POLICI
ES&PRACTICESTANDARDS•
STATENURSEPRACTICEACT
NSG6006STUDYGUIDE
5000(ROLES)
_Hist
oryandDe vel
opme nt
al Asp e
c tsofAdvancedPrac
tic
eNu r
sing
Def
ini
tio
no fadvanc
edp rac
ti
cen ur
se( APN)- Anurs
ewh ohascomp l
et
edana ccred
ite
d
g
raduate-
le
v e
le d u
cati
onp rogramp repar
in gh erorh imfort h
er ol
eofc e
rtif
iedn ur
se
p
racti
ti
oner,cert
ifi
edregis
terednursean e
s theti
st,c e
rti
fi
ednurse-
midwif
e,orcl
inica
ln ur
se
s
pe ci
al
ist
;hasp assedan at
ionalcer
tif
icat
ione xami nat
ionth
atme asur
estheAPRNr oleand
p
op ul
ati
on -focusedc ompetenci
es;ma intainsc ont
inuedcomp et
encea se v
idencedb y
r
ecert
if
icat
ion;andisli
censedtop r
acti
ceasa nAPRN
i
nvolv
esa dvancednursi
ngk nowledg
ea nds kil
ls;itisnotame di
calpr
acti
ce,al
thoughAPNs
p
erformexpan dedmedicalt
he r
apeut
icsinma n yroles
Historyo fAPNmo veme nt
Hi s
torya nde vol
u ti
ono fnursingscie nce
Kn owledged e v
elo pme nt
APNRol es
CNSsh a veas tronga ndt umultuou sh is
tory.Ov erth ep ast2 0yea rs
,t hed ep artu
re
fr
om d irectp atientc area sb eingama inf oc u
st owor kingp r
edomi n
antlyint hen urs i
ng
educationa nds ystemsi mp roveme ntd oma insh asc reat
edc on fusi
onwi t
hinn urs i
nga ndt he
publi
cb ecausen on-CNSs( e .
g .
,nu r
see d ucators,quali
tyimp roveme ntma nagers )functi
oni n
thes amec apac i
ty.Howe ver,CNSsa reu nique l
ye ducatedt op r
ovidea dv
an cedp rac
ticea nd
special
is texpe rt
isewh enwor ki
ngd i
rectl
ywi thc omp lexa ndv ul
n er
ablepa ti
ents ,edu c
a ti
ng
ands up port
ingi n t
erdiscipl
inarys taff
,a ndf ac i
li
tati
ngc han gea ndinnovat
ioni nh eal
thc a
re
systemst hatthos einot h
err olesinh ealthc arec annot.Ash e al
thca r
ereformc ont
inue sto
gainmome ntumt oi mp roveth eh eal
thc ares ystem, t
he r
ewi llb ema nyn ewop p ortuni
tiesfor
CNSs .Asma s
te r
soff le xi
bil
itya ndc r
ea t
ivi
ty ,
CNSsc and ev el
opn ewrolestome e tthen eeds
ofp ati
e ntsa ndh eal
thc ar
es y
s t
ems .F ore xa mple,inn urse-ma nagedc l
inics,p e r
hapsNPs
couldd eliv
erth ep ri
ma ryc aret op at
ientsint hema nageme n tofh ypert
ension.On cefirst-or
second-linethera pie
sori nt
erven t
ionsar efou ndtob eineffective,areferr
alc oul
db ep l
ace dto
thec ardiovascu l
a rCNSf ors pe ci
ali
zedp ha r
ma cologica ndn onpharma c
olog i
ca ltreatme nt
.
Also,th ec ardiov ascularCNSc ou l
di nteg rat
et h elateste videncet ocre at
ee ducati
on al
ma te
rialsforp atientsa ndot herhe al
thc ar
ep r
of es
s i
ona l
s.Pe rha p
saCNMwh oisc ar
ingf ora
pregnan twoma nwh od evelopsg e s
tati
on ald i
a bet
e s,pre
e clamp sia,andisinb re echp ositi
on
coulda skt hep erinatalCNSt oc ommon aget h epa t
ientbyf ollowingthep atie
n ta ndfe t
u sor
neonatei nt hep re n
a t
a lsetti
n gth r
oughh os pi
taldischargei n tothep ost
pa rt
ump hase.Th e
peri
na t
a lCNSc ou l
de stabli
shi nt
e r
ag en
c yp rocessestof acil
itatec ar
ed el
iveryac rossp racti
ce
setti
ngst op rovides e amle sst r
a nsi
ti
o nsofc are.Th ep os sibi
lit
iesa r
ee ndles sifCNSs
understan dt h
e irrole,imp roveu nderstandingoft hei mp ortanceoft hi
sr olei na dv anced
,practi
cen ur
s i
ng,andma xi
mi zet hed r
ivi
ngf orcesa ndmi ni
mizet herestr
ainingfor ce
si nt he
heal
thc aresystem.
Pri
ma r
yc areisth ef oundationoft h eevolvingU.S.hea l
thcares ystem.I facc essto
pri
ma rycarefora l
listheg oa l
,wh i
leco nt
a i
n i
ngc ostsandfocus i
ngonqu alityoutcome s ,
t h
en
NPswi llbec ruci
altoa chiev i
ngt hesea i
ms .Inou rcurr
ents y
s t
em,th er
ej ustare n'
te nough
PCPst ome etthen eeda nd ,witha nad di
tionales t
imated32mi l
li
onmor ep eoplewh owi llbe
covereda ndn eedac c
e s
st of ul
lprima r
yc are,ba sedont hePPACA,wewi llneeda dditional
provid
e r
smor et hane ver.Ph ys
ici
a nsa r
en otc hoosin
gp rima r
yc ar
ep ra ct
icef orc omp le
x
reasons.Ont heotherh and,mos tNPsc hoos epri
ma rycarep r
acti
cer ol
es( e.g.
,fa mil
y, adul
t,
andp ed i
atr
icNPs )b e
c a
u set heye nterthe sep r
og r
amss pecif
icall
ytop rovidep rimaryc are.
Twoa reasinp art
icul
armu s tbea d dre
ss edb eforeNPswi l
lb ea bl
et oc on t
ri
b utef ul
lyto
pri
ma rycaredeli
veryna t
ionwi de:
1.
Theremu stb ec han g
e si ntheou t
da t
eds tates copeofp ractic
el a wsa nd
regulat
ionsofn ursep racti
tioners.Th i
si sb ecausethev ar
iati
oni ns t
ater egul
a ti
onson
scopeofp racti
cea ndp r
e scri
b i
nga uthori
tyh asb eenama j
orba r
ri
ertou si
n gNPsf ul
lya nd
provid
ingincreaseda c
c e
s stoqu a l
i
ty,cost-effi
cientpri
ma r
yca r
e.
2.
Theremu stb esub stanti
vec hang esinh eal
thprofessi
on a
ledu c
ationtof ostertrue
coll
aborati
ona ndt eamwor ka mongp h ysi
c i
an s
,NPs ,andot herh ea
lthcar ed i
scipli
ne sin
generaltoobtai
nt hefull
b en ef
itofd i
versec omp etenci
esinherenti
nat eam.
1
, Ifbot hoft hesea rea ddre sse d, me eti
n gU. S.p ri
ma r
yc a ren e edsc ou l
db es igni
ficantly
affec t
edi nap os i
ti
v ewa y.Tod ay'
sNPs tud entsa n dg rad uat
e smu sta cc eptt hep rof essi
on al
respon s i
bil
ityf orb einga c ti
vei nt h eg ov ern anceofde l
iverys ys t
e msa ndi n f
or minga n d
chan gingp ol i
cy.Th erei st oomu cha ts taket ol ea veth istoaf ew,ort os ome on ee l
se.Th e
healthoft h eUn it
edSt ate sp op ula ti
ond ep end sonn ewmod elsofc are,ona l
lh ealt
hc a re
provide rsp r
a cti
cingt ot hef ulleste x t
e ntoft h eired ucationa n dt raini
n g ,an dons tron gteams
wh or esp ecte achot hera ndp artne rwi thp atients.NPsmu stsu p portth eire ff
or t
sa st heytak e
ana c ti
ver oleind ev el
op ings t
a bleh ealt
hc arep olicya ndc a r
ed e l
iverys ystemst ha tall
owf or
patienta cce sstop rima ryc ares erv i
c esp rovide db yNPs .
TheACNPr o l
ep rov i
de sa nop por tunityf orNPst oh aveas i
g nif
ica nti mp ac tonp at
ien t
outc ome sa tady nami ct i
mei nth eh i
s t
oryofh ealthc ared elive ry.Ast he i
rr ol
ec on ti
nuest o
evolv e,a nda sh ealt
hc ares yste msr e spon dt oma rketf or cesa nde con omi cc hang e,
opp ortun i
ti
e stod evelopt heACNPr olef u
rth erwi l
la ris
e.F utured ev el
op me ntoft heACNPr ol e
shou ldb eb as edont hee va luationoft hen e edf orth erole ,unde rstan di
n gt hes c
op eoft herole,
asse ssme n toft hep racticeoror ga nizati
on ,a ndt hes ervicen ee dsoft hep atientp opulat
ion .
Ensu ri
n gth atACNPsp rac t
ic etot h ef ullsc op eoft h ei
re d ucationa ndt rain i
ngi sina li
gnme n t
witht her eco mme nda ti
on soft heI ns t
it
u teofMe d i
ci
n e ( 20 1 1).Be cau set heACNPr ol e
cont i
nu estoe volve,participationi nn ati
on alor gan i
z ati
on stor e finec on se nsusr eg ardingrol e
comp on ents,p rogram c u rri
cu l
u m,ma r
k eti
n g,a n dr ol ee v a l
u ati
on i sn ece ssa ry.ACNP
educ atorsa n dc l
iniciansmu stwor kt og ethe rtoe n suret hatt h ep rep a r
ationa ndp ract
iceof
ACNPsi ss afe,e f
fective,a n dfu l
lyr epresen teda st h emov eme ntofdoc toralAPNe ducation
evolv es.ACNPsmu stb es tron ga c ti
v i
stsi ne ffortst og ainfullr e c
og nitionoft he i
rr olewith i
n
thei
rp r
op ers cop eofp racticea cros sa cutec ares ettin
g s.Int hise volv i
ngh ealthc area r
en a,
ACNPp racticeisr apidlye xpa nd i
nga n dhol dsu n l
imitedp otential.On g oingc hall
en g esinclud e
ensu ri
n ge xpa nsi
onoft h eACNPwi thaf oc usona d vance dp rac ti
cen ursin g,rathe rthana sa
phys ici
a nrep laceme ntmod e lofc are .
Nu r
s e-midwiferyp rac ti
c ee nc omp a sse saf ull r
an geofp rima ryh ealthc ares ervicesfor
wome n,f rom a dolesce nceb eyon dme nop a use.Th eses erv i
c esi nc lud et hei n d ependen t
provisionofp rimaryc are,g ynec olog ica n df ami l
yp l
a n ni
ngs ervices ,p recon cep ti
onc are,
preg nan cyc are,chil
d birt
ha ndt hep os tpartump e
riod ,careoft h en orma ln ewb ornd uri
ngt h e
fi
rst2 8da yso fli
fe,an dt r
e atme ntofma l
ep art
n ersf orse xuall
yt ransmi ttedi nfection s.CNMs
providei ni
tiala ndon goingc omp rehens i
v ea sses sme nt,d iag nos i
s ,a n dt reatme nt.Th e y
cond uctp hysicalex ami nations ,pr esc r
ibeme dications,i ncludin gc on trolleds ub sta ncesa nd
cont raceptiveme t
hod s,a dmi t,ma n ag e,an dd ischarg epa tient
sf romb i
r thc entersorh osp i
tals,
orde ra ndi nterpretlab oratorya ndd iag nos t
ict ests ,an dor de rt heu seofme dica ld evi
ce s.
CNMs 'c area l
soinc l
u desh ea l
thp romot ion ,d i
s e
a sep re venti
on ,an di ndiv i
du al
ize dwe llnes s
educ ationa ndc ou nseling.CNMsmu std emon stratet hattheyme ett hec or ec omp e tenciesfor
basicmi dwife r
yp racticeoft heACNM( ACNM,2 008 b)a ndmu stp ract icei na ccorda ncewi th
theACNMs t
a ndardsf ort hep r
a cticeofmi dwi f
e r
y( ACNM, 20 11 d).Wi thc ons t
an tc hang esin
healthc ar
e ,CNMsma yn eedt oe xp an dth eirk nowle dgea nds k i
llsb ey ondt ha tofb asicCNM
pract i
ce .Ad van cedCNM s kil
ls,s u cha sl eve l1u ltr
as oun dora ctinga sf i
rsta ssist
a ntin
surge ry,ma yb ein corpor atedi ntoaCNM' sp ra cti
cea sl on ga st heCNM f ol l
owst h e
recomme nda ti
onsf ora cqu iri
n gth e ses kil
lsb yob tainingf orma ldid actica n dc l
inic altr
a i
ning
toe nsu retha tthead van ceds k i
llisa cquir
e da n dmon it
or edtoe ns urep a t
ien tsafe t
y .
, Thereh avebe e
nma nyr ecentp osi
ti
vea dva
ncesinn urse
-mi dwif
erya n
db et
we e
nn urse
-
midwifer
ya ndt heb road e
rh e a
lthc ar
es yst
em.Th eACNM h a
sb e e
nr eac
hingou tto
profe
ssionalnursi
ng,mid wif
ery,me di
cal
,poli
cy,andpubli
ch ea
lthcoll
eague snati
onal
lyand
i
nternati
onal
ly.Thereh a
sb eenin t
ern
ati
onalrecogni
ti
onoft hen e
edf ormor emidwivesto
re
d ucema ter
nalandn eon at
almor tal
it
y.IntheUnit
edSt at
es,theIOM report,t
heF ut
ureof
Nu r
si
ng ,a
ndp assageoft hePPACAh asp l
acedCNMsa n
dotherAPRNsi nap ar
tner
shi
pr ol
e
i
nr edesi
gningtheh ea
lthc ar
es ystemforthefutur
e.Fromami dwifer
yp er
sp ect
ive
,weh ope
th
a tthi
ss y
stemwi l
lhon orwome na ndofferthe
ms upporti
nreali
zingthep owerthatcomes
withthechoic
eofawoma n-c
enteredhealt
hc ar
esyst
em.
Nurseanesthe
sia,theearl
iestnurs
ingspecia
lty,wasalsoth
ef i
rstnur
singspecia
ltytohave
s
tandar
d i
zede duc
ati
onalp r
ograms,ac erti
fi
cat
ionp r
oc es
s,ma ndat
oryc ont
inui
nge ducat
ion,and
r
ecert
if
icat
ion.Nurs
ea nest
h e
ti
stshav ebeeninv
olvedi nthedevel
opme n
tofa n e
sthet
ictechni
ques
a
longwi t
hp hysi
cian
sa nde ngine
ers.CRNAsh aveb eenn u
rsi
n glea
dersi nob t
ain
ingth i
rd-
par
ty
r
eimburse
me ntforprofes
sionalserv
icesa ndinc opi
n gwithchall
engess ucha sthep r
ospecti
ve
p
a ymentsyst
em,ma nage
dc are
,andph ys
ici
ansup e
rvi
sion.Nurs
ea nes
thet
istsprovi
desurgi
caland
2
ES&PRACTICESTANDARDS•
STATENURSEPRACTICEACT
NSG6006STUDYGUIDE
5000(ROLES)
_Hist
oryandDe vel
opme nt
al Asp e
c tsofAdvancedPrac
tic
eNu r
sing
Def
ini
tio
no fadvanc
edp rac
ti
cen ur
se( APN)- Anurs
ewh ohascomp l
et
edana ccred
ite
d
g
raduate-
le
v e
le d u
cati
onp rogramp repar
in gh erorh imfort h
er ol
eofc e
rtif
iedn ur
se
p
racti
ti
oner,cert
ifi
edregis
terednursean e
s theti
st,c e
rti
fi
ednurse-
midwif
e,orcl
inica
ln ur
se
s
pe ci
al
ist
;hasp assedan at
ionalcer
tif
icat
ione xami nat
ionth
atme asur
estheAPRNr oleand
p
op ul
ati
on -focusedc ompetenci
es;ma intainsc ont
inuedcomp et
encea se v
idencedb y
r
ecert
if
icat
ion;andisli
censedtop r
acti
ceasa nAPRN
i
nvolv
esa dvancednursi
ngk nowledg
ea nds kil
ls;itisnotame di
calpr
acti
ce,al
thoughAPNs
p
erformexpan dedmedicalt
he r
apeut
icsinma n yroles
Historyo fAPNmo veme nt
Hi s
torya nde vol
u ti
ono fnursingscie nce
Kn owledged e v
elo pme nt
APNRol es
CNSsh a veas tronga ndt umultuou sh is
tory.Ov erth ep ast2 0yea rs
,t hed ep artu
re
fr
om d irectp atientc area sb eingama inf oc u
st owor kingp r
edomi n
antlyint hen urs i
ng
educationa nds ystemsi mp roveme ntd oma insh asc reat
edc on fusi
onwi t
hinn urs i
nga ndt he
publi
cb ecausen on-CNSs( e .
g .
,nu r
see d ucators,quali
tyimp roveme ntma nagers )functi
oni n
thes amec apac i
ty.Howe ver,CNSsa reu nique l
ye ducatedt op r
ovidea dv
an cedp rac
ticea nd
special
is texpe rt
isewh enwor ki
ngd i
rectl
ywi thc omp lexa ndv ul
n er
ablepa ti
ents ,edu c
a ti
ng
ands up port
ingi n t
erdiscipl
inarys taff
,a ndf ac i
li
tati
ngc han gea ndinnovat
ioni nh eal
thc a
re
systemst hatthos einot h
err olesinh ealthc arec annot.Ash e al
thca r
ereformc ont
inue sto
gainmome ntumt oi mp roveth eh eal
thc ares ystem, t
he r
ewi llb ema nyn ewop p ortuni
tiesfor
CNSs .Asma s
te r
soff le xi
bil
itya ndc r
ea t
ivi
ty ,
CNSsc and ev el
opn ewrolestome e tthen eeds
ofp ati
e ntsa ndh eal
thc ar
es y
s t
ems .F ore xa mple,inn urse-ma nagedc l
inics,p e r
hapsNPs
couldd eliv
erth ep ri
ma ryc aret op at
ientsint hema nageme n tofh ypert
ension.On cefirst-or
second-linethera pie
sori nt
erven t
ionsar efou ndtob eineffective,areferr
alc oul
db ep l
ace dto
thec ardiovascu l
a rCNSf ors pe ci
ali
zedp ha r
ma cologica ndn onpharma c
olog i
ca ltreatme nt
.
Also,th ec ardiov ascularCNSc ou l
di nteg rat
et h elateste videncet ocre at
ee ducati
on al
ma te
rialsforp atientsa ndot herhe al
thc ar
ep r
of es
s i
ona l
s.Pe rha p
saCNMwh oisc ar
ingf ora
pregnan twoma nwh od evelopsg e s
tati
on ald i
a bet
e s,pre
e clamp sia,andisinb re echp ositi
on
coulda skt hep erinatalCNSt oc ommon aget h epa t
ientbyf ollowingthep atie
n ta ndfe t
u sor
neonatei nt hep re n
a t
a lsetti
n gth r
oughh os pi
taldischargei n tothep ost
pa rt
ump hase.Th e
peri
na t
a lCNSc ou l
de stabli
shi nt
e r
ag en
c yp rocessestof acil
itatec ar
ed el
iveryac rossp racti
ce
setti
ngst op rovides e amle sst r
a nsi
ti
o nsofc are.Th ep os sibi
lit
iesa r
ee ndles sifCNSs
understan dt h
e irrole,imp roveu nderstandingoft hei mp ortanceoft hi
sr olei na dv anced
,practi
cen ur
s i
ng,andma xi
mi zet hed r
ivi
ngf orcesa ndmi ni
mizet herestr
ainingfor ce
si nt he
heal
thc aresystem.
Pri
ma r
yc areisth ef oundationoft h eevolvingU.S.hea l
thcares ystem.I facc essto
pri
ma rycarefora l
listheg oa l
,wh i
leco nt
a i
n i
ngc ostsandfocus i
ngonqu alityoutcome s ,
t h
en
NPswi llbec ruci
altoa chiev i
ngt hesea i
ms .Inou rcurr
ents y
s t
em,th er
ej ustare n'
te nough
PCPst ome etthen eeda nd ,witha nad di
tionales t
imated32mi l
li
onmor ep eoplewh owi llbe
covereda ndn eedac c
e s
st of ul
lprima r
yc are,ba sedont hePPACA,wewi llneeda dditional
provid
e r
smor et hane ver.Ph ys
ici
a nsa r
en otc hoosin
gp rima r
yc ar
ep ra ct
icef orc omp le
x
reasons.Ont heotherh and,mos tNPsc hoos epri
ma rycarep r
acti
cer ol
es( e.g.
,fa mil
y, adul
t,
andp ed i
atr
icNPs )b e
c a
u set heye nterthe sep r
og r
amss pecif
icall
ytop rovidep rimaryc are.
Twoa reasinp art
icul
armu s tbea d dre
ss edb eforeNPswi l
lb ea bl
et oc on t
ri
b utef ul
lyto
pri
ma rycaredeli
veryna t
ionwi de:
1.
Theremu stb ec han g
e si ntheou t
da t
eds tates copeofp ractic
el a wsa nd
regulat
ionsofn ursep racti
tioners.Th i
si sb ecausethev ar
iati
oni ns t
ater egul
a ti
onson
scopeofp racti
cea ndp r
e scri
b i
nga uthori
tyh asb eenama j
orba r
ri
ertou si
n gNPsf ul
lya nd
provid
ingincreaseda c
c e
s stoqu a l
i
ty,cost-effi
cientpri
ma r
yca r
e.
2.
Theremu stb esub stanti
vec hang esinh eal
thprofessi
on a
ledu c
ationtof ostertrue
coll
aborati
ona ndt eamwor ka mongp h ysi
c i
an s
,NPs ,andot herh ea
lthcar ed i
scipli
ne sin
generaltoobtai
nt hefull
b en ef
itofd i
versec omp etenci
esinherenti
nat eam.
1
, Ifbot hoft hesea rea ddre sse d, me eti
n gU. S.p ri
ma r
yc a ren e edsc ou l
db es igni
ficantly
affec t
edi nap os i
ti
v ewa y.Tod ay'
sNPs tud entsa n dg rad uat
e smu sta cc eptt hep rof essi
on al
respon s i
bil
ityf orb einga c ti
vei nt h eg ov ern anceofde l
iverys ys t
e msa ndi n f
or minga n d
chan gingp ol i
cy.Th erei st oomu cha ts taket ol ea veth istoaf ew,ort os ome on ee l
se.Th e
healthoft h eUn it
edSt ate sp op ula ti
ond ep end sonn ewmod elsofc are,ona l
lh ealt
hc a re
provide rsp r
a cti
cingt ot hef ulleste x t
e ntoft h eired ucationa n dt raini
n g ,an dons tron gteams
wh or esp ecte achot hera ndp artne rwi thp atients.NPsmu stsu p portth eire ff
or t
sa st heytak e
ana c ti
ver oleind ev el
op ings t
a bleh ealt
hc arep olicya ndc a r
ed e l
iverys ystemst ha tall
owf or
patienta cce sstop rima ryc ares erv i
c esp rovide db yNPs .
TheACNPr o l
ep rov i
de sa nop por tunityf orNPst oh aveas i
g nif
ica nti mp ac tonp at
ien t
outc ome sa tady nami ct i
mei nth eh i
s t
oryofh ealthc ared elive ry.Ast he i
rr ol
ec on ti
nuest o
evolv e,a nda sh ealt
hc ares yste msr e spon dt oma rketf or cesa nde con omi cc hang e,
opp ortun i
ti
e stod evelopt heACNPr olef u
rth erwi l
la ris
e.F utured ev el
op me ntoft heACNPr ol e
shou ldb eb as edont hee va luationoft hen e edf orth erole ,unde rstan di
n gt hes c
op eoft herole,
asse ssme n toft hep racticeoror ga nizati
on ,a ndt hes ervicen ee dsoft hep atientp opulat
ion .
Ensu ri
n gth atACNPsp rac t
ic etot h ef ullsc op eoft h ei
re d ucationa ndt rain i
ngi sina li
gnme n t
witht her eco mme nda ti
on soft heI ns t
it
u teofMe d i
ci
n e ( 20 1 1).Be cau set heACNPr ol e
cont i
nu estoe volve,participationi nn ati
on alor gan i
z ati
on stor e finec on se nsusr eg ardingrol e
comp on ents,p rogram c u rri
cu l
u m,ma r
k eti
n g,a n dr ol ee v a l
u ati
on i sn ece ssa ry.ACNP
educ atorsa n dc l
iniciansmu stwor kt og ethe rtoe n suret hatt h ep rep a r
ationa ndp ract
iceof
ACNPsi ss afe,e f
fective,a n dfu l
lyr epresen teda st h emov eme ntofdoc toralAPNe ducation
evolv es.ACNPsmu stb es tron ga c ti
v i
stsi ne ffortst og ainfullr e c
og nitionoft he i
rr olewith i
n
thei
rp r
op ers cop eofp racticea cros sa cutec ares ettin
g s.Int hise volv i
ngh ealthc area r
en a,
ACNPp racticeisr apidlye xpa nd i
nga n dhol dsu n l
imitedp otential.On g oingc hall
en g esinclud e
ensu ri
n ge xpa nsi
onoft h eACNPwi thaf oc usona d vance dp rac ti
cen ursin g,rathe rthana sa
phys ici
a nrep laceme ntmod e lofc are .
Nu r
s e-midwiferyp rac ti
c ee nc omp a sse saf ull r
an geofp rima ryh ealthc ares ervicesfor
wome n,f rom a dolesce nceb eyon dme nop a use.Th eses erv i
c esi nc lud et hei n d ependen t
provisionofp rimaryc are,g ynec olog ica n df ami l
yp l
a n ni
ngs ervices ,p recon cep ti
onc are,
preg nan cyc are,chil
d birt
ha ndt hep os tpartump e
riod ,careoft h en orma ln ewb ornd uri
ngt h e
fi
rst2 8da yso fli
fe,an dt r
e atme ntofma l
ep art
n ersf orse xuall
yt ransmi ttedi nfection s.CNMs
providei ni
tiala ndon goingc omp rehens i
v ea sses sme nt,d iag nos i
s ,a n dt reatme nt.Th e y
cond uctp hysicalex ami nations ,pr esc r
ibeme dications,i ncludin gc on trolleds ub sta ncesa nd
cont raceptiveme t
hod s,a dmi t,ma n ag e,an dd ischarg epa tient
sf romb i
r thc entersorh osp i
tals,
orde ra ndi nterpretlab oratorya ndd iag nos t
ict ests ,an dor de rt heu seofme dica ld evi
ce s.
CNMs 'c area l
soinc l
u desh ea l
thp romot ion ,d i
s e
a sep re venti
on ,an di ndiv i
du al
ize dwe llnes s
educ ationa ndc ou nseling.CNMsmu std emon stratet hattheyme ett hec or ec omp e tenciesfor
basicmi dwife r
yp racticeoft heACNM( ACNM,2 008 b)a ndmu stp ract icei na ccorda ncewi th
theACNMs t
a ndardsf ort hep r
a cticeofmi dwi f
e r
y( ACNM, 20 11 d).Wi thc ons t
an tc hang esin
healthc ar
e ,CNMsma yn eedt oe xp an dth eirk nowle dgea nds k i
llsb ey ondt ha tofb asicCNM
pract i
ce .Ad van cedCNM s kil
ls,s u cha sl eve l1u ltr
as oun dora ctinga sf i
rsta ssist
a ntin
surge ry,ma yb ein corpor atedi ntoaCNM' sp ra cti
cea sl on ga st heCNM f ol l
owst h e
recomme nda ti
onsf ora cqu iri
n gth e ses kil
lsb yob tainingf orma ldid actica n dc l
inic altr
a i
ning
toe nsu retha tthead van ceds k i
llisa cquir
e da n dmon it
or edtoe ns urep a t
ien tsafe t
y .
, Thereh avebe e
nma nyr ecentp osi
ti
vea dva
ncesinn urse
-mi dwif
erya n
db et
we e
nn urse
-
midwifer
ya ndt heb road e
rh e a
lthc ar
es yst
em.Th eACNM h a
sb e e
nr eac
hingou tto
profe
ssionalnursi
ng,mid wif
ery,me di
cal
,poli
cy,andpubli
ch ea
lthcoll
eague snati
onal
lyand
i
nternati
onal
ly.Thereh a
sb eenin t
ern
ati
onalrecogni
ti
onoft hen e
edf ormor emidwivesto
re
d ucema ter
nalandn eon at
almor tal
it
y.IntheUnit
edSt at
es,theIOM report,t
heF ut
ureof
Nu r
si
ng ,a
ndp assageoft hePPACAh asp l
acedCNMsa n
dotherAPRNsi nap ar
tner
shi
pr ol
e
i
nr edesi
gningtheh ea
lthc ar
es ystemforthefutur
e.Fromami dwifer
yp er
sp ect
ive
,weh ope
th
a tthi
ss y
stemwi l
lhon orwome na ndofferthe
ms upporti
nreali
zingthep owerthatcomes
withthechoic
eofawoma n-c
enteredhealt
hc ar
esyst
em.
Nurseanesthe
sia,theearl
iestnurs
ingspecia
lty,wasalsoth
ef i
rstnur
singspecia
ltytohave
s
tandar
d i
zede duc
ati
onalp r
ograms,ac erti
fi
cat
ionp r
oc es
s,ma ndat
oryc ont
inui
nge ducat
ion,and
r
ecert
if
icat
ion.Nurs
ea nest
h e
ti
stshav ebeeninv
olvedi nthedevel
opme n
tofa n e
sthet
ictechni
ques
a
longwi t
hp hysi
cian
sa nde ngine
ers.CRNAsh aveb eenn u
rsi
n glea
dersi nob t
ain
ingth i
rd-
par
ty
r
eimburse
me ntforprofes
sionalserv
icesa ndinc opi
n gwithchall
engess ucha sthep r
ospecti
ve
p
a ymentsyst
em,ma nage
dc are
,andph ys
ici
ansup e
rvi
sion.Nurs
ea nes
thet
istsprovi
desurgi
caland
2
