Role Preservation of the Clinical Nurse Specialist and the Nurse Practitioner

Abstract

The following manuscript explores the historical development, as well as current and future roles of advanced practice nursing with specific emphasis on the clinical nurse specialist and the nurse practitioner. The term advanced practice nursing is based on the definition provided by the American Nurses Association (ANA). A statement originating from the National Association of Clinical Nurse Specialist provides the spheres of influence framework used in the critical analysis of the competencies, as well as implications for practice, role development, and scopes of practice for the clinical nurse specialist. Nurse practitioner education and development is based on the curriculum guidelines and program standards as developed by the National Organization of Nurse Practitioners. ADVANCED NURSING PRACTICE AND ISSUES OF A NEW MILLIEUM Historically advanced practice roles have lacked clarity. 1,2 Confusion regarding the educational preparation, titles, roles, and functions hampered understanding for quite some time.3 Harrell and McCullock 4 identified that words such as “specialist” or “advanced” were used to describe nursing roles without respect to educational or experiential backgrounds created confusion in the discussion of advanced practice nursing. Some institutions were using individuals with less than graduate level education in advanced practice roles, while others with graduate degrees lacked certification (American Association of Colleges of Nursing. 5 The educational background of the advanced practice nurse (APN) varied from state to state. These issues proved to be confusing for institutional management, nursing personnel, health care team members, as well as clients. Great strides have been made by the nursing profession to alleviate confusion, provide continuity and insure quality educational preparation for the advanced practice nurse. The American Academy of Nurse Practitioners has developed a number of statements that addressed standards of practice, curriculum and roles. 6,7,8 The American Nurses Association (ANA) 9 developed the Scope and Standards of Advanced Practice Registered Nursing in 1995, and the American Association of Colleges of Nursing (AACN) 10 produced The Essentials of Master's Education for Advanced Practice Nursing in 1996. That same year the ANA 11 published the Model Practice Act, a document that provided states with a recommendation for the incorporation of APNs into the mix of healthcare providers. The National Association of Clinical Nurse Specialists (NACNS) 12 produced their Statement on Clinical Nurse Specialist Practice and Education in late 1998. This document provided a solid base from which to clearly identify the clinical nurse specialist from other advanced practice nurses. The AACN 5 published its position statement on Certification and Regulation of Advanced Practice Nurses in 1998. Collectively these efforts provided the backbone for consistency among the advanced practice nurse population.