I am a graduate student in a Community Health Clinical Specialist program and I found the articles on Advanced Practice Nursing quite interesting. Health care is in the middle of many dramatic changes — changes that are at times confusing and difficult to understand. Nursing has always responded to changes in society's health care needs and I believe will continue to do so. Advanced Practice Nurses of some kind will lead the way through these changes to improved health care in the 21st century.
I agree with Marie-Annette Brown that "advanced practice would be better served by creating and supporting a variety of new advanced practice roles based on today's health care systems and strengthening current successful roles such as the Primary Care Nurse Practitioner." The proposal to combine the Clinical Nurse Specialist (CNS) and the NP and label them "Advanced Practice Nurse" was based on admirable concepts. However, it also has problems. Most agree that the role of the NP is as a direct provider and that they are invaluable in providing primary care. They are focused on diagnosis and treatment of disease. The CNS, on the other hand, spends less time in direct patient care practice and more time in education, consultation, research and administration. I believe that the expertise of the NP may be undermined by the dilution of skills needed to become the Advanced Practice Nurse.
Some believe that the combination of the two practices may produce better unity, provide the ability to speak with a single voice and may result in new opportunities for leadership roles in direct health care for the future. However, I believe that the combination does not factor in the different competencies that are currently required for each of these roles. I also think that it would be difficult to combine the roles into one curriculum.
The two roles may eventually blend but to force them together now would decrease the quality that currently is present without proof of increased quality with the blended role.
Phyllis Schulz, RNC, BSN
Casper, WY 82601