Nurses have moved into advanced practice, where they are gaining an increasing degree of autonomy. The aging baby boomer population is likely to put pressure on an already short-staffed nursing profession, pushing more nurses into advanced practice to assist, or even replace, physicians in clinical duties. Technology may relieve nurses of some of the more burdensome duties, such as paperwork, and better pay and shorter working hours may entice more into the profession to counteract the current shortage.
There still is no clear distinction in the nursing profession between advanced practice nursing and advanced nursing practice (Rozzano, 2002, 1-4). Initially a clinical nurse specialist (CNS) was defined by the educational preparation involved, whereas the role of the Nurse Practitioner (NP) was defined more by the scope of practice. CNSs were educationally prepared at the masters level, and were mainly found in hospitals managing acutely ill patients, and NPs who had varying levels of educational preparation were usually found in the community delivering primary care in physician's offices, ambulatory care centers, family planing centers, etc (2). 1n 1993, the National Alliance of Nurse Practitioners defined the role of NPs, in addition to health promotion and disease prevention, as including being "educationally prepared to assess, diagnose disease, and prescribe and manage primary care medical interventions" (2). The current aim of the National Association of Advanced Nurse Practitioners (NAANP) sees the role of the NP as grounded from a biomedical perspective while at the same time maintaining a basic nursing essence. In the future, the role will have to be more clearly defined.
One specialty of NP struggling for recognition is that of nurse anesthetist. In 1999 the American Society of Anesthesiologists proposed creating an educational affiliate to train nurse anesthetists and others (Prager, 1999, 19-20). For nurs...