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					Advanced Practice Nursing
               ICP II
          4/25/02 1:30pm
         A. Muhleman, MD
    Kimberly Moore, MSN,CRNP
Advanced Practice Nurse (APN)
• Registered Nurse (RN) with advanced
  education and clinical training
• Includes the following subcategories:
  –   Clinical Nurse Specialist (CNS)
  –   Certified Registered Nurse Practitioner (CRNP)
  –   Certified Registered Nurse Anesthetist (CRNA)
  –   Certified Registered Nurse Mid-Wife
          Areas of APN Practice
•   acute care           •   occupational health
•   adult medicine       •   pediatrics
•   emergency/trauma     •   psychiatry
•   family practice      •   school health
•   gerontology          •   women’s health
•   neonatal/perinatal
    Services Provided by APNs
• obtain medical histories and perform
  physical examinations
• diagnose/treat acute health problems (UTI)
• diagnose/treat/monitor chronic diseases
• order/perform/interpret diagnostic studies
• prescribe medications and treatments
       APN Services (cont’d)
• provide prenatal care and family planning
• provide well-child care, including
• provide health maintenance care for adults
• promote positive health behaviors and self
  care skills through education and counseling
      Physician Collaboration
• variable requirements state to state
• OH: APNs must practice within a
  collaborative relationship with a physician
  – does not equate with physician supervision
  – physician must be available for consultation in
    person or by phone or fax
         Prescriptive Authority
• variable requirements state to state
• OH: APNs prescribe from a formulary with
  drugs classes categorized:
  –   APN initiated
  –   MD initiated, APN renewable
  –   non-APN initiated or renewable
  –   can obtain DEA for prescription of controlled
      substances (certain restrictions apply)
  Complementing Your Medical
• utilize the APN to keep revenue in the
  office instead of referring to outside sources
• APN can see acute add-ons or walk-ins that
  notoriously cloud an already busy schedule
• APN can f/u on non-compliant patients or
  narcotic users to ensure narcotic contracts
  and tox screen compliance
• staff education and employee health
    Complementation (cont’d)
• utilize APN to assess and ensure
  documentation of primary care indicators as
  increased emphasis from third party payers
• APN can assist in rounding to multiple
• do NOT pay your APN to function as an
  RN - let the APN increase your office
    Case Scenario Discussions
• You are urgent care MD assigning patients
  to the physicians, Nurse Practitioner
  (CRNP), and registered nurses on staff.
  Which patient is most appropriate for the
  CRNP to see?
• You are an IM MD who requests his newly
  diagnosed patient with Fibromyalgia to
  return to see his CNS. Which of the
  following is the CNS most capable of
  addressing with the patient?
             Thank You!
• references listed in handout
• ?’s
• can email me at
  for future questions or comments

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