between RNs and NPs, RNs would sometimes demonstrate resistance to NPs by refusing to take vital signs, obtain blood samples, or perform other support functions for patients of NPs (Brykczynski, 1985; Hupcey, 1993; Lurie, 1981), and they were not admonished by their supervisors for these negative behaviors. These behaviors are suggestive of horizontal violence (a form of hostility), which 12
may be more common during nursing shortages (Thomas, 2003). Roberts (1983) first described horizontal violence among nurses as oppressed group behavior wherein nurses who were doubly oppressed as women and as nurses demonstrated hostility toward their own less powerful group, instead of toward the more powerful oppressors . Recognizing that intraprofessional conflict among nurses is similar to oppressed group behavior can be useful in the development of strategies to overcome these difficulties (Bartholomew, 2006; Brykczynski, 1997; Farrell, 2001; Freshwater, 2000; Roberts, 1996; Rounds, 1997; see Chapter 11). According to Rounds (1997), horizontal violence is less common among NPs as a group than among RNs generally. Over the years, as the NP role has become more accepted by nurses, there appear to be fewer cases of these hostile passive- aggressive behaviors, often currently referred to as bullying, toward NPs. However, they are still reported in APN transition literature (Heitz et al., 2004; Kelly & Mathews, 2001). • _ Conceptual models for APNs a conceptual model designed to facilitate the evaluation of the acute care nurse practitioner (ACNP) role in acute care settings (Fig. 23-2). Developed in Canada, this model was adapted from a nursing role effectiveness model and is also a derivative of Donabedian's framework , with components focusing on structure (patient, ACNP, and organization), process (ACNP role components, role enactment, and role functions) and outcome (goals and expectations of the ACNP role). A concern with this model is the use of the term goals and expectations for outcome and the focus on quality of care, which is a dimension of care delivery process rather than outcome. Four processes (mechanisms) within the ACNP direct care component are expected to achieve patient and cost outcomes: (1) providing comprehensive care; (2) ensuring continuity of care; (3) coordinating services; and (4) providing care in a timely way (Sidani & Irvine, 1999). According to this model, the selection of outcome indicators is guided by the role and functions assumed by the ACNP, how the role is enacted, and the ACNP's particular practice model. Like the models before it, the usefulness of this framework for determining APN impact is limited by its virtual absence of testing in clinical settings. • _ Conceptualization barriers Conceptualizations of the Nature of Advanced Practice Nursing The APN role-specific models promulgated by professional organizations naturally lead to the following questions: • What is common across APN roles? •Can an overarching conceptualization of advanced practice nursing be articulated? •How can one distinguish among basic, expert, and advanced levels of nursing practice?
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