Reflection Paper #1: Advanced Practice Nursing Roles

Reflection Paper #1: 1

Running head: REFLECTION PAPER #1: ADVANCED PRACTICE NURSING

Diane Morris

WASHBURN UNIVERSITY

Reflection Paper #1: 1

Reflection Paper #1: Advanced Practice Nursing Roles

In reflecting upon the Advanced Practice Nursing (APN) Roles from our clinical practicum so far, it helps to review what those roles actually encompass. APN roles include: educator, researcher, manager, leader, and consultant.

When looking at the #3 Course Outcome of “exhibiting advanced communication skills in interdisciplinary settings”, the role of consultant falls nicely into this category. This objective/outcome relates to the topic of APN role, in that effective communication with not only the provider/preceptor but also with any and all other collaborating providers who might be involved in delivering care to our patients. One example of this “advanced communication” was evident in one of my clinical experiences last week. I was doing a history and physical (H&P) exam on a 74 year old female who was admitted after falling at home the prior evening. She sustained a non-displaced left hip fracture, for which she was scheduled to undergo a left hip hemi-arthroplasty. The orthopedic physician’s assistant had already evaluated the patient and documented her H&P and written pre-operative orders for surgery. When interviewing the patient, I learned that she had undergone a dental procedure two days earlier and was receiving oral antibiotics. No mention was made of this finding in the orthopedic H&P. Since the patient had informed me of her dental procedure and realizing this potential complication with her upcoming surgery, I wanted to ensure that the orthopedic surgeon was aware of this potential issue. Obviously, patients do not always disclose the same information to each provider of care and if I had been the first provider interviewing the patient, she may well have left that piece of information out of our discussion. However, since I was aware of the information regarding her recent dental procedure, I had a duty and obligation to ensure that effective communication was carried out to provide safe care. In carrying out the APN role of consultant, I contacted the orthopedic surgeon and made sure they were aware of the patient’s recent dental procedure, so that precautions could be taken in her peri-operative treatment course. Further, the APN role of educator came into play in this instance, as the patient needed to be educated about the risks of infection that dental procedures may have on indwelling orthopedic devices. While I am certain the orthopedic physician/nurses include this education in his/her discharge teaching, repetition is good (especially for an elderly patient)!

When comparing the Program Outcomes related to the topic of APN roles, Outcome #7: “Integrating effective communication in advanced nursing roles” is easily related to the APN role of consultant. Effective communication with both the patient and healthcare team is crucial for delivering safe, comprehensive patient care. An example of this kind of communication that occurred in my clinical practicum this week was in coordinating antibiotic treatment of an inpatient diagnosed with cryptosporidium. Normally, such a diagnosis could be easily handled by the primary care provider; however, this particular young 36 year old female had significant complications with this infectious illness due to her chronic ulcerative colitis (UC). She had been ill for over one month with significant weight loss, which she assumed was related to her UC. This patient was also undergoing treatment with Humira, a recombinant human anti-TNF-alpha IgG1 monoclonal antibody, used to block the inflammatory activity of TNF-alpha (WebMD, n.d.). Antibiotic treatment for her required consultation and clear communication with the infectious disease physician and the patient’s GI physician, in order to properly treat her infection, in light of her immunosuppression due to her UC treatment with Humira. The patient’s immunosuppressive medications for her UC were temporarily held, while she undergoes treatment for the cryptosporidium. Obviously, precise effective communication is critical in situations such as this one to coordinate safe treatment for this patient.

The topic of APN roles is certainly a “hot one”, as we begin this first clinical practicum. Simply getting used to being in the primary care setting presents a challenge for me personally, as my previous nursing experience has been in the acute setting of the emergency department. Additionally, learning my role as an APN student compounds that challenge. Each day in practicum I experience the essential nature of each of the APN roles.

I am becoming especially intimate with the research role, as I am finding the need to “look up” or research so many things each day, including: lab values, diagnoses, medications, etc. The role of educator is certainly rewarding for both the patients and me. It is nice to be able to have the time and opportunity to offer education to my patients, at the same time I am educating myself in doing so. The management piece applies to so many APN duties including: medication management, time management, resource management, etc. The role of manager is certainly a challenge, as time management appears to be a daily struggle. The role of leader is an odd one to get used to. While in my experience as a staff nurse in the emergency room, I have been looked as a “leader” due to my 8 years of clinical experience; however, leader takes on a new meaning in the APN role. It is interesting, as I feel like such a “pre-novice” in this arena, but patients automatically view even the APN student as a leader, as do the staff members in the office setting. Becoming accustomed to leadership is proving to be more challenging than I imagined, since I often feel like a fish out of water!

My future advanced practice as an APN will certainly be influenced by the definition of the various APN roles. Learning to incorporate these roles in my own practice will no doubt make my practice more effective but therein lies the challenge. These roles are new to me and the extent in which I will carry them out will evolve as my work as an APN student evolves.

Reference

WebMD (n.d.). Humira. Retrieved September 22, 2011, from http://search.mesdcape.com