Altogether, A CRNP, CNM, and PA play a significant role in nursing. They however have their differences about the role each has. The following is a description of their roles to differentiate them. The explanation also includes their impact on my practice as an FNP. 

A nurse practitioner (CRNP) has certified health professions under the nurse practice act and their roles identify them as seniors in a medical institution. The job description gives the mandate of performing the following roles; processing health care information to patients and their families. A CRNP is given the authority to create wellness and self-care by engaging patients on their medication protocols and the associated procedures in advancing their medication. Second, a nurse practitioner gathers patients’ concerns and concepts on their medication and uses it in advancing better health care decisions. And also, providing individualized care, they have the responsibility of ensuring a health complication is dealt with in a manner that promotes the best for patients (What is a Nurse Practitioner? 2021). A CRNP complements my work as a family nurse practitioner (FNP) in that it provides sufficient details on what is expected from a nurse from a general perspective enhancing the integration of best practice in a home care setting.Discussion: Different Roles of the Nurse Practitioner

A certified Nurse-Midwife (CNM) is an individual with a job specification related to women’s reproduction health. Their job differs from a nurse practitioner and a PA in that CNM concentrates on women’s health and in particular the reproduction health. They have the following roles; providing primary care in reproductive health which entails directing women in their pregnancy on the best healthcare strategies to improve their health. Attending births which include being there when women are delivering to ensure the process does not fall into complications. And also performing gynecological evaluations, entails providing assessments to women during and after pregnancy to ensure the period comes into a success (What is a Certified Nurse-Midwife (CNM), 2021). A CNM is an extension of FNP in that it provides a substantial ground on how to handle reproductive assessment from a home setting. It completes the field by laying a platform over which an FNP understands how to intergrade best strategies in caring for the expectant mothers during and after delivery.Discussion: Different Roles of the Nurse Practitioner

A Physician Assistance (PA) as the title implies is people with the responsibility of assisting physicians during medical procedures such as surgery. They work under the supervision of a senior physician who is responsible for their medical practice. They have the following roles; performing a physical assessment, diagnosing and overriding medication process, engaging in medical tests, and assisting in surgery. Thus, PA is a qualified physician, only that they are in the transformation from junior to a senior level and it has to be monitored by a physician (Kaple, 2021). A PA also has a significant role in generating the best family nursing. It is a basic platform over which a family nurse practitioner can formulate the best tactics to develop their services to home-based patients. They can borrow advice from the PA on the best ways to undertake a family emergency.

In conclusion, a CRNP, CNM, and PA have relative differences which can confuse a person without medical knowledge. Thus, it is critical to understand the differences in the role they play. They altogether advance an FNP and should be incorporated in developing the field.Discussion: Different Roles of the Nurse Practitioner

References

Kaple, T. (2021). Nurse Practitioner vs. Physician Assistance. Nurse Journal. https://nursejournal.org/resources/np-vs-physician-assistant/

What is a Nurse Practitioner? (2021). Pennsylvania Coalition of Nurse Practitioners. https://www.pacnp.org/page/whatisapractitioner.

What is a Certified Nurse-Midwife (CNM)? (2021). Nurse Practitioner Schools. https://www.nursepractitionerschools.com/certified-nu

response 1

Great post, you included a lot of informative and pertinent information on the similarities and differences of the three specialties. I liked how you included that a Certified nurse midwife (CNM) is an extension of the Certified registered nurse practitioner (CRNP).  The CRNP does typically go through nursing school then advance practice nurse practitioner schooling before getting their CNM certification and board exam. The care within the three specialties overlap even though are trained differently (Ritter, Bowles, O’Sullivan, Carthon, & Fairman, 2018). The shortfalls within healthcare have allowed for collaboration with Nurse Practitioners and Physician assistants and Certified Nurse Midwives to work together (Peterson et al., 2016).Discussion: Different Roles of the Nurse Practitioner

Reference

Peterson, L. E., Blackburn, B., Petterson, S., Puffer, J. C., Bazemore, A., & Phillips, R. L. (2016). Which family physicians work routinely with nurse practitioners, physician assistants or certified nurse midwives. The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association, 30(3), 227–234. https://doi-org.ezp.waldenulibrary.org/10.1111/jrh.12053

Ritter, A. Z., Bowles, K. H., O’Sullivan, A. L., Carthon, M. B., & Fairman, J. A. (2018). A policy analysis of legally required supervision of nurse practitioners and other health professionals. Nursing Outlook, 66(6), 551–559. https://doi-org.ezp.waldenulibrary.org/10.1016/j.outlook.2018.05.004Discussion: Different Roles of the Nurse Practitioner

Response #2

Great post! An interesting thing that I learned is that there are three different types of midwifes.  There are Certified Nurse Midwifes (CNM), Certified Midwifes (CM), and Certified Professional Midwifes (CPM). A CNM is allowed to practice in all 50 states, a CM may practice in 5 states, and a CPM is accepted to practice in 31 states (Marzalik et al., 2018).  There are several pathways of becoming a midwife, nonetheless, all are associated with positive patient outcomes and satisfaction (Marzalik et al., 2018).  The scope of practice of CNMs and CMs are similar, but a CPM’s scope of practice is determined through North American Registry of Midwives (NARM) Job Analysis, state laws, and regulation. In addition, the practice guidelines for each individual CPM are dependent to the midwifes skills and knowledge. CNMs and CM are both certified through the American Midwifery Certification Board (AMCB) and its education program is accredited by Accreditation Commission for Midwifery Education (ACME).  CPM, on the other hand, requires at the very minimum a high school diploma and because CPMs don’t have to be board certified, all CPMs must show proof of midwifery work experience and competency in skills (Marzalik et al., 2018). Currently, there are only 10 American Midwifery accredited schools in the U.S that are recognized. In some programs, CPMs receive degrees and in others certificates, the biggest barrier to completing this program is the lack or preceptors.   Discussion: Different Roles of the Nurse Practitioner

References

Marzalik, P. R., Feltham, K. J., Jefferson, K., & Pekin, K. (2018). Midwifery education in the US-Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife. MIDWIFERY, 60, 9–12. https://doi-org.ezp.waldenulibrary.org/10.1016/j.midw.2018.01.020

Midwives Education Accreditation Council. (n.d). Compare MEAC schools. Retrieved from https://www.meacschools.org/midwifery-schools/compare/

Initial Post

Throughout this discussion post I will explain the differences in roles of a Certified Register Nurse Practitioner (CRNP), a Certified Nurse Midwife (CNM), and a Physician Assistant (PA). I will also describe how these roles may impact the way Family Nurse Practitioners (FNPs) practice.

CRNPs are also known as Advanced Registered Nurse Practitioners (ARNPs). Both titles refer to a nurse that holds an advanced degree (master’s or doctorate degree) which includes advanced didactic and practicum training providing the knowledge to diagnose and treat patients (once passing the appropriate board certification test) (31st Annual APRN Legislative Update, 2019)Discussion: Different Roles of the Nurse Practitioner. Although CRNPs practice throughout the country, their location determines how their job might actually look (National Council of State Boards of Nursing, 2021). For example, I will compare the rules and regulations regarding CRNPs/APRNs in Alaska and Indiana. One of the most significant differences is their practice authority and freedom.  CRNPs practicing in Alaska are able to practice independently without any physician supervision while Indiana CRNPs must be in collaboration with a physician to practice (American Nurses Association, n.d.). Despite the regulation from state to state, a CRNP can diagnose injuries and illnesses, provide patient education, prescribe medications, and refer patients for additional testing or therapies. CRNPs can be found in all medical settings including primary care provider offices, urgent care centers, and hospitals. They are able to specialize in many fields including family practice (i.e. Family Nurse Practitioner (FNP)), pediatrics, women’s health, and psychiatrics (31st Annual APRN Legislative Update, 2019).   Discussion: Different Roles of the Nurse Practitioner

As I mentioned before, a FNP is a CRNP which is governed by the appropriate local Board of Nursing. The Board of Nursing has rules and regulations. These regulations help define the roles of CRNPs and FNPs accordingly. To further demonstrate this information, I will expand on the comparison of CRNPs practicing in Alaska and Indiana. CRNPs practicing in Alaska are able to practice independently without any physician supervision (American Nurses Association, n.d.).  They also have no transition period to practice on their own. They are able to practice freely immediately after graduating from school. CRNPs practicing in Alaska can also prescribe mediations on their own. No physician involvement is required (American Nurses Association, n.d.)Discussion: Different Roles of the Nurse Practitioner.  I found that although Alaskan CRNPs practice independently, they too are unable to sign death certificates (American Nurses Association, n.d.). Although this collaboration is required, there are not many requirements for the partnership itself. It is not stated that the physician has to practice in the same location nor are there any geographical distance restrictions. But their shared responsibility must be spelled out in their agreement. CRNPs practicing in Indiana must also have physician supervision to prescribe medications. They are able to prescribe Schedule II to V controlled substances; however, the collaborating physician must review at least 5% of the charts of the patients that were prescribed medications within seven days (American Nurses Association, n.d.). Another fact is that Indiana is one state that does not require CRNPs to be nationally certified. However, many of them do become nationally certified.  Their CRNPs are also not allowed to sign death certificates (American Nurses Association, n.d.).

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A CNM is an advanced practice nurse that specializes in women’s health (31st Annual APRN Legislative Update, 2019). They are known for their focus on reproductive health, prenatal care, and childbirth although they can provide more generalized and preventative care (31st Annual APRN Legislative Update, 2019). Since CNMs provide services related to pregnancy and childbirth they often practice in a hospital or clinic settings however they are able to provide services in any birthing setting. Along with assisting with the birthing process they provide exams such as pelvic or breast exam and prescribe medications such as birth control. CNMs also provide patient education and referrals. The biggest differences between CNMs and FNPs are the services they provide and the patient population they see.Discussion: Different Roles of the Nurse Practitioner

When I think of advanced care providers, I think of a charm bracelet. A FNP is an example of the chain itself. And the charms are specialized care providers such as CNMs. FNPs are the chain because they link together the information and input from all the specialists a patient may need. They allow the patient to come full circle and be treated as a whole person. A CNM may also consider a holistic approach but they are typically more focused on providing services related to reproductive health conditions. For example, a FNP may have a pregnant patient. The FNP will refer the patient to a women’s health provider (e.g. a CNM). The CMN will treat the patient regarding all pregnancy concerns. But the FNP can continue treating this patient for other concerns such as ear infections or a twisted ankle.Discussion: Different Roles of the Nurse Practitioner

A PA is much like a CRNP. PAs have also obtained advanced degree which includes advanced didactic and practicum training providing the knowledge to diagnose and treat patients. PAs diagnose illnesses and injuries, prescribe medications, refer patients for additional testing or therapies, and provide patient education (American Academy of Physician Assistant, 2021). PAs can work in all types of medical settings and specialties from emergency rooms to family practice clinics. There are far more similarities than differences. The two major differences are their educational backgrounds and regulating bodies. PAs receive their bachelor’s degree in a science such as biology and then continue their education in a master’s degree program (American Academy of Physician Assistant, 2021). CRNPs are registered nurses first and then continue their education in a master’s degree program. PA’s training is more disease-centered whereas CRNP’s training is more patient-centered (American Academy of Physician Assistant, 2021). PAs are regulated by state medical boards and CRNPs are regulated by state nursing boards (American Academy of Physician Assistant, 2021; National Council of State Boards of Nursing, 2021).Discussion: Different Roles of the Nurse Practitioner

Although PAs and FNPs have some differences they are very similar considering the services they can provide and the roles that they have in the medical field. PAs are fellow advance care providers and colleague. FNPs can collaborate with them just as they would any other advance care provider. If an FNP had a patient they wanted a second opinion on they could collaborate with or refer to a PA. For example, a FNP may collaborate with a PA who is a co-worker when starting new medication on a complex renal patient due to the PAs extensive knowledge and experience as it relates to renal disease and dialysis. Or maybe that patient becomes so complex or increasing ill that the patient needs a referral for cardiology. The FNP may refer this patient to a PA that works in a cardiology clinic.Discussion: Different Roles of the Nurse Practitioner

Throughout this post I have discussed the different roles of CRNP, CNM, and PA. I was discussed the connection they have with an FNP and how that may influence how the FNP practices.

 

 

References

American Academy of Physician Assistant. (2021). PAs & NPs: Similarities and differences.  https://www.aapa.org/download/60509/

American Nurses Association. (n.d.). ANA enterprise. http://www.nursingworld.org

National Council of State Boards of Nursing. (2021). The world leader in nursing regulatory knowledge. https://www.ncsbn.org/index.htm

31st Annual APRN Legislative Update. (2019). Nurse Practitioner, 44(1), 34–55.