Sherwood, G.D., Brown, M., Fay, V. & Wardell, D. (1997)
Defining nurse practitioner scope of practice: Expanding primary care services.
The Internet Journal of Advanced Nursing Practice, 1(2), 1-13.

• Reviewed by Richard Alcorta

Advanced Practice Nurse (APN) is “a current licensed nurse who is prepared in advanced nursing practice by virtue of knowledge and skills obtained through post – basic or advanced education program of study acceptable to the State Board of Nurse Examiners.” Article targets their role as a primary care giver since there is an increased demand for primary care services since there is a shortage of primary physicians). A justification for the expanded role and historical evolution is provided.

Scope of practice – Not well defined but includes Assessment of health, Diagnosis which includes ordering appropriate tests and formulating a differential, and Case management including prescriptions, education, care plan with medical and health goals. They have select target populations: Children and adolescents (PNP), woman and Infants (Woman’s Health Care Nurse or Perinatal Nurse Practitioner) and Elderly (Gerontological Nurse Practitioner). Focus was originally to provide care in undeserved rural areas but the new roles include hospital inpatient specialty care and emergency departments.

Series of article sited justifying NP when compared to physician services and interpersonal skills and customer satisfaction.

The three major barriers to practice are: lack of third party reimbursement, prescriptive authority and Hospital admission privileges.

Assessment:
Article provides a thoughtful format and presentation for an advanced scope of Nursing practice, replacing physicians in certain areas. The scope of practice is not well defined but stresses primary care with reimbursement, prescriptive, and admitting authority issues or barriers. Again a ceiling.
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol1n2/scope.xml