Independent practice and full practice authority

Abstract

Nursing practice, and in particular pediatric/child health nursing practice, is ever evolving as a specialty nursing practice. Concepts of practice that are now found in our nursing literature such as, “nurse-led,” “nurse-directed” typify the changes in practice that are evocative of the advances being made in our professional practice. In light of the advances in the realms of our nursing practice, it is timely to reflect upon the American Nurses Association definition of nursing:Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations. (ANA, p. 11). This vision of nursing rooted in our long-traditions of care and practice enables forward-thinking pediatric nursing colleagues to envision and create nursing-led and nurse-directed practice models of care for children, youth and families. These models of care build upon the concepts integral to pediatric and child-health nursing practice that emerged within our scope of practice decades ago and long before they were adopted by other professional disciplines. A few of these concepts include family-centered care, parental visitation, primary nursing and care coordination (Adair, 1969Adair V.S. Patient care–coordination or fragmentation?.45. NLN Publication, 1969: 6-9Google Scholar; Barnsteiner, 2009Barnsteiner J.H. Letter to the editor.Journal of Pediatric Nursing. 2009; 24: 446https://doi.org/10.1016/j.pedn.2008.03.003Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar; Beatty, 1972Beatty A. Symposium on family-centered care in a pediatric setting.Nursing Clinics of North America. 1972; 7: 1-3PubMed Google Scholar; Felton, 1975Felton G. Increasing the quality of nursing care by introducing the concept of primary nursing: a model project.Nursing Research. 1975; 24: 27-32Crossref PubMed Google Scholar; Harrison, 2009Harrison T.M. Family-centered pediatric nursing care: state of the science.Journal of Pediatric Nursing. 2009; 25: 335-343https://doi.org/10.1016/j.pedn.2009.01.006Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar). These foundational concepts have provided a framework for nurse-led and nurse-directed practice models so very unique to nursing practice. More recently, other concepts of care promoted by pediatric nursing colleagues are now being advocated to effect widespread changes in the philosophical approaches to care, such as child-centered care (Coyne et al., 2018Coyne I. Holmström I. Söderbäck M. Centeredness in healthcare: a concept synthesis of familycentered care, person-centered care and child-centered care.Journal of Pediatric Nursing. 2018; 42: 45-56https://doi.org/10.1016/j.pedn.2019.07.001Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar; Ford et al., 2018Ford K. Dickinson A. Water T. Campbell S. Bray L. Carter B. Child centred care: challenging assumptions and repositioning children and young people.Journal of Pediatric Nursing. 2018; 43 (e39–43)https://doi.org/10.1016/j.pedn.2018.08.012Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar). These concepts of care provide the foundational framework for practice innovations. These nurse-led and nurse-directed models of care can be developed, implemented and tested as to their effectiveness for protecting and promoting health and preventing illness along the health-illness continuum in a myriad of clinical and community-based settings. Rather than viewing the work of pediatric nurses as more narrowly defined within the context of institutional boundaries, these services can be re-conceptualized as nurse-led and nurse-directed in a variety of practice settings. Other far-reaching developments that now have and will continue to have dramatic impacts on the scope of practice for advanced practice pediatric nurses is full practice authority (FPA). According to the American Association of Nurse Practitioners, “Full Practice Authority is the authorization of nurse practitioners (NPs) to evaluate patients, diagnose, order and interpret diagnostic tests and initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing” (Issues At-A-Glance: Full Practice Authority, 2021Authority In policy briefs..https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-briefDate: 2021Google Scholar; American Association of Nurse Practitioners, 2021aAmerican Association of Nurse Practitioners Issues at-a-glance: Full practice.2021Google Scholar). Currently, FPA exists for one or more categories of advanced practice registered nurses (APRNs) upon licensure/certification in 24 states, District of Columbia, Guam and Northern Mariana Islands. In 16 states, and the territories of Puerto Rico, Virgin Islands, and American Samoa FPA is contingent on “transition to practice” requirements. That is, the advanced practice nurse needs to have her/his practice monitored following licensure/certification. This professional monitoring varies from just under a thousand hours to 9000 hours of supervision (American Association of Nurse Practitioners, 2021bAmerican Association of Nurse Practitioners State practice environment.https://www.aanp.org/advocacy/state/state-practice-environmentDate: 2021Google Scholar). Ten states restrict FPA which include the highly populated states of California, Texas and Florida. These advanced practice nursing roles include the following four APRN roles: nurse practitioner (NP), certified nurse midwife (CNM), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA). Recently, the American Academy of Nursing issued the position statement entitled, Full practice authority for advanced practice registered nurses is necessary to transform primary care (Bosse et al., 2017Bosse J. Simmonds K. Hanson C. Pulcini J. Dunphy L. Vanhook P. Poghosyan L. Position statement: full practice authority for advanced practice registered nurses is necessary to transform primary care.Nursing Outlook. 2017; 65: 761-765https://doi.org/10.1016/j.outlook.2017.10.002Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar). Importantly and unequivocally, the acknowledgement of APRNs independent roles in health care was asserted and supported by the evidence of their value and benefits to promoting and improving care outcomes for recipients of APRNs with FPA.APRNs have the education, knowledge, skills, and experience necessary to provide basic and comprehensive primary care services; they are a ready workforce, ideally positioned to improve access to care, contribute to health disparities reduction efforts, and lower the cost of providing such care. (Bosse et al., 2017Bosse J. Simmonds K. Hanson C. Pulcini J. Dunphy L. Vanhook P. Poghosyan L. Position statement: full practice authority for advanced practice registered nurses is necessary to transform primary care.Nursing Outlook. 2017; 65: 761-765https://doi.org/10.1016/j.outlook.2017.10.002Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar, p. 761). These are monumental periods of change for the nursing profession. This period of change will require ever vigilant and committed leaders at all levels of practice to effect this movement forward. It is going to be an exciting adventure to observe and partake in this period of professional evolution. We at JPN look forward to contributing to this movement of change by publishing scholarly and evidence-based papers on nurse-led, nurse-directed and FPA services and programs.