Randy Fink Frontier Nursing University December 5 th, 2012

 A Registered Nurse trained in one of four advanced practice roles at the graduate level (National Council of State Boards of Nursing, 2008)

 Certified Nurse Practitioner  Clinical Nurse Specialist  Certified Nurse-Midwife  Certified Registered Nurse Anesthetist

 Anesthesia care through the lifespan  Surgery  Obstetrics  outpatient (American Association of Nurse Anesthetists [AANA], 2012a)

BSN 1 year critical care experience graduate from accredited CRNA school with minimum MSN and pass national certification (AANA, 2012a) 112 CRNA programs nationwide 9 programs in Florida (Best Nursing Degree, 2012a) 3500 CRNAs in Florida (Florida Association of Nurse Anesthetists, 2012 )

 Primary healthcare to women  Physical exams  Prescriptions  Laboratory testing  Gynecological care  Labor, birth, and prenatal care  Counseling and health education (American College of Nurse-Midwives [ACNM], 2012a)

 Birth centers  Hospitals  Outpatient  Homes (ACNM, 2012b)

 RN  Graduate level CNM program  National certification (ACNM, 2012c)  38 CNM programs nationwide  2 programs in Florida (Best Nursing Degree, 2012b)  722 Florida CNMs (Florida Department of Health [FDOH], 2012)

 Specialized care for: ◦ Population ◦ Setting ◦ Type of care, problem or disease (National Association of Clinical Nurse Specialists [NACNS],2012)

 RN  MSN or Doctoral  Advanced Clinical Training  Specialization certification (NACNS, 2012)  193 CNS nationwide  4 programs in Florida (Best Nursing Degree, 2012c)  272 CNS in Florida ◦ Divided into 8 specialties:  Adult, pediatric, adult health, medsurg, gerontology, adult mental health, child mental health, community health (FDOH, 2012)

 Primary, preventive, chronic, acute, or specialty care  Autonomously or in collaboration  Outpatient ◦ Office, clinic, retail  Inpatient (American Academy of Nurse Practitioners [AANP], 2012)  Numbers ◦ 180, 233 Nurse Practitioners ◦ 12, 677 Florida NPs (Pearson Report, 2012)

 Order and interpret x-rays  Order and interpret diagnostic labs  Prescribe medications and treatments  Patient education and counseling  Manage chronic and acute conditions  Utilize Nursing Process (ADPIE): ◦ Assess ◦ Diagnose ◦ Plan ◦ Implement ◦ Evaluate (AANP, 2012)

 Family Health  Sub-specialties (systems) (AANP, 2012) Acute healthAdult Health GerontologyNeonatal OncologyPediatric PsychiatricWomen’s Health

 RN  MSN or Doctorate  Certification/specialty (AANP, 2012)  Over 350 universities nationwide ◦ 850 different program tracks  15 programs in Florida (Best Nursing Degree, 2012d)

 Each state defines ◦ Scope ◦ Roles ◦ Prescriptive authority  19 states no physician required  32 states require physician involvement (Pearson Report, 2012) ◦ Diagnosis and treatment  27 states no physician involvement  24 states require physician involvement (Pearson Report, 2012)

 Joint regulations: ◦ Board of Nursing/Board of Medicine ◦ Physician involvement required  Written agreement between:  MD, DO, DDS (FDOH, 2007)

 NP Functions: ◦ History and physicals ◦ Diagnostic studies ◦ Well care ◦ Preventive care ◦ Patient Education ◦ Drug therapies ◦ Medical treatments ◦ Minor procedures (FDOH, 2007)

CRNA Civil War st program in Portland, OR st national organization Principal anesthesia providers in military (AANA, 2012b)

 CNS ◦ Early 20 th century ◦ Push for curriculum standards ◦ 1950s psychiatric clinical specialist ◦ Today CNS highly specialized (Fulton, Lyon, & Goudreau, 2012)

 CNM ◦ Early colonists ◦ 1920s nurse midwifery profession  High infant and maternal mortality ◦ 1920s Mary Breckenridge Frontier Nursing Service  1939 Frontier Graduate School of Midwifery (My Midwife, 2012)

 CNP ◦ st NP program in Colorado ◦ NP programs ◦ 1985 AANP established  Increased standardization (AANP, 2012)

 Legislative ◦ Medicare reimbursement 1990 (rural areas) ◦ Balanced Budget Act 1997 (all locations) (Medicare Payment Advisory Commission, 2002) ◦ Affordable Care Act  Then and Now ◦ 1960s: birth of CNP ◦ Today: CNS mainstream care  CNPs found in ½ primary care offices (U.S. Department of Health And Human Services, 2011)

 Occupational Health Clinic ◦ Convenience Sample  Patient Satisfaction = 89.1% (Guzik, Menzel, Fitzpatrick, & McNulty, 2009)

 Systematic literature review = ◦ CNP/CNM/CNS  Outcomes and quality = or> than MD (Newhouse et al., 2011)

American Academy of Nurse Practitioners (2012). What's an NP? Retrieved from American Association of Nurse Anesthetists (2012a). Become a CRNA. Retrieved from American Association of Nurse Anesthetists (2012b). History of nurse anesthesia practice. Retrieved from American College of Nurse-Midwives (2012a). About midwives. Retrieved from American College of Nurse-Midwives (2012b). Definition of midwifery and scope of practice of certified nurse-midwives and certified midwives. Retrieved from College of Nurse-Midwives (2012c). Become a Midwife. Retrieved from Best Nursing Degree (2012a). Certified registered nurse anesthetist programs. Retrieved from Best Nursing Degree (2012b). Nurse-midwife programs. Retrieved November 8, 2012, from Best Nursing Degree (2012c). Clinical nurse specialist degree programs. Retrieved from Best Nursing Degree (2012d). Nurse practitioner programs. Retrieved from Florida Association of Nurse Anesthetists (2012). FANA home. Retrieved from Florida Department of Health (2007). Nurse practice act. Retrieved from

Florida Department of Health (2012). Search for practitioner profile information. Retrieved from Fulton, J., Lyon, B., & Goudreau, K. (Eds.). (2012). Foundations of clinical nurse specialist Practice (1st ed.). New York: Springer. Guzik, A., Menzel, N., Fitzpatrick, J., & McNulty, R. (2009). Patient satisfaction with nurse practitioner and physician services in the occupational health setting. American Association of Occupational Health Nurses, 57(5), doi: / Medicare Payment Advisory Commission (2002). Report to the Congress: Medicare payment to advanced practice nurses and physician assistants. Retrieved from My Midwife (2012). A brief history of nurse-midwifery in the U.S. Retrieved from National Association of Clinical Nurse Specialists (2012). CNS FAQs: What is a clinical nurse specialist. Retrieved from Newhouse, R., Stanik-Hutt, J., White, K., Johantgen, M., Bass, E., Zangaro, G.,...Weiner, J. (2011). Advanced practice nurse outcomes. Nursing Economics, 29(5), Retrieved from Pearson Report (2012). Florida. Retrieved from U.S. Department of Health and Human Services (2011). Nurse practitioners, certified nurse midwives, and physician assistants in physician offices (NCHS Data Brief: No. 69). Washington, DC: U.S. Government Printing Office.

Contact information: Randy Fink