Randy Fink
Frontier Nursing University
A Registered Nurse trained in one of four advanced practice
roles at the graduate level (National Council of State Boards of Nursing, 2008)
Certified Nurse Practitioner Clinical Nurse Specialist Certified Nurse-Midwife
Anesthesia care through the lifespan
Surgery Obstetrics outpatient
• BSN
• 1 year critical care experience
• graduate from accredited CRNA school with minimum MSN and pass national certification
(AANA, 2012a)
• 112 CRNA programs nationwide • 9 programs in Florida
(Best Nursing Degree, 2012a) • 3500 CRNAs in Florida
Primary healthcare to women Physical exams
Prescriptions
Laboratory testing Gynecological care
Labor, birth, and prenatal care Counseling and health education
Birth centers Hospitals Outpatient Homes
RN
Graduate level CNM program National certification
(ACNM, 2012c)
38 CNM programs nationwide 2 programs in Florida
(Best Nursing Degree, 2012b)
722 Florida CNMs
Specialized care for:
◦ Population ◦ Setting
◦ Type of care, problem or disease
(National Association of Clinical Nurse Specialists [NACNS],2012)
RN
MSN or Doctoral
Advanced Clinical Training Specialization certification
(NACNS, 2012)
193 CNS nationwide 4 programs in Florida
(Best Nursing Degree, 2012c)
272 CNS in Florida
◦ Divided into 8 specialties :
Adult, pediatric, adult health, medsurg, gerontology, adult
mental health, child mental health, community health (FDOH, 2012)
Primary, preventive, chronic, acute, or specialty care Autonomously or in collaboration
Outpatient
◦ Office, clinic, retail
Inpatient
(American Academy of Nurse Practitioners [AANP], 2012)
Numbers
◦ 180, 233 Nurse Practitioners ◦ 12, 677 Florida NPs
Order and interpret x-rays
Order and interpret diagnostic labs Prescribe medications and treatments Patient education and counseling
Manage chronic and acute conditions Utilize Nursing Process (ADPIE):
◦ Assess ◦ Diagnose ◦ Plan ◦ Implement ◦ Evaluate (AANP, 2012)
Family Health
Sub-specialties (systems)
(AANP, 2012)
Acute health Adult Health
Gerontology Neonatal
Oncology Pediatric
RN
MSN or Doctorate
Certification/specialty
(AANP, 2012)
Over 350 universities nationwide
◦ 850 different program tracks
15 programs in Florida
Each state defines
◦ Scope
◦ Roles
◦ Prescriptive authority
19 states no physician required
32 states require physician involvement
(Pearson Report, 2012)
◦ Diagnosis and treatment
27 states no physician involvement
24 states require physician involvement
Joint regulations:
◦ Board of Nursing/Board of Medicine ◦ Physician involvement required
Written agreement between: MD, DO, DDS
NP Functions:
◦ History and physicals ◦ Diagnostic studies ◦ Well care ◦ Preventive care ◦ Patient Education ◦ Drug therapies ◦ Medical treatments ◦ Minor procedures (FDOH, 2007)
• CRNA
• Civil War
• 1909 1st program in Portland, OR • 1931 1st national organization
• Principal anesthesia providers in military (AANA, 2012b)
CNS
◦ Early 20th century
◦ Push for curriculum standards
◦ 1950s psychiatric clinical specialist ◦ Today CNS highly specialized
CNM
◦ Early colonists
◦ 1920s nurse midwifery profession
High infant and maternal mortality
◦ 1920s Mary Breckenridge Frontier Nursing Service
1939 Frontier Graduate School of Midwifery
CNP ◦ 1965 1st NP program in Colorado ◦ 1973 65 NP programs ◦ 1985 AANP established Increased standardization (AANP, 2012)
Legislative
◦
Medicare reimbursement 1990 (rural areas)
◦
Balanced Budget Act 1997 (all locations)
(Medicare Payment Advisory Commission, 2002)
◦
Affordable Care Act
Then and Now
◦
1960s: birth of CNP
◦
Today: CNS mainstream care
CNPs found in ½ primary care offices
Occupational Health Clinic
◦ Convenience Sample
Patient Satisfaction = 89.1%
Systematic literature review = 1990-2008
◦
CNP/CNM/CNS
Outcomes and quality = or> than MD
American Academy of Nurse Practitioners (2012). What's an NP? Retrieved from http://www.aanp.org
American Association of Nurse Anesthetists (2012a). Become a CRNA. Retrieved from http://aana.com
American Association of Nurse Anesthetists (2012b). History of nurse anesthesia practice. Retrieved from http://aana.com
American College of Nurse-Midwives (2012a). About midwives. Retrieved from http://www.midwife.org
American College of Nurse-Midwives (2012b). Definition of midwifery and scope of practice of certified nurse-midwives and
certified midwives. Retrieved from http://www.midwife.org
College of Nurse-Midwives (2012c). Become a Midwife. Retrieved from http://www.midwife.org
Best Nursing Degree (2012a). Certified registered nurse anesthetist programs. Retrieved from http://www.bestnursingdegree.com
Best Nursing Degree (2012b). Nurse-midwife programs. Retrieved November 8, 2012, from http://www.bestnursingdegree.com
Best Nursing Degree (2012c). Clinical nurse specialist degree programs. Retrieved from http://www.bestnursingdegree.com
Best Nursing Degree (2012d). Nurse practitioner programs. Retrieved from http://www.bestnursingdegree.com
Florida Association of Nurse Anesthetists (2012). FANA home. Retrieved from http://www.fana.org/default.asp
Florida Department of Health (2012). Search for practitioner profile information. Retrieved from http://ww2.doh.state.fl.us/IRM00profiling/searchform.ASP Fulton, J., Lyon, B., & Goudreau, K. (Eds.). (2012). Foundations of clinical nurse specialist Practice (1st ed.). New York: Springer.
Guzik, A., Menzel, N., Fitzpatrick, J., & McNulty, R. (2009). Patient satisfaction with nurse practitioner and physician services in the occupational health setting. American Association of Occupational Health Nurses, 57(5), 191-197. doi:10.9999/08910162-20090428-06
Medicare Payment Advisory Commission (2002). Report to the Congress: Medicare payment to advanced practice nurses and physician assistants. Retrieved from http://www.medpac.gov/documents/jun02_NonPhysPay.pdf
My Midwife (2012). A brief history of nurse-midwifery in the U.S. Retrieved from http://www.mymidwife.org
National Association of Clinical Nurse Specialists (2012). CNS FAQs: What is a clinical nurse specialist. Retrieved from http://www.nacns.org
Newhouse, R., Stanik-Hutt, J., White, K., Johantgen, M., Bass, E., Zangaro, G.,...Weiner, J. (2011). Advanced practice nurse outcomes. Nursing Economics,
29(5), 230-250. Retrieved from https://www.nursingeconomics.net/ce/2013/article3001021.pdf
Pearson Report (2012). Florida. Retrieved from http://www.pearsonreport.com
U.S. Department of Health and Human Services (2011). Nurse practitioners, certified nurse midwives, and physician assistants in physician
Contact information: Randy Fink randy.fink@frontier.edu
