Conceptualization, Definition, and Competencies of Advanced Practice Nursing with a Focus on Endocrinology

Advanced practice roles emerged from a combination of economic factors, staffing needs, political action, and supportive legislation. Fuelled by similar issues, there is a global movement for the development and implementation of advanced practice roles in primary care (general practice) and specialty roles, including endocrinology. Predicted shortages of physicians, particularly for practice in rural and underserved populations, along with spiralling health care costs have made more attractive the philosophy of integrating independent advanced practitioners into an organization and health care system. To this end, a global definition is needed that clarifies the concept of ‘advanced’ practice and forms a basis for operationalization of these roles. Scope of practice regulations, and credentialing requirements for practice, are dependent on this conceptualization. Specialty practice can be further delineation with a description of competencies. The increasing complexity of illness and knowledge explosion have resulted in more specialization and driven the need for higher education in nursing. This is also a global trend. Utilization of nurses as physician substitutes and different country and organizational specific practice models have resulted in role confusion and poor standardization. Using a unifying concept can help to alleviate this confusion for patients and other health care practitioners. More standardization allows for comparative research to further support the efficacy and quantify improvement in patient outcomes achievable by advanced practice nurses. In this chapter, these issues are explored with recommendations for the application in endocrine nursing.