CLINICAL CHANGE

Clinical Change

Clinical Change

Introduction

Nurses in advanced clinical nursing practice have a graduate degree in nursing. They conduct comprehensive health assessments and demonstrate a high level of autonomy and expert skill in the diagnosis and treatment of complex responses of individuals, families and communities to actual or potential health problems. They formulate clinical decisions to manage acute and chronic illness and promote wellness. Nurses in advanced clinical practice integrate education, research, management, leadership, and consultation into their clinical role. They function in collegial relationships with nursing peers, physicians, professionals, and others who influence the health environment. (McLoughlin 1992).

Analysis of the Book: Leadership Roles And Management Functions In Nursing

Roles in Nurse Midwifery and Nurse Anesthesia developed in the first half of the 20th century, while the Certified Nurse Specialist and the Nurse Practitioner roles developed in the second half of the century. There were many elements that created the demand for Advanced Practice Nurses. The large number of immigrants in the early 1900s created the need for Nurse Midwives. Another thing that influenced the growth of Nurse Midwives was when the government started to become aware of the poor maternal and child health in the US when it didn't have enough healthy males to serve in the armed forces in WWI. (Komnenich 1998). Physicians also had a lack of interest in obstetrics and this increased the opportunity for nurses to fill the role of Nurse Midwife (Komnenich 1998).

Physician shortages in the 1960s created the need for clinical specialization in nursing in the form of Certified Nurse Specialists and Nurse Practitioners (Ford 1995; Komnenich 1998). Overall poor health care, especially for children, led to the development of the first Nurse Practitioner program at the University of Colorado in 1965 (Ford 1995). The practice of Nurse Practitioners has been constantly evolving since 1965, when the role was developed by Henry Silver, M.D., and Loretta Ford, R.N. (Sox 1979). Consumers liked the humanistic, health-promoting and cost-effective services that the Nurse Practitioner and the Nurse Midwife provided and this consumer demand and preference led to the expansion of these roles. This was a simple concept of supply and demand.

Nurse Anesthetists owe the biggeat part of their development to the wars (Bigbee 1996). Also, in the early 1900s physicians became more interested in surgery than in anesthesia and this provided the opportunity for nurses to move into this field (Bigbee 1996).

Government and agency funding and support have financed the developed of new programs to educate and prepare nurses in the Advanced Practice roles. "There are now approximately 100,000 Advanced-Practice Nurses, half of them Nurse Practitioners and Nurse Midwives, and half Clinical Nurse Specialists" (Nursing Facts, 1993). Although they are similar to the physician in making primary care decisions, Nurse Practitioners bring additional benefits to their practice. "Nurses are more likely to talk with patients and adapt medical regimens to a patient's preferences, family situation, and environment" (Bessman, 1974). "They are also more likely to provide disease-prevention counseling, health education, and health-promotion activities, as well as to know ...