Advanced Nurse

Practitioners
Advanced Nurse Practitioners (ANPs) are highly experienced and educated nurses who
are able to assess, investigate, diagnose, and prescribe.
What is an ANP?
Definition
'' An Advanced Nurse Practitioner (ANP) is an experienced and highly educated
Registered Nurse who manages the complete clinical care for their patient, not solely any
specific condition. Advanced practice is a level of practice, rather than a type of
speciality of practice.
ANPs are educated at Masters Level in advanced practice and are assessed as competent
in this level of practice. As a clinical leader they have the freedom and authority to act
and accept the responsibility and accountability for those actions. This level of practice is
characterised by high level autonomous decision-making, including assessment,
diagnosis, treatment including prescribing, of patients with complex multi-dimensional
problems. Decisions are made using high level expert, knowledge and skills. This
includes the authority to refer, admit and discharge within appropriate clinical areas.
Working as part of the multidisciplinary team ANPs can work in or across all clinical
settings, dependant on their area of expertise.''

Nurse Practitioner Scope of Practice

> a nurse practitioner utilizes theoretical knowledge and scientific process in
practice, the NP has a unique combination of skills that provide a broad range of
practice options. The more commonly recognized responsibilities of an NP include
health care provider, educator, consultant, researcher, administrator, and coach.
And, because NPs have consistently focused on health promotion and ways to
reduce the impact of disease, their services have become well-respected by patients
and physician colleagues alike.

> For new NPs, the scope of practice will now extend to the medical diagnosis and
treatment of patients with acute, episodic, or chronic medical conditions. Many nurse
practitioners working in specialty areas, and especially primary care, must become
skilled at using and interpreting a wide range of diagnostic tools. While NPs do not
perform complex surgical procedures, NPs can perform some invasive treatment
procedures. And, at least one state includes hospital admissions within their practice
scope.

> an NP can work in primary or specialty health care, skills that blend nursing and
primary care services can be utilized in a wide variety of settings from large
healthcare organizations to small free clinics. Nurse practitioners also provide care in
independent and collaborative practices, hospitals, specialty clinics, long-term
facilities, surgical centers, family planning clinics, school health centers, hospices,
home care agencies, and health maintenance organizations.

Standards of Practice refer to the clinical practice aspects of patient care. An NP

should follow national standards of care that are appropriate for practice in a
particular setting, such as an ambulatory, acute, or long-term care facility. There are
five primary practice standards for patient care, each with several important
components:

 Assessment
 Diagnosis
 Development of treatment plans
 Plan implementation
 Plan evaluation

Additional responsibilities include health education and promotion, patient advocacy,

quality assurance, and collaborative responsibilities. Other standards can include the
practitioner’s obligation for staying current within the practice area, self-management
of quality issues, and alignment with practice guidelines and legislative policies.

Quality standards of care are determined and monitored by several agencies,

including governmental agencies. Examples include the Joint Commission on
Accreditation of Healthcare Organizations (now known as the Joint Commission,
formerly JCAHO), the Agency for Health Care Research and Quality (AHRQ), the
National Committee for Quality Assurance (NCQA), professional societies, and
licensing boards. Some states include select standards of care in their laws. These
standards can be general in scope and relate to maintaining skill levels, or they can
be specific, as in the case of the Montana requirement that 5% of all charts be
reviewed by a physician and a peer practitioner.

The American Nurses Association (ANA) has developed the Nursing: Scope and
Standards of Practice. This document provides links to the various certifying
organizations that have published scope and standards of practice documents
detailing the processes of care in evidence-based practice for NPs in most patient
population groups, as well as other non-NP APRNs.

Prescriptive Authority
Following the certification process, the new nurse practitioner must apply for the
state Board’s prescriptive authority that governs the prescribing of medications.
Because individual state nurse practitioner prescribing laws vary and the application
process or paperwork may be handled differently, it is wise to become familiar with
the process in advance. Typically, the advanced pharmacology education needed
before this authority can be granted is completed within the NP academic program. If
additional pharmacology course work is needed, it is possible to meet knowledge
requirements through accredited continuing education. There may be variations from
state to state, but the application process usually requires that the state Board
receive proof of pharmacology education, an application form, and a fee.

While differences in state prescribing laws have diminished in recent years,

variations in authority still exist. Some states require an NP to be in collaborative
practice with a physician and need a written agreement from the physician before
providing prescriptive authority. A state Board may also require further detailed
information from the physician regarding the types and frequency of drugs that may
be prescribed within the practice. Prescribing drugs for family members or people
who are not being treated within the practice is usually not allowed.

One notable difference among states is the policy on prescribing controlled

substances. At this time, Alabama and Florida are the only states that do not allow
NPs any authority to prescribe controlled substances. Several states do not allow
NPs to prescribe controlled substances for weight management or chronic
intractable pain, while others have restrictions or limitations on the drug type, dosing,
or length of supply. Finally, a few states require the prescription to show the name of
the prescriber and the collaborating physician.