NUR 513 Describe how the role of advanced registered nurse transformed over time

NUR 513 Describe how the role of advanced registered nurse transformed over time

NUR 513 Describe how the role of advanced registered nurse transformed over time

The role of advanced registered nurse has transformed over time primarily by shifting from a role to fill shortage in availability of physicians, to a role with structured education and professional definition. Historically, advanced practice nursing roles including nurse practitioners, nurse midwives and nurse anesthetists came into being as an attempt to improve care access in regions, or specialties, where access to physician care was limited (DeNisco & Barker, 2019). However, these roles, initially had variable educational requirements, and authority often based on region. This lack of role definition was paralleled by other advanced practice nursing roles that did not necessarily have direct clinical contact with patients such as nurse educators, nurse managers and nurse researchers. In 2004 the American Association of Colleges of Nursing (AACN) defined advanced practice nursing as:

“Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.”

While this definition continues to leave room for variable interpretation, this has served as a point of delineation regarding current and future educational requirements (DeNisco & Barker, 2019). Undoubtedly, the role of advanced registered nurse will continue to be refined by professional and regulatory bodies. The responsibilities of the advanced registered nurse will evolve to continue to meet population health needs, while maintaining strong roots in nursing practice and applications.


American Association of Colleges of Nursing (AACN). (2004). AACN position statement on the practice doctorate in nursing. Retrieved from


DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284176124

Week 1 DQ 1

“If millions of nurses in a thousand places articulate the same ideas and convictions about primary healthcare, and came together as one force, then they could act as a powerhouse for change (WHO, 1985) (Schober et al, 2006)”. These words were spoken by Halfan Mahler, Director General of the World Health Organization (WHO). These words have helped to propel the advancement and development of the nursing profession over time. The nursing practice has change over the years, however, in the 20th century the term “specialist” started to be evolved with the development of more postgraduate courses. With this development came opposition, especially from physicians. However, with the shortage of physicians, advanced practice nurses (APN) were utilized in rural and remote areas as primary healthcare Nurse Practitioners (NP) (Schober et al, 2006).

Over the years however, advanced practice nurse roles and values have been misinterpreted, but with the work of the

NUR 513 Describe how the role of advanced registered nurse transformed over time
NUR 513 Describe how the role of advanced registered nurse transformed over time

International Council of Nursing (ICN). APN has been viewed in a different light. Policy makers are seeking creative ways to integrate APN into the healthcare system. However, there are a few challenges that exist. With the healthcare reformation and issues that exist in healthcare stakeholders were forced to proactive seek ways to develop the profession. Through consistency and competency develop APN practices has improved.


Schober, M., Affara, F., & Affara, F. (2006). International council of nurses: Advanced nursing practice. John Wiley & Sons, Incorporated

The role of registered nursing has come a long way since the 19th century when Florence Nightingale revolutionized modern nursing on the front lines of the Crimean war and Lillian Wald’s nurses elevated nursing to provide primary medical care for inner city low income families. Initially education of nurses who provided advanced specialized care was in the form of apprenticeship training, but it is now a requirement to have obtained a master’s degree or higher to qualify as an official Advanced practice Nurse. Currently there are four degrees that meet  the criteria to qualify as an advanced practice nurse (APRN). They are Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist (DeNisco & Barker, 2019). As the demands and expectations of the healthcare system continue to increase, the number of roles qualifying to be an advanced practice nurse are bound to expand. Two roles that have potential to be included as APRNs are the roles of case managers, and nurse navigators. Along with the expansion of the field of APRNs in the near future, there will also be an increase in the expectations of their education, training and responsibilities.

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One example of how the education and training of an Advanced Practice Nurse has changed over time is in the role of nurse practitioner(NP). From the time that the role of nurse practitioner was formally developed in 1965 by Loretta Ford, EdD and Henry Silver, MD, until the 1980s and 1990s, when it moved to the university setting as a master’s level program, most NP training programs were continuing education programs. (DeNisco & Barker, 2019). The goal of the American Association of Colleges of Nursing was to have all entry level Nurse Practitioners be educated at the Doctorate level by 2015, but this has proven “impossible to achieve” (DeNisco & Barker, 2019, p. 30).


Doctorate-level nursing education has become the bar for the role of nurse practitioner because NPs have been proven to be a cost effective way to provide high quality care, and the expectations of nurses in this increasingly complex healthcare system are becoming more demanding. The Institute of Medicine (IOM) has “identified the need for nurses to be placed at the forefront of healthcare” (DeNisco & Barker, 2019, p. 24). Nurse practitioners are currently working alongside other doctorally prepared clinicians such as physicians (MD), pharmacists (PharmD), and physical therapists (DPT) to name a few (DeNisco & Barker, 2019). Requiring nurse practitioners to be doctorally prepared would ideally elevate them to be equal with other doctorally prepared clinicians in their respective fields.



DeNisco, S. M., & Barker, A. M. (Eds.). (2019). Advanced practice nursing: Essential knowledge for the profession (4th ed.) Jones & Bartlett Learning.



I really enjoyed your post. Pioneers such as Florence Nightingale and Lilian Wald have helped to pave the road toward awareness and acceptance regarding the importance of nurses within the healthcare field. I’ve always thought of these types of influential figures as strong and persevering. Imagine the hardships and backlash they faced, and how they continued forward for the patients and communities.

I found an interesting article that talks about how even at the doctoral level of Nursing, often times the programs have a missing element regarding the conduction of clinical research. This article discusses the key differences between DNP versus PhD programs for Nurses. The importance of research skills lands within the development and testing of interventions to improve patient outcomes (Oermann & Kardon-Edgren, 2018). DNPs would benefit highly from integrating the knowledge base and competencies to conduct research within their programs. This could provide the level of mastery needed to gain expertise and skill in the translation of research and other evidence into clinical practice, measurement of outcomes, and using evidence to improve systems are transferable to evidence-based teaching because all those elements need definitive research to generate evidence-based practice (Oermann & Kardon-Edgren, 2018). Nurses are the ones in the frontline of patient care and to be able to have this added autonomy of actually creating and performing clinical research would help the advancement of evidence-based practice initiatives.

Oermann, M.H. & Kardong-Edgren, S. (2018). Changing the conversation about doctoral education in nursing: Research in nursing education. Nursing Outlook. 66(6), 523-525. DOI: