Download Advanced public health nurse (APHN)

Chapter 39
The Advanced Practice Nurse in the
Community
Objectives
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Briefly discuss the historical development of the
roles of the advanced public health nurse and
the nurse practitioner.
Describe the educational requirements for
population-focused advanced practice nurses.
Discuss certification/credentialing mechanisms
in nursing as they relate to the role of the
advanced practice nurse.
Copyright © 2016 by Elsevier Inc.
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Objectives (Cont.)
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Compare and contrast the various role functions
of population-focused advanced practice nurses.
Explore current issues and concerns related to
practice.
Identify five stressors that may affect nurses in
expanded roles.
Copyright © 2016 by Elsevier Inc.
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Issues in Public Health Nursing:
Advanced Public Health Practice
Mike and Lexi are part of a coalition of
advanced public health nurses (APHNs) that
serve an interstate region. But Mike, Lexi, and
the rest of their team members all have
responsibilities that vary greatly from one
another.
APHNs have advanced degrees. Given what you
have learned so far in this course, what kinds of
roles might you imagine an APHN might take on?
Copyright © 2016 by Elsevier Inc.
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Advanced Public Health Nurse
(APHN) Titles and Roles
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Start by examining the various titles a public
health nurse with an advanced degree might
go by:
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Advanced public health nurse (APHN)
 Public health clinical nurse specialist (CNS)
 Nurse practitioner (NP)
 Clinical nurse leader (CNL)
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Definitions
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Advanced public health nurse (APHN)
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Nurse with an advanced degree who takes leadership
roles in applying nursing process and public health
sciences to achieve specific health outcomes for the
community
Public health clinical nurse specialist (CNS)
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Nurse with advanced degree who provides both direct
patient care and expert consultation to nursing staffs;
implements improvements in health care delivery
systems
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Definitions (Cont.)
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Nurse practitioner (NP)
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Advanced-degree nurse who, autonomously and in
collaboration with health care professionals and other
individuals, provides a range of primary, acute, and
specialty health care services to individuals or
families
Clinical nurse leader (CNL)
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Master’s prepared generalist who functions at the
micro-system level and assumes accountability for
health care outcomes for a specific group of clients
within a unit or area
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Historical Perspective
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Shift from institution-based health care to
population-focused health care
CNS role began in early 1960s
NP movement began in 1965 at the University of
Colorado
Physician assistant (PA) role initiated in 1965 at
Duke University
Extending the Scope of Nursing Practice (1971)
Nurse Training Act of 1971
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Competencies
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Quad Council of Public Health Nursing
Organizations (2003)
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Developed national public health competencies
specific for public health nursing (PHN) practice
(2003) based on the Core Competencies for Public
Health Professionals (2001)
Updated in 2011
Scope and Standards for Public Health
Nursing Practice (American Nurses
Association [ANA], 2013)
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APHN Educational Preparation
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Minimum education: a master’s degree
Synthesis of current knowledge and research in
the following areas:
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Nursing
Public health
Other scientific disciplines
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Educational Preparation
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Association of Community Health Nursing
Educators’ (ACHNE’s) five role characteristics of
APHNs
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Population-level health care focus
Ecologic view
Responsibility for health outcomes for populations
Partnership/collaboration using an interprofessional
approach
 Leadership in practice
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Practicum experience must—
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Take place at the population level
Be grounded in an ecologic perspective
Include measurement of outcomes
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Educational Preparation (Cont.)
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Role characteristics of NPs (master’s)
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Assessing and diagnosing
 Conducting physical examinations, ordering
laboratory and other diagnostic tests
 Developing and implementing treatment plans for
some acute and chronic illnesses
 Prescribing medications
 Monitoring client status
 Educating and counseling clients
 Consulting with, collaborating with, and referring to
other providers
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Educational Preparation (Cont.)
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Educational essentials for DNPs (doctorate
of nursing practice )
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Knowledge with a scientific underpinning
 Organizational and systems leadership
 Clinical scholarship
 Information systems
 Policy
 Collaboration
 Prevention and population health
 Advanced nursing practice
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Credentialing
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American Nurses Credentialing Center (ANCC)
certificate examinations for advanced practice
nurses (APNs)
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NP certifications renewed every 5 years
• AANP competency-based exams
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CNS certification
• Added master’s degree in public health (PH) with a
specialization in community/PH nursing
• Changed to either advanced public health nursing or
public health clinical nurse specialist; however, exams
no longer offered
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APHN-BC (board-certified) obtained through portfolio
assessment with appropriate degrees
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Advanced Practice Roles
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Clinician
Educator
Administrator
Consultant
Researcher
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Issues in Public Health Nursing:
Advanced Public Health Practice
Remember Mike and Lexi? Both work for an
interstate cooperative that comes together cyclically
for research purposes.
The rest of the year, Mike is a clinician and
administrator, whereas Lexi is a private APHN
consultant.
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So how do their responsibilities differ?
And if Mike is a clinician, how does that role fit into
public or population-based practice? As an APHN,
how is his role different from that of a nurse
practitioner?
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Clinician Roles
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APHN
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Conduct community assessments.
Identify needs of populations at risk.
Plan, implement, and evaluate population-focused
programs to achieve health goals, including health
promotion and disease prevention activities.
NP
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Assess, diagnose, and treat individuals and families.
Use protocols.
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Educator
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Increase wellness.
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Provide education about disease processes.
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Maintain and promote health.
Teach the importance of good nutrition, physical exercise,
stress management, and a healthy lifestyle.
Includes the importance of following treatment regimens
Provide anticipatory guidance on the use of the
following:
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Medications
Diet
Birth control methods
Other therapeutic procedures
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Administrator
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May be responsible for and have direct or indirect
authority and supervision over the organization’s
staff and patient care
Serves as a decision maker and problem solver
May also be involved in other business and
management aspects, such as the following:
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Supporting and managing personnel
Budgeting
Establishing quality control mechanisms
Program planning and influencing policies
Public relations
Marketing
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Consultant
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Lexi works as a consultant, sometimes traveling
to help communities deal effectively with
population-based health challenges. So what
are the responsibilities of a PH consultant?
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Problem solving with an individual, family, or
community to improve health care delivery
Steps of the consultation process:
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Assessing the problem
Determining the availability and feasibility of resources
Proposing solutions
Assisting with implementing a solution, if appropriate
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Quick Recall
We have learned that as an APHN, Mike acts as a
clinician. Which of the following roles is he likely to
assume most often?
A. Support and manage personnel.
B. Identify the needs of a population at risk.
C. Teach a parent and child how to use an inhaler.
D. Establish marketing strategies for his agency.
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Get That?
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APHN clinician roles include the following:
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Conducting community assessments
Identifying needs of populations at risk
Planning, implementing, and evaluating populationfocused programs to achieve health goals, including
health promotion and disease prevention activities
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Research Role
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Twice yearly, both Mike and Lexi operate as part
of a research forum. As APHNs, their role in
research includes the following tasks:
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Conducting their own investigations
Collaborating with doctorate-prepared nurses
Purpose: to answer questions related to nursing
practice and primary health care
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Arenas for Practice
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Primary care
Independent practice
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Nursing centers
Retail clinics
Faith community nursing/parish nursing
Institutional settings
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Ambulatory/outpatient clinics
 Emergency departments
 Long-term care facilities
 Industry/occupational health
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Arenas for Practice (Cont.)
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Government
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U.S. Public Health Service
Armed services
Public health departments
Schools
Other arenas
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Home health agencies
Correctional institutions
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Issues and Concerns
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Legal status
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Reimbursement
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Rural Health Clinic Services Act
Institutional privileges
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Prescriptive authority
Criteria vary by hospital and state
Most require national certification
Employment and role negotiation
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Portfolios of credentials and samples of professional
accomplishments
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Role Stress
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Professional isolation
Liability
Interprofessional collaborative practice
Conflicting expectations
Professional responsibilities
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Trends in APN
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Effects of Patient Protection and Affordable
Care Act (PPACA) and Healthy People 2020
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Increased need for practitioners
 Need for population-focused APHNs and NPs
 Prominence of interprofessional education and
practice
 Team-based and patient-centered care
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