Advanced Practice Nursing

The evolution of the term “advanced” in nursing is unclear, several fellow colleagues have asked me what does it mean to have a Master’s degree in nursing and what does specifically a nurse at a Master’s level is entitled to do. Indeed, it is a tough question since it’s almost impossible to have a short and concise answer that captures what nurses actually do. However, I will try as much as I can to give you an overview of the commonalities of the various advanced practice specialties in nursing and I will specifically elaborate on the role of Advanced Practice Psychiatric Nursing (APPN).

Some assume that the end point of a graduate degree in nursing is an administrative or managerial position; while this could be a very prospective role it is not exclusive to nursing advancement. In the American University of Beirut (AUB)  we have 4 specialization tracks at a Master’s level accredited by the Commission on Collegiate Nursing Education (CCNE) and they include: MSN in nursing administration, MSN in adult care, MSN in community nursing, and MSN in psychiatric mental health nursing. Furthermore, postgraduate training and certification are encouraged for nurses at a Master’s level who wish to deepen their proficiency in their practice. Advanced development in nurses’ role has emerged because of the complexity of the health care knowledge and technology. In Fact, the historical context of advanced nursing practice is very broad and encompasses health manpower and sociopolitical issues.

Advanced nursing practice has reached high levels of demand after World War I and II with the increasing case reports about war-related psychiatric problems in returning soldiers. Thus, with escalating public recognition of mental health concerns, psychiatric nursing was able to make major strides in the development of a specialized direct care role. By 1946, the National Mental Health Act designated psychiatric nursing as a core discipline and during the early 1950s, the primary contributor to mental health law reform, Hildegard Peplau has published the middle-ranged nursing theory of interpersonal relations that helped revolutionize the apprenticeship of psychotherapy. In 1980, the American Nurses Association (ANA) have reported that specialization in nursing is now clearly established and that specialization is a mark of development in the nursing profession. Advanced practice psychiatric nursing (APPN) is one of the oldest and most highly-developed clinical specialties in nursing, this expansion in the psychiatric nursing body of expertise provided the support for mental health nurses to begin seeking new management roles while gaining the attention of mental health patients as well as policy makers.

The spheres of influence of the APPNs are improving in function to the escalating need. Unfortunately, in Lebanon there still exist a big gap between what APPNs can actually do and what they are credentialed for. The nursing practice law in Lebanon does not recognize advanced practice; excluding AUB Medical Center, employers are not aware of the important roles that an advanced practice nurse can have in enhancing patient safety and improving quality of care. APPNs assess, diagnose, plan treatment, implement psychotherapy and evaluate the mental health of patients. One of the many assets nurse psychotherapists encloses patience, primarily because of their work experience with the chronically ill. In addition, nurses respect others’ limitations and follow a holistic paradigm of care; they are resourceful (both BSN and MSN programs have extensive pathophysiology and pharmacology courses) and ethical. In 2012, and for the 11th year in a row, the Gallup poll found that nurses top the list of the most ethical profession. Moreover, advanced nurses contribute to quality care improvement, academia, research, and policy development in health reform.

There is, without a doubt, an increasing need of the community for advanced nurses on all levels: practice, education, and management. Nurses continue to play a significant role in everyone’s daily life. Many nurses have changed lives and some of them have managed to change the course of a nation. Clara Barton was the founder of the American Red Cross, Dorothea Dix founded the first American mental hospital, Margaret Sander is one of the pioneers in teaching Planned Parenthood, and Anna Carolina Maxwell the founder of the Army Nurse Corps who bravery cared for wounded men and was a major force in improving the sanitary conditions in military hospitals. With the advancement in nursing practice, nurses will continue to be a key workforce in making this world a safer place to live.


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