THE ROLE OF THE

NURSE PRACTITIONER


BY
T.PUVANA
II YEAR M.Sc.(Nusing)
INTRODUCTION
The care nurse practitioners provide
can be distributive and episodic.
Distributive cares is continuing care
that is directed toward maintenance of
health and diseases prevention,
episodic care is periodic and focus on
the patient illness or current health
care needed.
ISSUES THAT AFFECT NURSE
PRACTITIONER PRACTICE EDUCATION
The initial pediatric nurse practitioner
program began in 1965.
More NP programs followed with graduates
specializing in others clinical areas.
Still other NPs were created by on the job
training with the employing institution
providing educational approaches allowed
nurses to acquire further clinical
knowledge and skills.
Now masters degree programs and the
continuing education models are being
phased out.

The shift to master programs means
that more NPs will possess leadership
skills necessary to implement this role in
the changing job market.
THE LENGTH OF EDUCATIONAL
PROGRAMS HAS CHANGED
The average length of certificate programs was
8.5 months in 1975.
By 1980 this had increased to an average of
11.7 months.

Master degree programs the average length was
15.3 months in 1973 and 16.1 months in 1980.

With the trend toward in corporation of NP skills
under the graduate level curriculum in the
further more NPs will have masters degree.

Nurse practitioners have traditionally been
defined as nurse who completed a specialized
educational program in primary health care.

However NPs have demonstrated their ability
to deal with both acute and chromic problems
plus the collaborative and coordinating
aspects of client and family care needs.

NPs are also eligible for ANA exams, but may
also have others certifications test available
through professional boards with member
representation from nursing as well as
medicine.

LEGISLATION / CERTIFICATION
Legislative definition of nursing
practice can seriously affect the use
of NPs. Nursing literature
documents may attempts to limit
the practice of NPs by physicians.
The Florida Medical Board attempted
to limit the number of NPs employed
in that state and force tight new
controls on the practice of the NPs
already certified by the Florida State
Board of Nursing. Nurses midwives
efforts to practice independently.
Advanced registered nurses must have
graduated from a national accredited
advanced practitioner of nursing,
program or have passed a national
certification examination.
Lowa defines the ARNP as a Nurse
who is prepared for advanced nursing
practice by virtue of additional
knowledge and skills gained.

REIMBURSEMENT

Another factor affecting utilities of
the nurse practitioner is 3rd party
reimbursement. Effort have made to
allow NPs to reimbursement party
payment for their services.
IMPACT ON PATIENT CARE
Numerous studies documents positive aspects
of NPs in their effects on the health status of
clients and contribution to health care delivery.

Findings of these studies include increased
profits for the employer in some
circumstances, saving of physicians time,
improving continuity of care, consumer
acceptance and performance levels comparable
to that of physicians.
NPs FUNCTIONS
Abdellah states that

Applies the nursing process.
It is accountable to herself and t the
consumer for her service.

Behaves as a decisions maker and risk
taken.

Delivers care independently and
interdependently with other health
professionals.

She goes on to state typical setting
where the NP can function effectively in
the expanded role of primary care
provider are satellite facilities in a rural
or urban area or in acute care setting
such as intensive care units where
prompt decisions on the part of the
nurse are required.
DISTRIBUTIVE CARE
The care NPs provider can be
described as distributive and
episodic. Distributive care is
continuing care that is directed
toward maintenance of health and
disease prevention.
The ANA defines the two components as

The care the consumer receives at the
point of contact with the health care
system.

The continued care of the individual as
a health care as a health care
consumer.
THE CARE IS TWO DIMENSIONAL

The identification, management and
referral of the health problems.

The maintenance of the consumer real
by means of preventive and primitive
health care action typical practice
settings for the primary health care
nurse practitioner include out patient
clinics health maintenance
organizations.
CLINICAL SETTINGS
Direct patient care is the major activity
performed by NPs in ambulatory settings.

A relatively large portion of NP patient
care was in the area of health
maintenance.

In 1983 Scope of practice surgery found
that of more than 1,000 respondents
68% was employed in ambulatory
settings.
EPISODIC CARE
Episodic care is periodic and focuses
on the patients illness or current
health care need.

A historical review of NP employment
settings reveals that a majority of NPs
have practiced in ambulatory care
settings.


NPs have provided services to
individuals in underserved area. NPs
are well prepared to prepared to provide
care not only in distributive care
settings, but in episodic settings as well.
CLINICAL SETTING
One setting where NPs have provided care is
in hospitals, while role varied with the nature
of the clinics, NPs were found to be well
prepared to participate in management of
chronic childhood disorder.
NPs were also active in management of acute
pediatric problems, teachings patients as
well as collaborating with other health
provides in coordinating many services
required by children with complex disorders.
Another aspects of episodic care is
the potential for more satisfactory
patient care through primary nursing
by NPs in hospitals. The philosophy
of nursing promotes the blending of
professional nursing roles including
clinical practice consultation and the
opportunity for teaching and
research.
Another opportunity for NP care is
in nursing homes. The effects of
primary nursing care delivered by
fine NPs each carrying a care load of
between 30 and 35 nursing home
residents.
BARRIERS AND SOLUTIONS
Several approaches are needed to over
come barriers to NP use in episodic
care setting one of the better
communication between health care
provides are the NP.

Another solution is identification of
groups underserved by the other
provides and program area in episodic
care.
The absence of skilled nursing in
nursing homes is well documented.
Incorporation of NPs in to hospitals and
nursing homes carries with it the
potential for NPs to expand the episodic
based care to include disease,
prevention and health primitive
activities.
Solution may also be found is same
episodic care settings where NPs may
provide care instead of the physician.
[
Comprehensive nursing care of the
chronically ill and there recovering from
illness can be an economically
attractive alternative to traditional
expensive medical care.
Communication with care provides,
policymakers, and consumers regarding
benefits from NP employment in
episodic care is essential.
SUMMARY
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