The purpose of this paper is to discuss four distinct questions relating to the advanced nursing practice. The discussion involves an analysis and/or comparison of material presented in "Advanced Nursing Practice: An Integrative Approach" (Hamric, Spross & Hanson, 2000).
COLLABORATION WITH PHYSICIANS AS AN APN
Collaboration between physicians and NPs are essential for the benefit of smooth patient care. So how does an NP/APN best achieve effective collaboration? Since it is generally up to the APN to ensure that collaboration works, it is in the best interests of patient care that an APN formulate effective strategies. This entails first and foremost that the NP recognizes the adversarial nature that is inherent between the physician setting and the APN/NP practice. In today's healthcare environment, many cost containment measures threaten physician salaries and job security. This makes it hard to embrace the possibility of competition from the APN (pp. 730-731).
Thus, it is important for the APN to stress the benefits of collaboration, both economically and professionally. From an economic point of view, the APN should stress the possibility of referral. This specifically relates to areas that are outside the scope of practice of the APN when it comes to taking care of patient needs. A joint practice where frequent informal consultation between physician and APN exists benefits the patient. Different perspectives on care can result in patients being provided with the interests and skills corresponding with their needs (pp. 170-171; 231-232).
The U.S. health care system is largely based on a "medical model" of care that relies on physicians to be the "gatekeepers" to services. As medical specialization has grown, there has been a parallel growth in sophisticated medical technology, and treatments to the exclusion of basic primary health care services. APNs are capable of providing much of that basic care, which...