Advanced practice in nursing: conceptual issues

Area of Science:

• Nursing
• Advanced Practice Nursing
• Healthcare Roles

Background:

• The definition and scope of advanced practice nursing roles are subjects of ongoing national debate.
• There is a trend towards the term "nurse practitioner" (NP) encompassing or replacing the "clinical nurse specialist" (CNS) role.
• Current discussions often lack a comprehensive conceptual approach to role integration.

Purpose of the Study:

• To review the historical development of both nurse practitioner (NP) and clinical nurse specialist (CNS) roles.
• To evaluate the strengths and weaknesses of NP and CNS roles in contemporary nursing practice and education.
• To provide a foundation for informed dialogue regarding the future of these advanced practice roles.

Main Methods:

• Historical review of the evolution of NP and CNS roles.
• Comparative analysis of the strengths and weaknesses of each role in current practice.
• Evaluation of educational models and outcomes for both roles.

Main Results:

• Both NP and CNS roles have distinct developmental trajectories and core competencies.
• Current practice and educational frameworks present challenges and opportunities for both roles.
• The tendency to replace CNS roles with NP roles lacks sufficient justification based on a comprehensive review.

Conclusions:

• Inadequate justification exists for the complete discontinuation of the CNS role in favor of the NP role.
• A broader conceptual approach is needed to guide the integration or merging of NP and CNS roles.
• Continued thoughtful dialogue among stakeholders is essential to define the future of advanced practice nursing.