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Emergency care. Advanced practice nursing in the US: an overview
1University of Texas-Houston School of Nursing, Houston, Texas, USA.
Summary
Advanced practice nurses (APNs), including nurse practitioners (NPs) and clinical nurse specialists (CNSs), have distinct educational paths and roles. While both can specialize in areas like emergency care, NPs focus on direct patient care, and CNSs emphasize improving nursing systems and complex patient care.
Area of Science:
- Nursing Science
- Advanced Practice Nursing
- Healthcare Systems
Background:
- The clinical nurse specialist (CNS) role in the U.S. predates the nurse practitioner (NP) role.
- Historically, CNS education has been at the master's degree level, while NP education varied but is now predominantly at this level.
- Advanced practice nurses (APNs) with master's degrees can pursue post-master's certificates for new specialties or role changes.
Purpose of the Study:
- To delineate the historical development, educational requirements, and role distinctions between CNSs and NPs in the U.S.
- To examine the specific application of NP and CNS roles within the clinical specialty of emergency care.
- To highlight the current status of scope and standards of practice for NPs and CNSs in emergency care settings.
Main Methods:
- Comparative analysis of historical educational pathways for CNSs and NPs.
- Review of regulatory and approval requirements for APN practice.
- Examination of existing and developing scope and standards of practice documents for emergency care NPs and CNSs.
Main Results:
- CNSs have a longer history in the U.S. than NPs, with consistent master's level education.
- NP education, while historically varied, is now also predominantly at the master's level.
- Both NPs and CNSs can specialize in emergency care, requiring licensure, program graduation, and state approval; certification may be necessary.
- NPs in emergency care have established scope and standards of practice, while these are under development for CNSs.
- NPs primarily provide direct patient care, whereas CNSs focus on improving nursing care systems and managing complex patient health problems.
Conclusions:
- NPs and CNSs represent distinct yet complementary advanced practice nursing roles.
- Specialization in areas like emergency care is achievable for both roles through specific educational pathways.
- The evolving development of standards of practice for CNSs in emergency care is crucial for role clarity and integration.