Psychiatric CNSs were among the first entrepreneurial APNs to hang out their

Psychiatric cnss were among the first entrepreneurial

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Psychiatric CNSs were among the first entrepreneurial APNs to hang out their shingle, despite the litigious climate in which they could be threatened with lawsuits for “practicing medicine.” CNMs and CRNAs have led the way in using data effectively to justify their practice and attain appropriate scopes of practice. Early in their history, both groups began to record the results of their practices, showing the quality and suitability of their care (see Chapter 1). In the 1990s, NPs, with their flexible, community-based primary care practices, stood at the forefront of the changing health care delivery system. Although these subgroups of APNs have made impressive strides for advanced practice 28
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nursing, an obstacle to effective leadership is the tendency for APN specialty groups to separate and establish rigid boundaries that distinguish them from one another, thereby fragmenting APN groups and blocking opportunities for the increased power that unity would bring . The tension and fragmentation created by rigid boundaries require leaders who can transcend APN roles and specialties. APNs must manage and bridge boundaries among other nursing groups and within the ranks of the various APN constituencies . Although the uniqueness of each type of APN must be protected, a professional structure that provides a forum for discussing issues pertinent to all types of APNs also needs to be created. This structure may simply be an annual meeting for APNs or a permanent entity residing within an existing or new professional organization. Consensus groups at the national level have been meeting to discuss policy issues in which the power of the collective numbers of all APN groups speaking with one voice cannot be overemphasized (see Chapters 2, 12, and 21). An excellent example of professional collaboration among nursing leaders is the Consensus Model work (Chapter 21). APN organizations have joined to speak out collaboratively about state regulations regarding reimbursement, prescriptive authority, and managed care empanelment . It is critical that each APN, regardless of specialty, takes on the responsibility of moving toward an integrative and unified understanding of advanced practice nursing. Creating community in the current health care environment is particularly challenging because of the realignment of clinical decision making, scopes of practice for APNs and physicians, and new roles that blur boundaries between nursing and medicine. An understanding of change, effective communication, coalition building, shared vision, and collaborative practice leads to the development of structures on which unity is built. These five building blocks form the foundation of interdisciplinary leadership and practice. Motivating and Empowering Others Motivation and empowerment are core elements of the APN leadership competency . Empowerment was defined earlier as the ability of the leader to give followers the freedom and authority to act .
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