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♪ [music] ♪ - i feel my role as aclinical nurse specialist just to take what's already in existenceand to make it that much better. the role of the clinical nurse specialistlooks it was being provided and seeing what we can do better. how can we betterbring the care that we need to provide to that patient that's maybe missing. - as a nurse practitioner, i'm able to notonly assess a patient's condition but also diagnose that condition and then treat it. we have a lot of tools available to us as

a professional to be able to treat thepatient's that we see in unique settings. - in most hospitals, we are consideredlicense independent practitioners. so, we can really take care of thewhole woman. their annual exam, their prenatal care,their delivery, their postpartum care, menopause. - my predominant role is to be the primaryanesthesia provider in about 80% of settings in the united states. as ananesthesia care team, which consist of an anesthesiologist and crnas and typicallyas the crna that is in the room delivering the anesthetic.

- the nurses you have just seenrepresent over 267,000 advanced practice registered nursesacross the united states. one of the fastest growinghealthcare professions, advanced practice registered nursesprovide comprehensive care to their patients and play a vital role in theinstitutions and communities they serve. currently, significant variations exist instate laws regarding the requirements for advanced practice registered nurse,licensure, education, certification, and practice. these variations may limitmobility and practice and decrease the access patients have to their care. mostimportantly, to fully protect the public,

advanced practice registered nurses acrossall states should meet the same requirements. the best way for states to achieveuniformity, is the adoption of the new advanced practice registered nurserequirements, outlined in a document called the consensus model for aprnregulation. this model was developed by nurse leadersfrom across the united states and as a president for thehealthcare of the future. - [narrator] in 2004, nurse leadersrepresenting 23 organizations began working together over a four-year periodto develop new national standards for

advanced practice registered nurses. thesestandards when adopted by each state will ensure that the education, accreditation,certification, licensure, and practice requirements for advanced practiceregistered nurses are the same throughout the country. this will increase mobility at advancedpractice registered nurses and allow them to move to other states withouthaving to meet different licensure requirements. and most significant, thenew changes outlined in the consensus model ensure public safety by makingcertain that an aprn in one state is equivalent to aprn's in every other state.

- we're responsible for the whole care ofthe patients, so we have to have all the skills to be able to do that. and so, wehave graduate level education. - all of the programs i've been affiliatedwith at minimum, offer masters of science, of nursing as the entry level, the diplomaor academic preparation for anesthesia practice. - [narrator] a high-level of education isneeded to be an advanced practice registered nurse. that's why the new national standardsoutlined in the consensus model, required that regardless of role,aprn education be at the graduate level.

at the university of pennsylvania,an institution just like at across the country, students studying to be anadvanced practice registered nurse endure a demanding curriculum and undergorigorous clinical experiences in preparation for becoming safepractitioners to meet the challenges of 21st century health care. - graduates of all of the programs in theunited states that have adopted the consensus model can be assured that theirprogram has been pre-approved and accredited before they even begin to takeone course, graduate student regardless of whether they were a nurse practitioner,clinical nurse specialist, midwife, or

nurse anesthetist would be able to go intoan auditorium and all learn together these three, what we call the 3ps, they arebroad, general, courses on pharmacology, physical assessment, and pathophysiology.they would also have seminar, courses and didactic courses before they even begantheir minimum 500 hours of clinical practice in a setting where they would bedelivering one-to-one direct patient care. - a certified nurse midwife is an investpractice nurse trained at the masters level to provide care to maternitypatients and well-woman. we do a real good job here by having very holistic programof care, which includes a lot of factors that you will not find in your local ofob's office. some examples of the extra

care that we provide include groupprenatal care, which really combines your prenatal care with your childbirtheducation and you really understand what's going on throughout the pregnancy and thenwhat to expect for labor. we have a wellness program, which includes nutritioneducation. we have yoga classes. we have a breastfeeding peer counselor program. - so, when in 1993, i was fortunate enoughto get at macarthur fellowship, i decided i wanted to come to washington where theworst outcomes in the country are for both infants and mothers, i wanted to comehere to see if the techniques of the midwifery model could be of any help inreducing the so-called intractable

disparities. - this particular facility was located inthe worst part of district of columbia as far as where the bad outcomes where,specifically to address those outcomes. it's primarily african american, they'revery low income, they have shorter life expectancy than the rest of the districtof columbia. it takes a population which is at risk for lots of poor outcomes. andgives them the kind of care that actually provides them with superior outcomes towhat you find on average in the rest of the district. - we've reduced preterm birth by at least2/3rds and the date that coming in now

look like even more. this is amongstafrican american populations. we have reduced low birth weight by three quartersand we have reduced cesarean section rates back to the 10% that they were in the1970s before they increased as they have now. - the importance of an accredited schoolof nursing is very important in your selection of program. that does bringcredibility to the program and ultimately if you do graduate from a program that isaccredited your degree is sound. - it tells me that that program meets acertain standard of academic excellence. we're teaching in a standardize waywhat they're teaching nationwide.

- [narrator] to ensure that every programpreparing students to be advanced practice registered nurses meet specificrequirements in program essentials. the new national standards requirethat each educational program be accredited by one of the majornursing accrediting bodies. - as part of the new advance practice ofmodel that we are looking at the consensus model, accreditation has a very importantrole, because accreditation will do pre-approval of the program, so that anyprogram that begins will use that model to guide the development of the curriculum,the competencies that are used, and so on and so forth.

we look at the overall design of theprogram to ensure that it's based on national standards. why? well, not onlythat we want that graduate to be able to obtain licensure and credentials whenthey're finish, but it is a mechanism to protect the public. our goal in all ofthese process is to assure safe and competent people to practice. - [audrey] nurse practitioners have aspecial unique awareness, a lot of times on the public healthaspects of what we do. kentucky is a very rural state,so a lot of nurse practitioners do work in rural clinics and ruralsettings here. physicians are not as

available as they are in some other statesor in urban areas. so, when i started here at the preclinic in danville, the diseasesthat we treat, diabetes, high-blood pressure, high-cholesterol,obesity and reflux disease are all impacted by smoking. our patients that come to us initiallyabout 46% of them smoke and their smoking has been a significantcontributing factor to their illness. of those, we've been able to assist about a fourth of those patients toquit smoking completely. another half of those patients that smokehave reduced their smoking

significantly and hopefully have reducedsome of the harm of smoking as well as still working on their path towardsquitting smoking. - [narrator] after graduation from anaccredited program, passage of a national certification exam is required. theseexamination are based on the specific advanced practice role and the populationstudied while enrolled in the graduate program. certification exams are requiredto be psychometrically sound and assess the competencies that are required forpractice. - the benefit of the aprn on consensusmodel is the enforcement of the congruence of the educational preparation to thecertification exam. the american board,

specially nursing certification and thenational commission for certifying agencies are the two external bodies thataccredit the certification program at ancc. certification renew is actually aperfect example of how the public will know if they have a competent individualmanaging their gear. certification is time limited, it can range from three to fiveyears. before that certification can be renewed, the individual must provideevidence of having that specific criteria. to renew that certification, we have tohave 75 hours of continuing education, five hours a year through the state ofkentucky board of nursing requirement and through ancc needsto be in pharmacology,

which keeps us updated for prescribing. - the role of the cns here at rush entailsbeing a resource to the staff nurses of role model, to help them with theirquality improvement activities, any research activities they are involve withand to be part of the team with collaboration to get in the patients tothe next level that they need to be. we do have patients that have cancerin this particular unit and suppose to have surgical unitand we do have a primary female populationthat we serve and these patients have been given a diagnosis ofprimarily ovarian cancer.

what we do do is providethe high-touch in addition to the high-tech. that is so important here at rush to be able to meet those needs ofthose patients we have gotten a very difficult diagnosis and have been throughrigorous treatments and surgeries. as an aprn and my role as aclinical nurse specialist, the role of the change agent is themost important component and the management teamworks together as a whole but without the change agent of theclinical nurse specialist and the whole

picture, sometimes these things cannothappen because of the other duties that are assigned to the nurses and to themanagement team. - there are a lots of things that we aretrained to do, confident to do, have experience doing, which we may not able todo. the states then designate rules about how we can practice in that state and thatdoes vary from state to state unfortunately. - [narrator] licensure is the next steprequired for practice as an advance practice registered nurse. this is an addition to the rn license.

oversight of licensure and practice of advanced practice registered nursesis through the state board of nursing. - boards of nursing are the mostappropriate bodies to oversee the regulation of advanced practice registerednurses because they are the bodies that are composed members of the profession.they are the people who know the standards of the profession. the educational requirements,the scope of practice and so on. the consensus model has a number ofbenefits. it will benefit the public and then it will increase the access toqualified healthcare professionals.

it will benefit the advancedpractice nurse, who doesn't have to meet differentrequirements for different states. advance practice nurses have the sameknowledge and skills regardless of what state they're in. andthere's no reason for them to meet different requirements in order topractice within their scope of practice. - [narrator] the advance practice licensewill be specific for each role. for examples, nurse practitionerswill receive a license that indicate that theyare nurse practitioners. nurse midwife licenses will indicatefair midwifes.

in addition, the license will alsospecified what population of patients the advanced practice registered nurseis qualified to care for. whether it would be neonatal,pediatric, adult, the family, women's health, or psych mentalhealth populations. - my role is the lead crna and clinicalpractice and i provide pain management and anesthesia services for a pretty broadarray of adult oncology patients. getting my predominant role as to be the primaryanesthesia provider may that along with one of the anesthesiologist. we meet andgreet the patient in the morning, review their history and physical, while oursurgical colleagues are doing their

interventions, our charge is to keep thatpatient physiologically safe and stable. a kind of broad array of thingsincluding positioning of the patient, their appropriate physiology from acardiovascular and respiratory standpoint, and making sure that atthe time of completion of the surgery that theyaroused comfortably, safely, and physiologically sound. - [narrator] advanced practice educationfocuses on developing safe practitioners that can function in independent roles andhave full prescriptive authority. - idaho was the first statein the united states to

recognize advance practice nursesin statute in 1972. the board of nursing is very concernedabout patient safety. access to care is also another importantissue. we feel that the care is safe, confident, and on the side of patient'ssatisfaction, patient's appear to be very satisfied, although the board of nursingdoesn't really monitor the patient's satisfaction, the professionalassociations do. and people who live in rural communities are very satisfied withthe quality of care they receive by nurse practitioners and that the access isavailable in their community and they don't have to drive sometimesup to a 100 miles to see a provider.

- [narrator] studies indicate thatadvanced practice registered nurses are safe and confident practitioners,providing healthcare in a variety of settings. - i'm one of five gynecologic oncologist,and our group has four nurse practitioners who works with us. and i think thati couldn't practice the way i did if i didn't have nurse practitioners in mypractice. providing healthcare is a team activity. we use social workers 'causethey have a skill set. we used an intro-medicine doctor versus an oncologistand surgeon like me to do different activities. i think there's a lot ofthings that nurse practitioners are the

perfect fit for. - every state has different laws andrequirements for advanced practice registered nurses. by adopting the new requirementsoutlined in the consensus model, your state will be assuringconsumers that advance practice registered nurses are highly prepared and ready toprovide safe care. in addition, they will be supporting amodel that would allow for a greater mobilityand access to care to

more people across the country. - [narrator] support the new requirementsin the consensus model for advanced practice registered nurses. for more information, go to the nationalcouncil of state boards of nursing website at