 ...."

ISPUB - Defining Nurse Practitioner Scope of Practice: Expanding Primary Care Services

"Definition of the Advanced Practice of Nursing

The advanced practice of nursing by nurse practitioners, nurse anesthetists, nurse-midwives and clinical

nurse specialists, is based on the following:

a. knowledge and skills acquired in basic nursing education;

b. demonstration of minimal competency in basic nursing as evidenced by licensure as a Registered

Nurse;

c. graduate degree with a major in nursing or a graduate degree with a concentration in an

advanced nursing practice category, which includes both didactic and clinical components,

advanced knowledge in nursing theory, physical and psycho-social assessment, appropriate

interventions, and management of health care.

Skills and abilities essential for an advanced practice registered nurse within the designated area of

practice include:

• assessing clients, synthesizing and analyzing data, and understanding and applying nursing

principles at an advanced level;

• providing expert guidance and teaching;

• working effectively with clients, families and other members of the health care team;

• managing clients' physical and psycho-social health-illness status;

• utilizing research skills;

• analyzing multiple sources of data, identifying alternative possibilities as to the nature of a health

care problem and selecting appropriate treatment;

• making independent decisions in solving complex client care problems;

• performing acts of diagnosis and prescribing therapeutic measures consistent with the area of

practice; and

• recognizing limits of knowledge and experience, planning for situations beyond expertise, and

consulting with or referring clients to other health care providers as appropriate.

Each individual who practices nursing at an advanced level does so with substantial autonomy and

independence recruiting a high level of accountability. The scope of practice in each of the advanced roles

of a nurse practitioner, nurse anesthetist, nurse-midwife, or clinical nurse specialist is distinguishable from

the others. ..."

https://www.ncsbn.org/1993_Position_Paper_on_the_Regulation_of_Advanced_Nursing_Practice.pdf

"Advanced practice registered nurses

Advanced practice registered nurse (APRN) is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements, at a minimum of a Master’s level, beyond the basic nursing education and licensing required of all RNs and who provides at least some level of direct care to patient populations. Under this umbrella fit the principal types of APRNs (numbers of APRNs based on 2004 data):

• Nurse practitioner (NP) – Working in clinics, nursing homes, hospitals, or private offices, more than 141,000 nurse practitioners are qualified to provide a wide range of primary and preventive health care services, prescribe medication, and diagnose and treat common minor illnesses and injuries.

• Certified nurse-midwife (CNM) –Almost 14,000 CNMs provide well-woman gynecological and low-risk obstetrical care. In 2002, CNMs attended more than 300,000 of U.S. births that year, in hospitals, birth centers, and homes.

• Clinical nurse specialist (CNS) –Working in hospitals, clinics, nursing homes, private offices, and community-based settings, some 72,000 CNSs handle a wide range of physical and mental health problems, and also work in consultation, research, education, and administration.

• Certified registered nurse anesthetists (CRNA) – The oldest of the advanced nursing specialties, CRNAs administer more than 65 percent of anesthetics given to patients each year. There were about 32,000 CRNAs in practice in 2004."

More About RNs and Advanced Practice RNs

Advanced practice nurses have the three P's as a component of their education: Physiology, Pharmacology, and Physical assessment. Some educators (including me) do also have these three specific courses as core components of their educational programs, but others do not. In the next two weeks, I will have my MSN but will not be eligible to sit for an APN exam. I may go on for midwifery, who knows??? If I weren't 45, I would say I definitely would. Anyhow, as part of my last course for the MSN I just sat in on a phone conversation with The National Association of CNS's and that is what I found out. Only CNS, NP, CNM, and CRNA are APN's. Go figure!

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