DNP Role Development for Doctoral Advanced Nursing Practice, Second Edition

3: THE EVOLUTION OF ADVANCED PRACTICE NURSING ROLES ■ 95

representatives. In several states, APRNs have become major players in malpractice
reform, and have been integrally involved in state Medicaid legislation. As the pro-
fession has matured, APRNs have hired their own professional lobbyists and formed
political action committees. In Kentucky Association Health Plans, Inc. v. Miller, Kentucky
Commissioner of Insurance (2003) the United States Supreme Court upheld any- willing
provider law where insurers must open their networks to any provider recognized by
the state, including APRNs.
In addition to promoting external changes, APRNs have also focused inwardly to
improve the quality of practice. APRNs are reexamining the essential degree for entry-
level advanced nursing practice and moving toward unification through the Consensus
Model for Advanced Practice Registered Nurses (Advance for Nurse Practitioners, 2010;
Pearson, 2010). In addition, APRNs are moving toward uniform regulation of practice
through licensing, accreditation, certification, and education. As the nation experiences
dynamic changes in its health care system, APRNs— both master’s and now including
those doctorally prepared, stand ready to move the profession forward to provide the
highest quality universally accessible health care.

■ CRITICAL THINKING QUESTIONS

1. How have social, professional, and economic changes from the 1950s to the present influ-
   enced the APRN scope of practice?


2. How can historical factors in the evolution of the APRN shape the role and practice of future
   APRNs?


3. How is APRN practice different from generalist and medical practice? What accounts for
   its outcome in terms of patient satisfaction and health status?


4. APRN practice, particularly NP and CNM practice, may be conceptualized as built on a
   social justice foundation— to increase access to care for underserved and/ or economically
   vulnerable populations. Current APRN practice has expanded beyond these boundaries,
   and many APRNs provide health services to clients who have access to adequate health care
   services, and who have adequate financial resources. How does this fit with nursing’s val-
   ues? How does this fit with the argument that APRNs should provide lower cost care than
   physicians and care that is more accessible?


5. What factors will influence full implementation of the consensus model for APRN practice?
   How? What are the barriers to fully autonomous APRN practice?


6. What strategies could be used to increase physician support of autonomous APRN practice?


7. What are the advantages and disadvantages of APRN movement toward the consensus
   model for APRNs and uniform regulation of practice through licensing, accreditation, cer-
   tification, and education?


8. What are the factors of APRN practice that make it uniquely different from medical prac-
   tice? How do they enhance or weaken the profession?


9. What are the theoretical factors that set APRNs apart from the discipline of medicine? How
   does this theory base influence research and practice?

■ REFERENCES

Advance for Nurse Practitioners. (2010). Annual legislative updates 2000–2010. Retrieved from
http://nurse-practitioners.advanceweb.com/Editorial/Search/SearchResult.aspx?KW=
annual+legislative +update