Advanced Nursing Practice Traditionally, nurses are viewed as support staff for physicians. They provide most of the 'frontline' care, from drawing blood to ensuring the patient is comfortable, but all medical decisions must be made by a doctor. As a result, nurses cannot be primary caregivers. But the truth is, many nurses do have sufficient training to provide primary care. There are multiple levels of nursing: Licensed vocational nurses (LVNs), registered nurses (RNs) and advanced practice nurses, or nurse practitioners. Although someone can become an LVN or RN with just an associate's or bachelor's degree, advanced practice nurses all have specialized advanced education. A master's degree is the minimum requirement to become a nurse practitione r. Furthermore, most graduate nursing programs offer advanced training in a specific area of care, such as anesthesia, family practice, gerontology, midwifery, psychiatry or public health. Nurses can even pursue a doctoral degree, known as the Doctor of Nursing Practice (DNP), that prepares them for the highest level in patient-centered healthcare. No matter what their area of focus, advanced practice nurses are trained to perform a number of primary care activities. These include assessing patient needs, deciding to admit patients to hospitals, making diagnoses, writing prescriptions, ordering tests and making referrals to specialists. Expanding the Scope Organizations such as the Institute of Medicine (IOM) argue that the advanced training provided by graduate nursing programs prepares nurse practitioners to provide the same basic primary care as a general physician. IOM recently published astudyexploring the future of nursing and offering a number of recommendations for how the practice of nursing should be redefined in the 21st century. The four key messages from the study are: Nurses should be allowed to practice to the full extent of their training. The nursing education system should provide seamless academic progression (much like the pre-med to medical school system) in order to help more nurses achieve higher levels of education. Nurses should be equal partners with physicians and other health practitioners in t he process of redesigning the American healthcare system. Better data collection and a more consistent information infrastructure will be required in order to improve workforce training and policymaking.
