Various scholars and health care practitioners have tried to the definition the role of a nursing practitioner, but unfortunately, a universal definition does not exist. In this regard, the purpose of this study is to investigate the roles of a nursing practitioner (NP) by providing conceptual and operational definitions of the construct “nurse practitioner.” Therefore, before providing a personal conceptual and operational definition of an NP, the words “conceptual” and “operational” need to be defined. According to Hurley and Watson (2016), a conceptual definition tries to explain what a concept is in theoretical and abstract ways while operational definitions, on the other hand, are built to tie down relatively complex theories or scientific concepts to the ground of empirical reality. While the conceptual meaning of an NP-only illustrates what the words mean, the operational definition illustrates how to measure the concept to determine realistically how to measure and observe it.
In this regard, the understanding of the concept NP in plain language suggests an individual who, in their daily duties, conducts nursing care and other related services to patients. However, the conceptual definition is abstract in this sense since other healthcare professionals like doctors, clinical officers, or surgeons can also be considered to be NPs from an operational standpoint. For this reason, it is essential as Gifford and O’Connor (2013) suggest, to balance between constructs at some conceptual level while also providing ways of operationalizing these constructs. Therefore, problems of definitions and measurement are inevitable in this case, and as a result, it is essential for this study to evaluate the conceptual and operational definitions of a nurse practitioner.
Consequently, the study will look at the role of nursing practitioners and attempt to define the term less generally but more accurately. In addition, the study will focus on a review of the literature on the various definitions of nursing practice that scholars have postulated in the past five years. The research design will be a purposeful search for peer-reviewed literature on the subjects in online databases like Google Scholar. Similarly, analysis and discussion of the findings will assist to conceptualize a model of the NP role by synthesizing the conceptual and operational definitions given earlier about the construct of “nurse practitioner” as it relates to practice.
Review of Literature
The concept of NP emerged from the need of more primary care providers in some underserved areas of the community. Although the development of the role has been a contentious one, while most provide primary care, some work in the specialty. In this regard, their purpose is integrating and ensuring that healthcare services are accessible to deal with people’s healthcare needs creating partnerships that benefit everyone involved.
Therefore, while attempting to discover how other scholars define the term NP, it is essential to identify the role to communicate more clearly with the stakeholders involved in healthcare practice. McGivern (2013) suggests that the descriptions of the NP role are often determined on multiple levels that have had it difficult to get a consensus for a universal definition. In this regard, the author claims that these descriptions are proposed by national professional organizations, state statutes, institutional procedures, and policies, as well as the role requirements expected by the general population. Furthermore, the evolution of terms is often informative reflecting a preoccupation with different aspects of the role as its responsibilities and competency requirements change as the goals of organized nursing change to establish some desired parameters of practice (McGivern, 2013). Consequently, the term nursing practitioners have been given many definitions.
According to the nursing practitioner’s association of Maryland’s definition, an NP is a registered nurse with one or two years of additional education and training. Furthermore, the additional training prepares them for the same kind of service provision and competency that doctors provide (“What is an NP”, n.d). In addition, NPs are required to work in teams together with other healthcare professionals like doctors, therapists, nurses, counselors, radiologists to mention a few. Simply put, their role is to provide health and wellness to people of different race, age, sex, or socio-economic status (Stewart & DeNisco, 2018). The competencies make them authorized to diagnose patients, order lab testing and x-rays as well as prescribing medicine. The second meaning provided by The American College of Nursing Practitioners defines an NP as a registered nurse who is prepared through advanced education and clinical training to provide a wide range of preventive and acute health services to individuals of all ages. The third definition of NP as given by The Maryland Board of Nursing, is simply that an NP is a registered nurse who has obtained additional advanced specialized education. The fourth definition of an NP according to the federal law of America is a nursing practitioner who performs such services that the individual is legally authorized to perform in their state of residence by state laws and who meets such training, education, and experience required as the secretary has prescribed in regulations (Carthon, Barnes, and Sarik (2015). The fifth and final definition that was obtained in this literature review is according to the California board of registerd nursing. It states that the NP is a registered nurse who possesses additional preparation and skills in physical diagnosis, psychosocial assessment, and management of health-illness needs in primary healthcare and who has been prepared in a program conforming to board standards as specified in section 1484 of the California code.
Analysis of Definitions
In this regard, a summary of the definitions of the NP suggests that to be an NP, one has to be a registered nurse for sure before anything else. And before one can be a registered nurse, they must first go through the relevant clinical education and training and obtain the necessary work experience and licensing requirements before they can be considered as a registered nurse (“Advance Practice Registered Nurse License Requirements in Maryland, “n.d.). However, the differences in this definition are that while the second one is general suggesting that nurses provide a wide range of preventive and acute health care services to individuals’ the classification is not specific enough to show which services exactly can nurses provide leading to a grey area. However, the advantage of this is that it can leave everything else to a matter of perception and interpretation. Therefore, the recommendation would be to adjust the definition to describe in specificity, the roles of a NP so that their definition of what they do can be clear like the nursing practitioner’s association of Maryland’s definition which highlights that they NPs have legal authority to order laboratory work and X-rays, diagnose a patient as well as prescribe medication for them, which is what doctors essentially do.
Similarly, while the first and the second definition both state that NPs should provide care to all patients despite their age, it appears discriminatory in other levels. For instance, an NP can state that they have been advised to serve people of all ages, but they can decide to discriminate regarding racial, gender, or other biases which is unacceptable. Therefore, for a better definition for an NP, the analysis would suggest the inclusion of the phrase ‘without discrimination’ to indicate that an NP should treat people without discriminations.
Moreover, comparing the first two definitions suggests that the first one is more practical than the second since it indicates that the NP works with other healthcare practitioners such as doctors, therapists, and counselors. While the wording suggests inclusivity, which is a good thing, it also names some health professionals and excludes others.
Therefore, for purposes of developing an operational definition, the third definition of NP as given by The Maryland Board of Nursing, is simply that an NP is a registered nurse who has obtained additional advanced specialized education. The definition is vague since advanced specialized training is broad and can be expected in other fields like nursing anesthetists, clinical nurse specialists, certified nurse midwives, and nurse practitioners who provide a wide range of services. Such include evaluation, diagnosis, treatment, education, risk assessment, health promotion, case management, coordination of care as well as counseling to a broad base of patients depending on the level of certification they have been given (“What is a Nurse Practitioner and What Do They Do”, n.d). Consequently, to model a proper operational and contextual definition of NP. It is essential also to include the specific roles than an NP will perform instead of leaving it vague to be a matter of interpretation.
Moreover, the fourth definition of an NP according to the federal law of America is by far the most practical since it states that a nursing practitioner who performs such services that the individual is legally authorized to perform in their state of residence in accordance with state laws and who meets such training, education, and experience required as the secretary has prescribed in regulations is an NP. The wording of this definition suggests that the role of an NP can change depending on what the laws and rules of a state define that they are legally authorized to perform (Brown, 2013). Similarly, an analysis of the definition given by the California state law that an NP is a registered nurse who possesses additional preparation and skills in physical diagnosis, psychosocial assessment, and management of health-illness needs in primary healthcare and who has been prepared in a program conforming to board standards as specified in section 1484 of the California code (Worcester, 2014). It clearly suggests that the definition of is not abstractly intertwined in law as in the fourth definition but is practically laid out in an act that defines the circumstances to which a person becomes an NP.
Overall, the first definition by the nursing practitioner’s association of Maryland is more operational than conceptual while the second definition by the American college of nursing practitioners is more ideological in its wording. Therefore, developing a model to construct the operational definition of an NP would include the scope of their work, who they work with, who their work affects as well as specific laws and regulations that support the role. Therefore, the contextual definition of the NP as provided by the literature review is that an NP is a registered nurse with specified additional education and training who provide healthcare service competently while working with other healthcare professionals. However, the most operational definition of an NP can be a modification of the fourth definition that suggests that an NP is a registered nurse with the competencies necessary to provide healthcare services to people of different demographics without discrimination. Similarly, an NP acts according to the prescribed laws and regulations as set out in a particular act of parliament that allows them to perform some stipulated amount of services. Simply put, the role of an NP is to provide qualified health and wellness to people of different races, age, sex, or socio-economic status while working with the knowledge obtained from the experiences using authorized methods to diagnose patients, order lab testing and x-rays as well as prescribing medicine.
Advance Practice Registered Nurse License Requirements in Maryland. (n.d.). Retrieved from https://www.nursinglicensure.org/np-state/maryland-nurse-practitioner.html
Brown, E. (2013). Nurse Practitioners laws and regulations. Sacramento, CA: California Board of registered nursing.
Carthon, J. M., Barnes, H., & Sarik, D. A. (2015). Federal Polices Influence Access to Primary Care and Nurse Practitioner Workforce. The Journal for Nurse Practitioners, 11(5), 526-530. doi:10.1016/j.nurpra.2015.01.028
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What is a Nurse Practitioner and What Do They Do? Maryland Board of Nursing. (n.d.). Retrieved from https://www.nursepractitionerschools.com/faq/what-is-np
What is an NP? (n.d.). Nursing practitioner’s association of Maryland. Retrieved from https://www.npamonline.org/page/4
What’s a Nurse Practitioner (NP)? (n.d.). American Association of Nursing Practitioners. Retrieved from https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner
Worcester, J. P. (2014). 2014 Sine Die Report Maryland General Assembly. Retrieved from https://www.npamonline.org/page/77