Theory-Based Nurse Practitioner Practice: Caring in Action

Susan Hagedorn, PhD, RN, PNP, WHCNP; Agatha A. (Tracy) Quinn, PhD, RN, FNP


Topics in Advanced Practice Nursing eJournal. 2004;4(4) 

In This Article

The Advanced Practice Role

The nursing component of the NP role continues to be challenged from within nursing, as well as by large national physician organizations. Fawcett asks, "Why do we call nursing practice that incorporates activities traditionally associated with medicine advanced practice nursing?" (p. 136).[6] Does diagnosing illness and prescribing treatments, including medications, make us physician extenders? Rather, haven't we evolved from the nursing profession with increased education and knowledge that advances the healthcare of our patients? Is it not our role, from knowledge, teachings, and skills, to promote the health of our patients? As such, NPs are an extension of nursing, not medicine, and are guided by nursing theory. The success of NPs depends on practicing evidence-based care with competency in assessment, diagnosing, and managing patients (including writing prescriptions) and maintaining a caring practice.[7,8,9,10]

The American Association of Pediatrics (AAP) issued a policy statement in 2003 that challenged the role of the pediatric NP (PNP).[11] This large, well-respected national medical organization stated that optimal care depends on the physician leader "to have general oversight over, to superintend or to inspect... [The AAP also believes that] the pediatrician should participate in the training and educational experiences of non-physician clinicians to help ensure the competency of all team members" (p. 428).[11]

Early NPs were under the teaching auspices of physicians who believed in their abilities and knowledge, giving strength to Fawcett's proposition and the AAP's policy statement, but for the past 30 years, NPs have been educated in graduate nursing programs emphasizing formal courses in nursing theory, research, evidence-based practice, and advanced clinical practice, supervised by NPs. Watson believes that NPs practice in a holistic paradigm, looking at the patient, his environment, his beliefs and behaviors.[7] Quinn envisions the nurse as part of the patient's healing environment using not only specific healing methods but also herself (himself) as a healing modality.[12]

Although nurses traditionally see themselves as holistic in their practice, young NPs may embrace the medical model as their first clinical guide. Brown and Olshansky studied the first transitional year of novice NPs and found that many felt like imposters in their new roles, increasing their anxiety and worry trying to define themselves again.[13] Teaching the NP holistic paradigm in graduate schools reaffirms nursing beliefs. The transformation from nurse to the advanced practice role of NP involves development of advanced knowledge and skills for listening, knowing, being with patients, connecting patients to their communities, promoting health, preventing disease, and helping patients make changes in their lives. These activities define the NP role. The transformation is NOT the gain of prescriptive authority.

The American Academy of Nurse Practitioners states that NPs provide health promotion, knowledge of disease prevention, teaching and counseling functions, and patient advocacy. However, no specific reference to the NP-patient relationship is made.[14] It is important for those considering advanced practice nursing education, as well as patients and insurers, to know that the NP not only uses an expanded clinical toolbox, but also practices caring. The goal is to optimize health through caring.


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