Sunday, August 20, 2006

The Nurse Educator as an Advanced Practice Role

The changing health care delivery system has increased the demand for advanced practice nursing (APN) roles. Within a clinical framework, these roles have been clearly defined as the nurse practitioner (NP), nurse midwife, nurse anesthetist, and clinical nurse specialist (CNS). The initial purpose of these roles was to provide physician replacement and support, respond to changing reimbursement structures, and cost containment. Over time, the value of the APN on many levels has been validated and incorporated into many areas of primary care. Although the concept of advanced clinical practice is certainly inherent in these roles, the larger concept of advanced practice in nursing should be applied to other areas, including the nurse educator.
Although there is no one clear definition of advanced practice nursing, when the accepted tenets are examined, the role of the nurse educator with all of it’s inherent roles and responsibilities, as one of advanced practice, begins to appear within the framework.
The term advanced nursing practice addresses what nurses “do” in the role, and is distinguished from basic practice through specialization, expansion, and advancement. Advanced nursing practice:

  • maximizes the use of nursing knowledge
  • contributes to the development of the profession functions as a change agent and leader

Certainly, the capacity to potentiate change and promote leadership is inherent in the scope of the educator. This involves multiple roles broadly related to:

  • clinical practice
  • education
  • research
  • professional development
  • and organizational leadership

The term advanced practice nursing refers to the entire field of advanced nursing practice, and includes all of the APN roles, APN environments, and addresses the environmental factors affecting role development, implementation, and evaluation. Advanced practice nursing “is a way of viewing the world that enables questioning of current practices, creation of new nursing knowledge, and improved delivery of nursing and health care services” (Bryant-Lukosius, et al., 2004).
The concept of advancement, within the APN role, is the major key. In specialization, whether in a clinical or non-clinical role, the expansion of knowledge, skills and role autonomy is evidenced through advancement. There is an engagement in professional activities leading to innovation within the specialty (education) and nursing care (clinical education). The underlying commitment to a nursing orientation to practice is inherent. Nurse educators educate nurses (in academic, clinical, or staff development areas) regarding disease process and management from a nursing oriented perspective, to advance nursing as an art as well as a science. The information synthesis by the APN and by the nurse educator, are the same. It is the “integration of practical, theoretical, and research knowledge to accomplish the objective and assess the outcome” (Bryant-Lukosius, 2004). This integration, the application of role competencies, education, research, leadership, and ongoing professional development are the framework of an advanced practice role. Advanced practice occurs within multiple roles, not only in clinical practice.
The environment of acceptance for APN roles continues to evolve, not only in the larger healthcare environment, but also within nursing itself. The development, acceptability, and demand for APN roles is driven by societal values, expectations, and needs for nursing and health care services (Bryant-Lukosius, et al. 2004). The system influences these roles through need, as when the APN became more prevalent in community settings. Ongoing assessment or these environmental factors must be maintained and dealt with on all levels, including financial. Without ongoing and increasing financial support, the role of the APN can be considered expendable, and this is often seen in education budgets in academic a well as clinical settings.
Although the role of “educator” is inherent in the clinical APN roles (NP, CNS), role conflict, role overload, and time constraints are often cited by primary care APN’s. I stipulate that the “Educator” specialty as recognized as an APN would potentially increase patient, staff, and student satisfaction as the focus would be consistent and not part of a larger agenda. The nursing profession is responsible for defining these roles and establishing standards. The legitimacy is determined by the profession’s support, as well as identification of appropriate evidence to justify the need.

In 2005 The Scope of Practice for Academic Nurse Educators was developed by the National League for Nursing’s Certification Governance Committee. The purpose of this document is to describe academic nursing education as a specialty area and an advanced nursing practice role within professional nursing. This recognition, and the introduction of a Nurse Educator Certification exam requiring a minimum of a Masters degree points toward the establishment of the nurse educator as an accepted APN role. Certainly without such an exam, the nurse educator role meets the criteria of other accepted APN roles as has been discussed, but testing will provide the needed data to continue to justify and promote the role, leading to increased acceptance and potential financial consideration.
The current nursing shortage has presented the nursing profession with an unprecedented need on multiple fronts. No longer is the need only at the bedside and in other clinical care areas, but the need for graduate-level educated nursing faculty is overwhelming. Because of the inability of institutions to staff nursing programs, qualified applicants are being turned away or being put on waiting lists of up to three years at nursing schools around the country. The profession as a whole is shrinking in numbers related to attrition from aging, retirement, and career dissatisfaction. But, how can we “fight the fire without water?” It is only in the preparation of qualified, motivated, nurse educators that the profession can move forward on all levels. The “bar” for this area of specialization should be set high, because the nurse educators hold the future of the profession in their hands. Having these professionals maintain and exemplify the standards of advanced practice, and be recognized for the degree of advancement and scholarship that must be attained in meeting those standards is imperative. It ensures that from the new student nurse in the classroom to the seasoned nurse engaging in ongoing staff development, the “learner” will be afforded the opportunity to have the best “teacher” they possibly can, and in that, patients will have the opportunity for the best care.

References:
Bryant-Lukosius, D. et al. (2004) Advanced practice nursing role: development, implementation,
And evaluation. Journal of Advanced Nursing 48(5), 519-529.
Lindell, D. et al. (2005) The Scope of Practice for Nurse Educators, http://www.nln.org/publications/Scope/index.htm, retrieved 7/20/06

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