Be careful how unit uses advanced practice nurses
Resources exist for setting guidelines
Guidelines for the use of advanced practice nurses (APNs) in critical care have yet to be promulgated. Meanwhile, acute and critical care units at many hospitals are utilizing APNs in a range of clinical activities.
But many unit managers aren’t sure whether the responsibilities of those nurse specialists conform to state and local licensure rules and other regulatory constraints.
In the absence of national guidelines, head nurses can turn to several options in developing their own internal guidelines, suggests Roberta Fruth, RN, PhD, CCRN, vice president of nursing at Catholic Health Partners North, a two-hospital system in Chicago.
State hospital practice codes can offer clues to building your own set of guidelines, Fruth advises. The Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, has published practice standards that cover specific nursing roles, as do your own hospital’s medical staff bylaws, she adds.
The bylaws are particularly relevant because they contain specific information regarding clinical privileges and credentialing criteria for a range of positions, including nursing.
"These resources can serve as helpful guides to framing your department’s own guidelines until we get more specific national criteria," Fruth says.
Advanced nurses stir up controversy
But Fruth, a former Illinois chapter president of the American Association of Critical Care Nurses, cautions that those resources offer only rough outlines. It is up to each unit to determine the scope of practice for their own APNs, she states.
The issue has become important as controversy has swirled around the use of APNs. Critics, including many physicians, have questioned the broad authority given to some APNs in ordering medications and having similar decision-making powers as licensed physicians.
The issue is likely to draw increased attention to how units are employing APNs, such as clinical nurse specialists (CNSs), Fruth notes.
Earlier this year, the American Association of Critical Care Nurses Certification Corp. in Aliso Viejo, CA, introduced a new certification exam for acute and critical care CNSs. And the Nurse Practitioner Board Certification Examination Catalog, published by the American Nurses Credentialing Center in Washington, DC, outlines scope-of-practice and eligibility requirements relevant to APNs.
According to Fruth, both certification programs can help in the development of internal guidelines.
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