advanced practice nurse (APN)

 advanced practice nurse (APN)? Role development in advanced practice nursing is described here as a process that evolves over time. The process is more than socializing and taking on a new role. It involves transforming one’s professional identity and the progressive development of the seven core advanced practice competencies (see Chapter 3 ). The scope of nursing practice has expanded and contracted in response to societal needs, political forces, and economic realities ( Levy, 1968 ; Safriet, 1992 ; see Chapter 1 ). Historical evidence suggests that the expanded role of the 1970s was common nursing practice during the early 1900s ( DeMaio, 1979 ). However, the core of nursing is not defined by the tasks nurses perform. This task-oriented perspective is inadequate and disregards the complex nature of nursing.

In the current cost-constrained environment, the pressure to be cost-effective and to make an impact on outcomes is greater than ever, but studies have shown that the initial year of practice is one of transition (  advanced practice nurse (APN) 1998 ; Brykczynski, 2009 ; Kelly & Mathews, 2001 ) and an APN’s maximum potential may not be realized until after approximately 5 or more years in practice ( Cooper & Sparacino, 1990 ). This chapter explores the complex processes of APN role development, with the objectives of providing the following: (1) an understanding of related concepts and research; (2) anticipatory guidance for APN students; (3) role facilitation strategies for new APNs, APN preceptors, faculty, administrators, and interested colleagues; and (4) guidelines for continued role evolution. This chapter consolidates literature from all the APN specialties—including clinical nurse specialists (CNSs), nurse practitioners (NPs), certified nurse-midwives (CNMs), and certified registered nurse anesthetists (CRNAs)—to present a generic process relevant to all APN roles. Some of this literature is foundational to understanding issues of role development for all APN roles and, although dated, remains relevant. This chapter has been expanded to include international APN role development experiences.

The discussion is separated into (1) the educational component of APN role acquisition and (2) the occupational or work component of role implementation. This division in the process of role development is intended to clarify and distinguish the changes occurring during role transitions experienced during the educational period (role acquisition) and the changes occurring during the actual performance of the role after program completion (role implementation). Strategies for enhancing APN role development are described. The chapter concludes with summary comments and suggestions to facilitate future APN role development and evolution.

 

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