As nurses you have all learned the importance of clinical decision making, critical thinking and clinical judgement to making effective and safe patient care decisions in practice. As you move into your role of advanced practice nurse whether that is leadership and management or NP, how does this change? Does it? This week read through some of the articles provided about how nurses and advanced practice nurse make decisions in practice.
- Is there a difference between the skills required by the bedside nurse and those needed by APN? Support the discussion with rationale and readings.
- As you transition to your role as an APN what clinical decision-making skills do you feel are needed for nurses planning to be NP? Nurse leaders? Support this with course readings and other academic literature. Are these different, if so why or why not?
- What standardized decision-making tool has been created to guide nurses at all levels to make practice decisions? Why was this created, what is the purpose of the tool? How would this be used in your role as an APN; be specific and describe how to apply this tool. Are there other standardized clinical decision-making tools to guide NP/APN to make decisions in practice? Should these be employed and/or are they employed in all care setting for NP? Provide a rationale.
- Explain your rationale. Describe the role of the Consensus Model for APRN.
As nurses transition into the role of advanced practice nurse (APN), such as a nurse practitioner (NP) or nurse leader, there are certain differences in the skills required compared to those of a bedside nurse. While the foundation of clinical decision making, critical thinking, and clinical judgment remains essential for all nursing roles, there are additional skills and competencies that become more crucial in advanced practice.
- Differences in Skills for Bedside Nurses and APNs: As APNs, nurses are expected to demonstrate a higher level of autonomy, accountability, and expertise in making complex clinical decisions. Some of the key differences include:
a. Advanced Clinical Assessment: APNs must possess advanced assessment skills, including comprehensive health history taking, physical examination, and diagnostic reasoning. These skills enable APNs to diagnose and manage health conditions independently.
b. Advanced Pathophysiology and Pharmacology: APNs require an in-depth understanding of pathophysiology to interpret clinical manifestations accurately and make appropriate treatment decisions. Similarly, advanced knowledge of pharmacology is necessary to prescribe and manage medications safely and effectively.
c. Diagnostic Reasoning: APNs utilize their advanced knowledge and clinical expertise to critically analyze patient data, formulate differential diagnoses, and develop evidence-based management plans. This involves considering various factors such as patient history, physical findings, diagnostic results, and research evidence.
d. Integration of Evidence-Based Practice: APNs must stay updated with the latest research and evidence in their field to ensure that their clinical decision-making aligns with best practices. They need to critically appraise research literature and integrate it into their practice to optimize patient outcomes.
- Clinical Decision-Making Skills for NPs and Nurse Leaders: NPs and nurse leaders require a combination of clinical decision-making skills along with additional competencies specific to their roles:
a. NPs: NPs need to excel in differential diagnosis, treatment planning, and ongoing management of patients across the lifespan. They should possess the ability to adapt their decision-making process based on patient needs, preferences, and the available resources. NPs also require effective communication skills to collaborate with interdisciplinary teams and engage in shared decision-making with patients.
b. Nurse Leaders: Nurse leaders, in addition to clinical decision-making skills, need to focus on strategic decision-making and organizational management. They must possess skills in leadership, change management, financial planning, and resource allocation. Nurse leaders make decisions that impact the overall delivery of care, staff management, quality improvement, and patient safety.
- Standardized Decision-Making Tool: One widely recognized standardized decision-making tool is the Nursing Process. The Nursing Process is a systematic approach that guides nurses at all levels to make practice decisions. It consists of five steps: assessment, diagnosis, planning, implementation, and evaluation. This tool provides a framework for nurses to organize and prioritize patient care, ensuring a consistent and comprehensive approach to decision making.
As an APN, the Nursing Process can be applied by integrating advanced assessment and diagnostic reasoning skills into the assessment phase, developing evidence-based management plans during the planning phase, implementing and monitoring treatments during the implementation phase, and evaluating patient outcomes during the evaluation phase.
- Consensus Model for APRN: The Consensus Model for APRN Regulation is a framework developed by key nursing organizations in the United States to guide the regulation and uniformity of advanced practice nursing roles. It defines the core competencies, educational requirements, and licensure standards for various APRN roles, including NPs.
The Consensus Model aims to ensure that all APRNs, including NPs, possess a standardized level of knowledge and skills to provide safe and effective care. It promotes a uniform approach to APRN regulation across states, facilitating mobility and consistency in practice. The model emphasizes the importance of education, certification, and ongoing professional development to maintain competence in clinical decision making and practice.
In summary, while the foundation of clinical decision making, critical thinking, and clinical judgment remains important for all nursing roles, the skills required for APNs, such as NPs and nurse leaders, go beyond the bedside nurse’s scope. Advanced assessment, diagnostic reasoning, integration of evidence-based practice, and strategic decision-making are key skills needed by APNs. The Nursing Process serves as a standardized decision-making tool, and the Consensus Model for APRN helps regulate and guide the practice of advanced practice nurses.