A LITERATURE-REVIEW OF ADVANCED CLINICAL NURSING PRACTICE IN THE UNITED-STATES-OF-AMERICA

Advanced nursing practice in the United States of America has evolved over the past decades in two related but distinct directions:- the nur se practitioner (NP) and the clinical nurse specialist (CNS). This two -role evolution was in response to social demands for increased access to affordable, quality primary health care, and at the same time to t he specialised nursing care requirements of increasingly complex patie nts. Thus, nurse practitioners became synonymous with primary and clin ical nurse specialists with specialised, acute care. There is evidence that there is an advanced practice role for both the CNS and the NP a nd that much of the knowledge, skills and competencies are shared depe nding on the clinical situation. There have been successes and failure s in the development of the two roles. The clinical nurse specialists have a more respectable image among the powerful nursing education eli te, but nurse practitioners are widely recognised by consumers and oth er health care professionals and are valued by cost-conscious managers as a viable, cheaper alternative to physicians. The literature sugges ts it may well be time to take the best attributes of the two roles an d merge them under the term 'advanced nurse practitioner'.