Advanced Practice Career Plan. Carol A. Lamoureux-Lewallen. Briar Cliff University

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1 Advanced Practice Career 1 Running head: ADVANCED PRACTICE CAREER PLAN Advanced Practice Career Plan Carol A. Lamoureux-Lewallen Briar Cliff University

2 Advanced Practice Career 2 Advanced Practice Career Plan Synthesis of Core Values Nature of Persons I believe that a person is holistic, social and culturally diverse with an integrated mind, body and spirit existing within families, groups and communities. As each person is unique with different abilities, each person has the potential to affect her own health outcomes. I believe that each person has dignity, self-worth, and the potential for change. She has the right to participation in health care services and to make her own decisions. Each person has a right to respect, equality, and fair representation. Environment Environments have an impact on the health and quality of care for individuals, families, groups, and communities. Each person and community is living within an environmental system that influences human well-being, while at the same time human decision-making affects the health of environmental systems. Nursing interventions are directed toward creating, changing, and enhancing environments to promote optimal health. Health/Life Process I believe that health is a state of being when a person s biological, developmental and behavioral dimensions are the best they can be. Health is also an individual perception whereas each person has the ability to decide for themselves what health means for them. Health promotion is an avenue to teach and motivate people and communities to change their lifestyle, adopt positive attitudes and behaviors and assist in moving them toward optimal health. Each person s life process is a reflection of their health.

3 Advanced Practice Career 3 Health Care Systems I see health care systems as organizations that assist individuals, families, communities and groups in attaining optimal health within their environment. Healthcare systems are also the places that hold information and tools needed to achieve optimal health. Research helps define healthcare systems and how they function through an organized way of gathering information, developing knowledge, evaluating, and utilizing findings within healthcare to achieve positive outcomes. Nursing I believe that nursing is a caring art grounded in science. Nursing includes health promotion and disease prevention focusing on holistic care. Nursing functions within an ethical and professional value system to improve the lives of individuals, families, groups and communities. Nurses are advocates and educators who work independently but at the same time collaborate with teams and other healthcare providers. Nurses are accountable and responsible for providing evidence-based care in a cost effective manner. They include the ideas of culture, diversity, and human differences in the delivery of nursing care. Advanced Practice Nursing I believe advanced practice nursing is a higher level of nursing which encompasses health promotion and restoration, disease prevention, and adaptation. It occurs in multiple settings within institutions and communities. It involves the care of individuals, families, groups and communities across the lifespan. Advanced Practice Nurses are autonomous and although they are independent they utilize the dimensions of counselors, consultants, collaborators, educators, researchers, advocates, clinicians, and system managers in practice. Advanced Practice Nurses are continually learning and self-reflecting to improve advanced practice.

4 Advanced Practice Career 4 Nursing Education Learning is a life-long process of gaining new information that builds upon previous knowledge. Nurse educators are responsible for providing an environment conductive to learning. They also serve as primary role models of professional nursing practice. Nurses as well as students are accountable and responsible for learning by engaging in ongoing independent education, seeking additional information, and critiquing and utilizing research to improve patient outcomes. I believe each nursing education program has its place in developing nursing practice but entry into nursing practice should be at a baccalaureate level, entry into advanced practice nursing should be at the master s level. Literature-based framework of APN role/settings Patricia Benner has probably been the most utilized theorist in advanced practice nursing. The National Organization of Nurse Practitioner Faculties (NONPF) is the organization that provides leadership in promoting nurse practitioner (NP) education. In 1990, NONPF published a set of domains and core competencies for primary care NPs. The competencies were based on Patricia Benner s (1984) domains of expert care nursing. She described domains and competencies for advanced nursing practice (National Organization of Nurse Practitioner Faculties [NONPF], 2002, p. 2). The competencies were also adapted from the work of Karen Bryckzynski (1989) who explored the clinical practice of nurse practitioners (NONPF, p. 2). There are seven domains and within each domain are 75 specific competencies (Hamric, Spross, & Hanson, 2009). In 2004, NONPF released four curriculum models. The models they suggest follow the theoretical basis of Benner s novice to expert concepts. Each model has the same level of competencies starting with a pre-professional level moving into basic nursing, clinical leader,

5 Advanced Practice Career 5 nurse specialist and finally to the doctoral competencies (National Organization of Nurse Practitioner Faculties [NONPF], 2004). Relationship of framework to my Vocare /Call I see myself within the framework of Patricia Benner s theory of novice to expert. I feel in the current position I am working I would be considered an expert in my field. I have been working in surgical services for the last 12 years and do not rely on rules and frameworks. I have a deep knowledge and high skill level in the specialty I work in. I trust and act on my intuitions as they relate to surgical patients. Benner s (1984) model describes five stages of nursing development: novice, advanced beginner, competent, proficient, and expert. There are distinct differences in the practice abilities and experience levels within the five stages (Benner, 1984). Novices must be given rules to guide them because they have no experience in the situations they have I front of them. Advanced beginners have had enough experience to be guided by a mentor and have an understanding of the situation or the aspects of the situation. The competent practitioner has 2-3 years of experience in the same or similar setting; engages in conscious and deliberate planning; and consistently uses an analytical framework. The proficient practitioner views situations as a whole rather than an aspect and are able to perceive the meaning in the situation and anticipate expectations. The expert practitioner has practiced for 6 or more years in the same or similar setting and does not rely on maxims, rules, or analytic frameworks (Benner, 1984). As a student in the master s program to become an NP, I find myself between the novice level and advanced beginner level. I find myself learning new information and realizing that I will be in new situations, making decisions that I have never had the experience to make, despite 20 years of nursing experience that I currently have under my belt. The Dreyfus model used in

6 Advanced Practice Career 6 Patricia Benner s work is a situational model. A nurse can float between different levels or go back and forth between levels of novice to expert depending on the situation she is in (Benner, 1984). My goal after this master s degree is to work as a Family Nurse Practitioner in an industry that employees low to middle income, culturally diverse, individuals, and families. I would like to suggest to an industry that they can be fiscally responsible and benefit their employees by hiring an advance nurse practitioner to have on staff. I would propose to do employment physicals, care for illness and injuries including workman s compensation claims, and to provide wellness and health promotion programs for employees and their families. Currently these industries spend an enormous amount of money on healthcare benefits and requirements for their employees. As a nurse practitioner able to bill for services, it could potentially save hundreds of thousands of dollars for the industry. I believe this would be my dream job because it would allow me to do all the things I want to do as an NP including: the opportunity for leadership, autonomy, research utilization, providing nursing care to underserved populations, health promotion, disease prevention, teaching, collaboration, counseling, and the chance to inspire others. I have many years of nursing experience to draw from, but I have a great deal to learn in order to become an expert nurse practitioner, this is what I hope to achieve. I am capable of many things and I am sure becoming an expert nurse practitioner is not out of my reach as a goal for the next step in the ongoing development of my nursing career.

7 Advanced Practice Career 7 References Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. (N. Evans, E. P. Lewis, & J. DeProsse, Eds.). Menlo Park, CA: Addison-Wesley. Hamric, A. B., Spross, J. A., & Hanson, C. M. (2009). Advanced practice nursing: An integrative approach (4th ed.). United States of America: Elsevier. National Organization of Nurse Practitioner Faculties (2004). Curriculum models for practice doctorates in nursing. Retrieved September 17, 2008, from National Organization of Nurse Practitioner Faculties. (2002). Nurse practitioner primary care competencies in specialty areas: Adult, family, gerontological, pediatric, and women s health [Brochure]. Rockville, MD: US Department of Health and Human Services.

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