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Nurse anesthetists, nurse midwives, and nurse practitioners, also referred to as advanced practice registered nurses (APRNs), provide and coordinate patient care and they may provide primary and specialty health care. The scope of practice varies from state to state.

BACKGROUND: The trauma service experienced preventable delays caused by an Accreditation Council for Graduate Medical Education work restrictions and a 16% increase in patient census. Furthermore, nurses needed a consistently accessible provider for the coordination of care. We hypothesized that using experienced acute care nurse practitioners (ACNPs) on the stepdown unit would improve throughput and decrease length of stay (LOS) and hospital charges. Moreover, we hypothesized that adding ACNPs would improve staff satisfaction. On December 1, 2011, the Vanderbilt University Medical Center Division of Trauma reassigned ACNPs to the stepdown area 5 days a week for a pilot program. METHODS: LOS data from December 1, 2011 through December 1, 2012 was compared with data from the same months from the previous two years and estimated hospital charges and patient days were extrapolated. Physician and nursing surveys were performed. Data from 2010 (n = 2,559) and 2011 (n= 2,671) were averaged and the mean LOS for the entire trauma service was 7.2 days. After adding an experienced ACNP, the average LOS decreased to 6.4 days, a 0.8 day reduction. Per patient, there was a $ 9,111.50 savings in hospital charges, for a reduction of $27.8 million dollars in hospital charges over the 12 month pilot program. RESULTS: A confidential survey administered to attending physicians showed that 100% agreed that a nurse practitioner in the stepdown area was beneficial and helped throughput. Dayshift nurses were surveyed, and 100% agreed or strongly agreed that the ACNPs were knowledgeable about the patient's plan of care, experienced in the care of trauma patients, and improved patient care overall. CONCLUSION: The addition of experienced ACNPs resulted in the decrease of overall trauma service LOS, saving almost $9 million in hospital charges

This is a nice synopsis of key moments in history that have triggered the growth and development of the NP role in the US.

"Council of Primary Care Nurse Practitioners, a move that helped solidify the role of Nurse Practitioners in the United States health care system"

The purpose of this hermeneutic phenomenology (van Manen, 1990) was to gain insight into the meaning and lived experience of nurse practitioners (NP) with at least one year of work experience regarding their initial transition from new graduate to hospital-based practitioner. This study provided information regarding NP hospital-based transition experience that had not been revealed in the nursing literature. The meaning of transitioning into hospital-based practice was discovered through analysis of nurse practitioner letters and interviews in this phenomenological study. Six themes emerged from this research including: Going from expert RN to novice NP; system integration; "Don't Give Up"; Learning "On the Fly"; They Don't Understand my NP Role; and Succeeding Through Collaboration.   Master's prepared, board-certified NPs in North Carolina (NC) with between one and three years of NP practice experience in a hospital setting comprised the population of interest for this study. Twelve participants were purposefully sampled from nine hospitals in NC. Individual, voice-recorded, in-depth, open-ended telephone interviews were conducted with each participant.   The majority of the participants indicated a timeframe that ranged from six to 18 months regarding how long it took them to feel more comfortable in their NP role, the lack of comfort was most intense during the first nine months of practice. Participants confronted multiple obstacles and challenges as new NPs. These challenges included navigating and negotiating a new health care provider role; becoming integrated into a hospital system in what was a new role for them and sometimes for the system; learning how to function effectively as a NP while simultaneously working to re-establish themselves as proficient clinicians with a newly expanded practice scope; building key relationships; and educating physicians, hospital leaders, clinical staff, patients, and families about the NP

Important Note: Nursing licensure and practice requirements are subject to change. Nursing License Map makes its best effort to keep content accurate; however, the official source is the State Board of Nursing. Make sure to confirm licensing requirements with the Georgia State Board of Nursing before applying for licensure or renewal.

This is a link to the American Nurses Credentialing Center on renewing your nursing certification

New advance practice nurses can use these tips to help them face the challenges of their new positions.

This article chronicles the history of nursing and how expanding the role of nurses was initially justified. It discusses how this expanded role eventually became the role of the nurse practitioner that we are familiar with today.

I found this article to be completely fascinating as I was almost completely unaware of the history of the APRN role. I have heard of Lillian Wald and Mary Breckenridge but didn't know the full extent of their backgrounds. I enjoyed the history provided in this article and feel that it was a perfect reading to begin my APRN transition. It provided some important information on how the role of the nurse changed and was diminished by ourselves (ANA) before being re-expanded in the 1960s with the role of the NP. I'd love to hear what others think and if you have other interesting historical articles on the background of the APRN role!

Great article on nursing residency programs and the opportunities they provide. BONUS- includes insight from an Emory NP Alum who completed a residency program in Washington!!

Faced with a shortage of primary care doctors, more and more clinics are relying on nurse practitioners to fill the gap. But that creates another gap, in the level of training providers bring to the job. Residency programs--once reserved for physicians--are popping up for nurse practitioners as well.

This article describes the results of a survey conducted of nurse leaders in Latin America and the Caribbean about their perception and knowledge of advance practice nursing. The results show that the majority of nurse leaders recognize a need for APRNS in order to create better access to care, however, the nursing education and legislation in the majority of the countries does not support APRN practices. This is an interesting introduction of APRNs in Latin America and the Caribbean for anyone who has interest of working in these areas.

The primary role of a pediatric acute care nurse practitioner is to provide care for acutely, critically and chronically ill children from newborn to 21 years old. In rare cases, care is extended to individuals older than 21.

The article provides a good comprehensive timeline of the history of Advanced Practice Nurse specialties.

Well written easy to understand article clearly maps out requirements and varying options for process to become AGACNP

Well written easy to understand article clearly maps out requirements and varying options for process to become AGACNP

My intended area of practice is in HIV nursing. In my last post I provided a link to the competencies needed to be an advanced practice nurse in the field, and I talked a little bit about steps I'm taking to close that gap. To hopefully move me along the continuum from novice to expert. I thought this article was interesting and provided a broader approach in how nurses might use residency program for exactly that purpose. The article talks about DNPs but it is no different for the MSN prepared nurse. It seems that residencies may become more the norm in the future - and that might be good for all, new nurses and patients alike.