Katelyn,
I agree with several assertions stated in your post about the role of advanced practice
nurses (APNs) in quality improvement initiatives across various hospitals. First, you stated that
APNs are clinical leaders for quality improvement projects as they recognize the issues that
necessitate change, lead the initiative to implement change, and utilize their advanced degrees
and clinical knowledge to contribute to the improvement of healthcare. APNs have completed
graduate education, possess an expert level of knowledge and complex decision-making skills,
and demonstrate clinical competencies for expanded practice to the context in which they are
credentialed to work (Lamb, Martin-Misener, Bryant-Lukosius, & Latimer, 2018). Advance
practice nurses are frontline healthcare providers and it creates opportunities to provide
leadership at the frontline. According to the study conducted by Lamb et al. (2018), the two
themes describing APN leadership in the clinical setting are “patient-focused leadership” and
“organization and system-focused leadership (p. 402). Patient-focused leadership pertains to
activities that are intended to have a direct impact on patients and families, while organization
and system-focused leadership are activities that are intended to have a direct impact on nurses
and other healthcare providers, the organization or larger healthcare system (Lamb et al., 2018).
This highlights the crucial role of APNs as clinical leaders in various healthcare settings in the
country, which intend to be beneficial not only to patients but to the organizations that they are a
part of as a whole.
You have also highlighted in your post the contribution of APNs in the improvement in
the quality and delivery of healthcare, such as reducing hospital-acquired infections, pressure
sores, and incidence of falls. The development of advance practice nursing contributed to a
service model to respond flexibly to the ever-changing needs of patients (Woo, Lee, & Tam,
2017). APNs provided the unit staff with a consistent point of contact in the multi-disciplinary
team and demonstrated the positive impact of APNs in the clinical setting. With the clinical
leadership of APNs, quality improvement initiatives that are geared toward reducing negative
and adverse patient outcomes are initiated, ultimately leading to enhanced patient experience and
patient satisfaction. APNs play a pivotal role in quality improvement, making significant
contributions to the analysis of methods that lead to the decrease in the cost of hospitalization
related to nurse-sensitive adverse patient outcomes (McEwen & Wills, 2014).
Lastly, you have underscored in your post the central role of APNs in serving as the link
connecting evidence-based practice to quality improvement by bridging the gap between the two
concepts. Evidence-based practice is a problem-solving approach utilized in the delivery of
healthcare with the notable integration of the best evidence gathered from well-designed studies,
the patients’ preference and values, and the clinician’s expertise (Melnyk, Gallagher-Ford, Long,
& Fineout-Overholt, 2014). Integration of evidence-based practice in the clinical settings results
in the best clinical decisions for patient care and yield positive patient outcomes. I have
witnessed in my clinical experience the impact of advanced practice nurses as clinical leaders,
change agents for quality improvement, and primary advocates of evidence-based practice in the
clinical settings. Numerous changes in our current nursing practice can be traced from the
pioneering efforts of APNs who have integrated their clinical knowledge, expertise, nursing
experience, and evidence from research to design nursing practice that is cost-effective and high-
quality.
As a registered nurse, it is my personal goal to complete my graduate education and to be
an advance practice nurse in the future as I have witnessed firsthand the crucial role of APNs in
changing and improving the face of the healthcare delivery system, bringing about beneficial
changes to patients and their families all over the country. As 2 Timothy 2:15 (English Standard
Version) reminds all of us, “Do your best to present yourself to God as one approved, a worker
who has no need to be ashamed, rightly handing the word of truth.”
References
Lamb, A., Martin-Misener, R., Bryant-Lukosius, D., & Latimer, M. (2018, March 14).
Describing the clinical leadership of advanced practice nurses using a qualitative
descriptive study. Nursing Open, 5, 400-413.
https://doi.org/https://doi.org/10.1002/nop2.150
McEwen, M., & Wills, E. M. (2014). Theoretical basis of nursing (4th ed.). Philadelphia, PA:
Wolters Kluwer Health.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014, February). The
establishment of evidence‐based practice competencies for practicing registered nurses
and advanced practice nurses in real‐world clinical settings: Proficiencies to improve
healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-
Based Nursing: Linking Evidence to Action, 11(1), 5-15.
https://doi.org/https://doi.org/10.1111/wvn.12021
Woo, B. F., Lee, J. X., & Tam, W. W. (2017, September 11). The impact of the advanced practice
nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the
emergency and critical care settings: A systematic review. Human Resources for Health,
15(63). https://doi.org/[10.1186/s12960-017-0237-9]
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