scope of practice Archives

Bone Marrow Aspiration: A Nursing Procedure?

Too much to do already?

A few months ago, we asked on our Facebook page whether nurses would ever be interested in adding a new “medical” skill, such as lumbar puncture, to their practice.

Common responses to this question were along the lines of “Are you crazy? I have too much to do already!” But what if you used a new set of skills as part of a small team of nurse “proceduralists” in a nurse-led clinic, and received excellent training and ongoing support?

One team’s expertise.

In “Bone Marrow Aspiration and Biopsy Performed by RNs: A Review of Clinical Practice” in the September issue of AJN, Eryn Draganski and colleagues share the details of their hospital’s longtime success in using a team of specially trained nurses to perform bone marrow aspiration and biopsies. In addition to reducing costs and allowing for more timely scheduling, this practice has also provided patients with a team of nurses whose extensive experience in the procedure ensured excellent outcomes and patient support.

“…using a small team of nursing proceduralists… provides a unique opportunity to improve consistency in practice, which may result in better quality control and, ultimately, boost patient safety.”

Nursing scope of practice.

Nurse practice acts in many states don’t specifically address whether or not this task […]

Betsy Todd, MPH, RN2019-09-13T11:42:36-04:00September 13th, 2019|Nursing|1 Comment

Is It Time to Retire the Term ‘Midlevel Practitioner’?

What are the implications of calling advanced practice nurses “midlevel practitioners”? According to Rachel Scherzer, a nurse educator and critical care nurse, such a term pigeonholes APNs in an implied (and disproven) hierarchy of value and quality of care rather than in relation to specific competencies and expertise.

In the Viewpoint essay in the July issue of AJN, Scherzer describes some of the reasons why such terms aren’t just inaccurate, they damage the standing of the profession:

Policymakers use the term while developing health care policy, health care economists use it when reporting data and performing cost analyses, and other health care providers use it in the clinical setting. . . . This term is both diminutive and inaccurate, implying that these professionals cannot provide the same level of care as other members of the interprofessional care team. Referring to APNs as “midlevel” practitioners contributes to a general misunderstanding of their role and of the services they provide.

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:06-05:00July 5th, 2016|career, Nursing, nursing perspective, Public health|0 Comments

The First 50 Years of NPs: An Illustrated Timeline Shows Triumphs, Continuing Practice Barriers

By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.

This year marks the 50th anniversary of the nurse practitioner (NP) role. Themes of innovation and sustainability emerge as one examines an illustrated timeline of the history of NPs in AJN‘s October issue and reads the accompanying text. (The first section of the timeline is below. Click to enlarge.)

How did this advanced practice nursing role come into being? As the timeline explains, ” [d]uring the 1960s, health care was becoming increasingly specialized. Physicians were moving out of general practice and into more complex and lucrative specialties, creating a void in primary care and prevention services, and in care of the chronically ill.”

To fill this void, public health nurse Loretta Ford, working with Dr. Henry Silver at the University of Colorado in 1965, launched the first NP certificate program, a seminal moment in the history of this prevention-driven, primary-care-focused nursing role.

Ford wrote about the compelling need for NPs. Calling health care a capital investment, Ford said:

“We have failed to realize the full potential of professional nurses to improve the quality of life. This group has great unused potential for bringing about health care reforms. Properly prepared and effectively utilized, nurses could advance the nation’s health in […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:01:52-05:00October 15th, 2015|career, Nursing, nursing perspective|0 Comments

Two Sons, Similar injuries—Two Very Different Experiences of Pain

Vincent-2015-AJN_The_American_Journal_of_Nursing We are often amazed by the richness of the archives here at AJN. In the April issue, we reprint an essay originally published in the February 2002 issue. “Morphine. Now.” by Peggy Vincent, touches on topics as relevant today as ever: inadequate pain relief and the costs to patients of certain nursing scope-of-practice limitations.

It’s also a story, written by a nurse, of encountering very different attitudes to human suffering in two different health care institutions after injuries sustained by her own children. There may or may not be clinical details or matters of protocol that don’t accord with every reader’s current clinical experiences, but the human interactions are as familiar as ever. Here’s a brief excerpt: […]

Jacob Molyneux, senior editor/blog editor2016-11-21T13:02:45-05:00April 1st, 2015|Nursing, nursing perspective, Patients|0 Comments

Takeaways from 2014 ANA Membership Assembly

Pamela Cipriano, incoming ANA president

By Maureen Shawn Kennedy, AJN editor-in-chief

So far, so good

In June, the American Nurses Association (ANA) convened its second membership assembly, which included representatives of constituent and state nurses associations, individual members groups and affiliated entities, plus the board of directors. (This is the structure that replaced the House of Delegates as the official governing body of the ANA, when ANA restructured in 2012. See our 2012 report on the restructuring.)

The assembly was preceded by ANA’s annual Lobby Day on June 12th, in which nurses visited legislators on Capitol Hill to talk up legislation important to nursing, like bills on staffing, safe patient handling, and one that would remove barriers to efficient home care services.

This membership assembly was subdued—perhaps a gift for Karen Daley, the outgoing two-term president who shepherded the organization through a turbulent period of change. There were no contentious resolutions to deal with this time—there were only three issues brought to the group through dialogue forums, to develop recommendations for the board of directors: