History Role Transition RN to FNP Valerie

History & Role Transition RN to FNP Valerie Dzubur Ed. D FNP-C NP Seminar I N 672 Samuel Merritt University

Advanced Nursing Practice Nurse Anesthesia Certified Nurse Midwife Clinical Nurse Specialist Nurse Practitioner

History 1873 – “Nightingale Schools” were established in Boston, New York and New Haven.

Traces & Archives Independent Practice 1877: Sister Mary Bernard administered anesthesia at St. Vincent’s Hospital in Erie, PA. 1893: Public health nurse - Lillian Wald Henry Street Settlement House visits the poor and sick in their homes.

Anesthesia Between 1884 – 1888 Sisters of the Third Order of St. Francis managed five hospitals in Erie, PA – nursing sisters served as anesthetists in all five settings. 1924 – Anesthesia courses was made available to secular

Mid-Wives Midwifery in U. S. dates back to 1600 s Childbirth was outside the purview of medicine and the domain of the lay midwife

Midwifery 1874 – est. midwifery School Utah 1911 – ASSTSN American Society of Superintendents of Training Schools for Nurses a resolution to provide for training, registration and licensure for midwives.

Early Nursing Legislation 1939 Nurse Practice Act established Regulating nursing through Licensure of a nurse Based on a defined scope of practice

Clinical Nurse Specialist 1944 – National League of Nursing Education’s committee to study Postgraduate Clinical Nursing Courses 1949 – National conference of graduate school directors developed programs for clinical-nurse specialty

Imagining the Role 1965: Loretta Ford, Codirector of Univ. of Colorado first uses term, “nurse practitioner”

Imagining the Role To extend the role of the nurse in community health – concerns about the underserved Working with Dr. Henry Silver Loretta Ford pioneered the role NP in the pediatric setting.

Evolving & Growing American Nurses Association 1974 Congress of Nursing Practice guidelines for advanced practice Educated - CE programs BSN programs

From RN to NP Nurse Training Act of 1964 (PL 88 -581) Title II of the 1968 Health Manpower Act (PL 92 -158) Nurse Training Act of 1975 (PL 94 -63)

Advanced Practice Legislation 1975 Amended Nurse Practice Act Recognized nursing as dynamic Expanding field that overlaps medicine Expanded definition to include advanced practice pursuant to standardized procedures

Prescriptive Authority January 1, 2003 B&P Code 4040 Division 2, Healing Arts Chapter 9, Pharmacy Allows “prescribing” by NPs drugs, devices and controlled substances (III-V) Health and Safety Code 11026 Defines “practitioner” Amended to included nurse practitioners Does not alter scope of practice

Controlled Substances January 1, 2004 – AB 1186 Authorization for prescribing of Schedule II controlled substances

New Legislation NPs can sign for pharm. sample NP’s name only on prescription label MD’s name no longer needed on Rx School Physical - Signature Disability Placard Signature Driver’s License Signature

The Provider Project CANP Legislation to eliminate Standardized Procedure Language Nurse Practice Act Change Supervision to Collaboration To be at the table Healthcare reform

Professional What are the four key concepts of that define professional practice?

Professional Practice The Four Essential of Professional Practice…. Decision making Scope Laying on of hands Evidence

NP Role Requirements Sophisticated clinical skills Critical thinking skills Political savvy High level of decision-making Ability to negotiate terms for job

Influences on Role of NP Evolving California U. S. and World Changing State Regulations NP practice settings Few role models Unequal power relationship Between NP and MD

Barriers to Role Attainment Non-supportive attitude of other nurses and the medical community Lack of influence on policy-making bodies Assuming too many responsibilities in a NP position Fear of replacement by other professionals Lack of administrative support Lack of savvy in marketing, business and politics

Role Transition “A dynamic movement between two relatively stable states with phases of entry, passage and exit, requiring life pattern changes. ” Chick & Meleis (1986)

Role Transition Entry Begins with the first anticipation of transition Passage Period of instability and role confusion/exploration Exit Ends when new stability has been achieved Individual may attain a higher level of stability and functioning compared to period before transition

Characteristics of Transition Changes in Identities Roles Relationships Abilities Patterns of behavior

Emotional Components to Role Change Any or all Disorientation Distress Depression Anxiety Elation Happiness

Variations in Responses to Role Transition Dependant on Differences in level of planning Emotional and physical well-being Level of knowledge and skill preparation Environmental resources and support Perception of the meaning and expectation of the individual

Facilitate and Influence the Transitional Process Awareness of the process Greater understanding Shorter adjustment period Realization that Disconnectedness, anxiety insecurity A normal part of the process Time limited

Facilitate and Influence the Transitional Process Become involved in professional groups and organizations to prevent feelings of isolation Careful selection of mentor to facilitate role development Who will your mentors be?

Welcome to your first stage of transition! This will be you!