Differentiating Advanced Practice Roles: Operational Definitions of Advanced Practice NursingAs noted earlier, it is critical to the public's understanding of advanced practice nursing that APNroles and resulting job titles reflect actual practices. Because actual practices differ, job titles should differ. The following corollary is also true—if the actual practices do not differ, the job titles should not differ. For example, some institutions have retitled their CNSs as clinical
coordinatorsor clinical educators, even though these APNs are practicing consistent with that ofa CNS. This change in job title renders the CNS practice less clearly visible in the clinical settingand thereby obscures CNS role clarity. As noted, differences among roles must be clarified in ways that promote understanding of advanced practice nursing, and the Consensus Model (NCSBN, 2008) clarifies appropriate titling for APNs.Workforce DataTable 3-1provides U.S. sample survey data on RNs prepared to practice as APNs from 2000 to 2008. As of 2008, an estimated 250,527 RNs, or 8.2% of the RN population, were prepared in at least one APN role (U.S. Department of Health & Human Services [HHS], 2010). Almost 17% of these individuals were from racial or ethnic minority backgrounds, a percentage comparable to that of the overall RN population (16.8%). This represents a substantial increase compared with 2004, when only 8% of APNs were from minority backgrounds. However, the diversity of the RN population remains lower than the U.S. population, of whom 34.4% are from racial or ethnic minority backgrounds. The overall number of RNs prepared as APNs represents a4.2% increase as compared with 2004 data. When changes in APN group numbers are compared over time, different patterns are evident. CRNA numbers show a 7% increase from 2004 to 2008.CNMs experienced 12% growth, although this is based on a small sample, and only 55.5% of CNMs reported graduate preparation. CNSs were the only APN role to experience a decrease, declining 18.3% between 2004 and 2008. However, there was an increase of 11.4% in the number of RNs prepared as both NPs and CNSs. Even so, this represents a net 7% decrease in the total number of RNs educated as CNSs.The APN role that continues to show the most significant growth is the NP. Although the rate of growth slowed between 2004 and 2008, the number of RNs educated as NPs increased by 12.3% (excluding dual-prepared CNS and NP) and more than doubled from 1996 to 2008. The number of RNs with dual preparation as a CNS and NP showed an 11.4% increase, as noted earlier; most of these nurses reported working as NPs. The 2008 National Sample Survey noted that there are APNs with additional role preparation, notably combining NP and CNM credentials; these APNsrepresent 17% of nurse-midwives. The breakdown of various APN roles is shown in Figure 3-4.Four Established Advanced Practice Nurse Roles
Advanced practice nursing is applied in the four established roles and in emerging roles. These APN roles canFIG 3-4 Registered nurses prepared for advanced practice, March 2008.
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