Thinking Like a Nurse (TLN) sheet Student Name: Week: Preparing for Professional Practice Knowing the Nursing Profession What is the role of the nurse in this clinical setting or with this client population? Consider: leadership, safety, teamwork, teaching, advocacy, professionalism etc. Knowing the Self What relevant knowledge and actions do I have from my education (e.g. nursing & health sciences courses), and previous life and nursing experiences? What are my strengths, limitations, assumptions? What are my learning goals for this week? Knowing the Case or Patient Population What does the diagnosis mean? What is the underlying pathophysiology? How do patients with this problem/issue typically present (signs, symptoms, emotional responses, difficulties, diagnostic test results)? What are the most common risk factors? What types of treatments (including medications) are used and why? What are the treatment priorities and why? What is the typical / usual clinical course? What is the population at risk for? What do I expect to find? What is the nursing role in caring for patients with this diagnosis? What types of assessment, communication, and nursing actions will I likely need to provide safe and effective care for my patient? During the Professional Practice Experience As a Patient Knowing the Individual . . . As a Person What makes my patient different from or the same as the “typical” cases? What’s the “normal” (i.e., baseline) for my patient? What is my patient’s story (narrative)? How do (or might) my patient’s past experiences with health & illness influence his/her responses to the pathophysiology, treatment, and care? Are there other factors affecting my patient’s health or response to care (e.g., age, social context, spirituality, personal preferences etc.)? Noticing – Gathering Cues & Information You need to gather data/ cues/ information from a wide variety of areas in order to thoroughly determine the main issues that are affecting your patient. Look for the following information: Chart Data Treatment Plan Admission note, medical history, report, progress notes (various members of health care team) Medication record, code status, treatments (IV, positioning, oxygen, diet, activity, dressings) Lab & Diagnostic Reports Cues from my Patient What do these findings mean for this patient? Patient’s perception of the situation (concerns, fears, hopes, expectations, etc.); my own observations and intuition about the patient’s needs My Assessments (initial assessment and focused cardiac, respiratory, GI, neurological, pain, skin, musculoskeletal) Interpreting – Recognizing Patterns and Interpreting Data Clinical Reasoning & Decision Making What are the most important issues and risks for my pt? Why could these things be occurring? How are these issues related to the cues and information found above? What needs to be attended to first and why? 1. 2. 3. Planning Outcomes What is the desired health status for this patient? What are short and long term goals to address the nursing issues identified above? 1. 2. 3. Actions Responding – Determining a Course of Action Rationale What course of action or interventions would best address the needs and goals for my patient identified above? How will continued noticing and interpreting influence these actions? What are the reasons for my decisions/actions? How does literature/evidence support these actions? 1. 1. 2. 2. 3. 3. After the Professional Practice Experience Reflection – On Action and Clinical Learning How did the course of action meet my patient’s needs? Were outcomes achieved? What were my strengths today? What areas could I work on? What did I learn from my patient today? What did I learn about myself? References: Gillespie, M., Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making, Nurse Education in Practice (2010), doi:10.1016/j.nepr2010.02.003) Tanner, C. A., Benner, P., Chesla, C., Gordon, D.R. (1993). The phenomenology of knowing the patient. Image: Journal of Nursing Scholarship, 25 (4), 273-280.
Whether you are currently in a nursing profession or are hoping to get into it, you may be wondering about opportunities for advancement. In the last few decades nursing has become a much-sought-after profession, as the pay is very good and jobs for nurses are steadily increasing, especially at the highly skilled level.
According to the Bureau of Labor Statistics, for instance, Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners – all types of advanced practice nurses – can expect job availability to grow at a rate of 31 percent between 2012 and 2022. This is much faster than average, and comes with an average salary of $96,460 per year or $46.37 per hour to boot.
With such excellent stats on its side, advanced practice nursing is a great profession to enter, but it does require a master’s degree. If you already have a nursing background, you may be able to enroll in a program right away. If, however, you have a lower level of certification, it may take you a little more time to get there – but you can do it!
This article will go over what an advanced practice nurse is and what they do, what the job industry looks like, and how you can get started in the field. While getting into a program, financing it, earning your degree and becoming certified may seem like a lot of steps, they are all crucial to becoming an advanced practice nurse and well worth it if this is the career of your dreams.
What Is An Advanced Practice Nurse?
Properly referred to as advanced practice registered nurses (APRNs), advanced practice nurses “provide and coordinate patient care and they may provide primary and specialty health care,” according to the Bureau of Labor Statistics. Although the exact scope of practice is defined on a state level and will therefore vary depending on where you live, they “work in a wide variety of healthcare settings, including hospitals, physicians’ offices, nursing care facilities, schools, and clinics.”
They care for patients as well as interacting with the public, often serving as a liaison between the doctor and the families of patients. Their advanced training means they have greater levels of knowledge than their RN counterparts, manifesting in greater decision-making ability and expertise in areas such as diagnosis and assessment, planning and implementation, evaluation of healthcare and record-keeping.
Although nurses have a long history of being subservient to the doctors or healthcare systems under which they work, advanced practice nurses have a chance to break this glass ceiling and become significantly more autonomous in their scope of practice and their ability to rely on their own knowledge to make decisions about patient health.
What Do Advanced Practice Nurses Do?
Advanced practice nurses serve many functions in a clinical setting. These include:
- Diagnosing patients as they come in
- Performing physical exams
- Performing other exam types, such as psychological, psychosocial, functional and developmental tests and diagnostics
- Ordering lab tests and interpreting results
- Developing differential diagnoses
- Maintaining patient records and ensuring patient privacy and clinic or hospital compliance
- Evaluating patient progress and responses to various treatments to modify treatment and care plans as necessary
- Providing counseling to patients and families
- Referring patients to other treatment facilities
- Providing consultations to patients who have yet to choose a course of action
- Dispensing medications to patients
- Participating in research studies
While registered nurses (RNs) provide many of these same services, advanced practice nurses have considerably more freedom to make decisions, suggest treatments and courses of action, and determine care for the patients with whom they work.
Not only that, advanced practice nurses often serve in a consulting capacity for the other nurses on their staffs. They may offer advice, give second opinions, help examine patients and craft treatment plans. They also often work to improve overall care in the settings at which they work and improve patient health delivery systems.
Types of Advanced Practice Nurses
Four main types of advanced practice nurse exist. In order to work in any of these positions, you must complete an applicable training program and pass the board of certification exam for that particular type of nursing.
Certified Nurse Practitioner
Certified Nurse Practitioners work in specialty areas. These range widely, from cardiology to pediatrics and women’s health, family care to surgical services, pain management and oncology. While they perform a range of services to patients and may assist doctors or other medical professionals, they are also often active in teaching and patient advocacy, and may conduct research as well. They may provide care independently in a range of settings, including doctor’s offices and hospitals, small clinics and other settings.
Certified Registered Nurse Anesthetist
This type of advanced practice nurse provides anesthesia to a wide range of patients in a variety of care settings. They are certified to provide a full spectrum of anesthesia care, including for surgical procedures, and may work with healthy to very sick individuals of all ages and all levels of acuity, including patients who cannot give consent or are in life-threatening condition.
Certified Nurse Midwife
A Certified Nurse Midwife (CNM) provides many of the same services as a gynecologist and midwife combined. Not only does a CNM help women with contraceptive control and gynecologic care as well as family planning, she assists in all stages of the pregnancy cycle. This includes initial consultations as well as prenatal visits and exams and postpartum care for the mother and care of the newborn. A nurse midwife also spends a lot of her time actually assisting in births, and may either work outside the hospital in women’s homes, or inside the hospital with her own practice, where she is able to make many of the critical care decisions, if not all. The level of autonomy depends on the state and the clinical setting.
Clinical Nurse Specialist
A Clinical Nurse Specialist, as indicated by the title, specializes in a certain area of medicine. These areas include:
- Setting: You may earn your specialty depending on where you work, such as in a clinic, in critical care or in the emergency room.
- Population: Your specialization may link to the population you serve, such as children, women or the elderly.
- Disease: You may choose to focus on a specific disease or group of diseases, such as cancer (oncology), heart disease or diabetes.
- Health Problem: If you choose to specialize in specific issues such as pain, wounds or stress, you may specialize in a health problem area.
- Care Type: You can specialize in care type, such as psychiatric or rehabilitative, if you wish to work with a specific type of patient undergoing a specific health condition.
Clinical Nurse Specialists – like all the advanced practice nursing types – do also provide primary patient care to those under their scope.
Can You Work On Your Own?
This is a question that many potential advanced practice nurses are interested in, since nursing has historically been a field that lacks autonomy. The answer is a partial yes: As an advanced practice nurse, some states allow you to actually have your own office or clinic, or to work independently in a larger setting. This is not true for all states at this time, however; according to the American Association of Colleges for Nursing, in fact, only 16 states authorize advanced practice nurses to operate independently without “physician collaboration or supervision.” In states where this is not allowed, advanced practice nurses must remain officially under the auspices of a doctor or a medical institution. However, advanced practice nurses are authorized to receive Medicaid reimbursement.
However, in a full 45 states, advanced practice nurses are authorized to dispense medication, meaning that they can very often complete the complete cycle of care on their own, from patient check-in and diagnosis to treatment plan and prescription of treatments and medications as well as follow-up visits.
Keep in mind that some advanced practice nursing jobs require by definition a larger setting, such as anesthetists, who have to work under doctors or surgeons in order to fulfill their roles. Many state laws also restrict the movements of midwives of any kind, including Certified Nurse Midwives, so the rules may be different for that scope of practice than for others.
Job, Salary and Benefits
As mentioned above, advanced practice nurses can expect a rapidly growing set of job opportunities across the country as well as a very decent salary. Because of the growing number of jobs, advanced practice nurses can expect:
- A wide range of settings in which to work
- An abundance of jobs in a range of available specialties
- Jobs to be available in most states
- Availability of work with a range of populations, especially with the Baby Boomer generation, who are living longer but simultaneously getting sicker
- Healthcare legislation that favors them and enables them to continue to expand their scope of practice
Earning an advanced practice nursing degree and certification comes with other, less tangible benefits as well. As discussed, advanced practice nurses enjoy a significantly increase in autonomy compared to their RN counterparts. Not only that, schedules become more flexible at the advanced level, and many jobs are available with both full-time and part-time hours. Nurses are also able to choose better schedules as well, working daytime shifts and avoiding weekend work.
Additionally, a degree in advanced practice nursing may allow for more career fulfillment. Nurses at this level serve as a source of knowledge and inspiration for other nurses, and may have teaching roles both within the settings in which they work and in the wider industry. They have increased abilities to participate in research and development and contribute to the advancement of their fields as well as growing their own careers and specialties. Many people find these benefits well worth the increased workload, money and school time required to earn the certification.
So How Do You Get a Degree?
For the most part, you need a Master of Science in Nursing, or MSN, to become an advanced practice nurse. Depending on the exact nature of the work you wish to do, you may even choose to earn a doctoral degree, which those who wish to become Clinical Nurse Specialists often do. However, in most cases, a master’s degree will suffice to become an advanced practice nurse.
Prerequisites vary by program, but typically you do need a BSN, or Bachelor of Science in Nursing. Some programs may allow you to hold a bachelor’s degree in another field as long as you have also earned an associate’s degree in nursing. You will need to check the specific program to find out. You may also need a current RN license, as well as good GRE scores, a certain GPA (often, but not always, of 3.0 or above), and completion of certain courses.
Again, requirements vary by school and nursing type, but typically programs range between a year and a half to three years, and require a wide range of science, anatomy and health courses.
Remember that completing your program and earning your degree is not the same as being certified, which you will need to do at the completion of your program. The certifications vary depending on which type of advanced practice nurse you wish to become, and they are listed here. Certification requires applying and passing an exam, after which you will be able to practice as an APRN.
No matter what type of advanced practice nurse you decide to become, keep in mind that you do not need to go right into advanced practice nursing. You can start as an registered nurse (RN), or even a certified nursing assistant (CAN) or licensed practical nurse (LPN) and go from there, working for a few years before earning higher degree and certification levels.
Financing Your Advanced Practice Nursing Degree
Financing your master’s degree (or beyond) is possible through grants and scholarships, federal loans and private loans from a variety of institutions. Keep in mind that you will need to not only pay for tuition, but make sure you can pay for rent, food and any other responsibilities you may have while in school. Here is a good list of places to start when putting together your financial aid. Apply to scholarships and grants, which are free; then move to federal loans, which have flexible repayment terms; then private loans, which are usually the worst deal.
If you are still unsure whether or not this degree is for you, don’t stress. Because the industry is growing so quickly, you have plenty of time to start at a lower level in nursing and decide if the career fits your personality and goals. If it does, you can always go back to school later to get first a BSN and then an MSN. If you are sure that you want to become an advanced practice nurse, however, you can also go right through school, earning first your high school diploma, then a bachelor’s degree in nursing and finally a master’s. No matter how you approach the prospect of advanced practice nursing, good luck!