Family nursing is a subgenre of medical care provided by Certified Nurse Practitioners (CNP). These are highly trained advanced practitioners of the nursing arts who have chosen to specialize in general care for children, adults and the elderly. CNPs hold either a graduate or doctoral degree in nursing and are qualified to diagnose and treat both physical and psychiatric infirmities. Family nursing is usually provided by a CNP who has pursued family medicine as a speciality. Other possible specialties include pediatrics, geriatrics, emergency nursing, occupational medicine, gynecological/ reproductive health and acute care.
Certified Nurse Practitioners
Although they are not physicians, nurse practitioners often function as the primary healthcare provider for many patients. Those who have obtained the Doctor of Nursing Practice (DNP) degree frequently run their own clinics, where patients receive family nursing services and, if necessary, referrals to other medical providers and health authorities. Family nurses have hospital admitting privileges and have the authority to prescribe many medications without a physician’s permission. In 17 states and Washington D.C., nurse practitioners have no limits in this area, which means that they may write prescriptions for narcotics and other controlled substances without a physician’s supervision. Furthermore, in more than twenty states, nurse practitioners are not obligated to practice under the authority of, or in collaboration with, a physician (although many, of course, still do).
Nurses specializing in family nursing must complete a lengthy and rigorous regimen of academic and clinical training, and must pass a series of formidable exams designed to assess their knowledge of both. Within the United States, the relevant professional certifications are granted by several organizations, including the American Nurses Credentialing Center and the American Academy of Nurse Practitioners. Before a nurse may apply for credentials, s/he must obtain a Bachelor of Science in Nursing (BSN) degree, through either a stand-alone program or as a waypoint in an academic curriculum that culminates in a graduate or doctoral degree.
Nurse Practitioners must also be licensed by the state in which they wish to practice. It’s important to understand that each of the fifty states has its own list of criteria prospective family nurse practitioners must fulfill. For example, some states don’t require nurses to have a graduate or doctoral degree in order to offer family nursing services; however, there is a strong trend in this direction, and by 2015 all – or almost all – of the states will only issue family nursing licenses to those holding the aforementioned advanced degrees.
Other Venues for Certified Nurse Practitioners
Family nursing isn’t confined to nurse-managed clinics. Nurse practitioners who specialize in family care are also frequently employed in hospitals, community clinics, convalescent/ nursing homes, hospices (for adults and children), educational institutions, home health care agencies and municipal medical offices. Schools are a tremendous environment for family nursing; school nurses must be able to switch gears quickly and often, assessing multiple patients one after the other, calling parents and interfacing with school administrators. Just as in private practice, a school nurse often has the opportunity to get to know an entire family, and provide care for growing children over four or five years. In this environment, the nurse must also be comfortable administering routine screenings for hearing loss, scoliosis, vision problems and head lice – especially in elementary schools. Furthermore, the nurse must be able to communicate clearly and effectively with individuals who come from a wide variety of cultural backgrounds and who may have unusual expectations regarding the role of the nurse in the care of their child(ren).
The Scope of Practice
Family nursing may also encompass:
- *prenatal care and birth coaching
- *immunizations and pediatric preventive care
- *education for patients with chronic illnesses, such as diabetes
- *providing school and sports physicals
- *interpreting data from many types of lab tests, X-rays, CAT scans and other diagnostic tools
- *assisting patients with basic illness prevention and health maintenance
- *educating patients about contraception, safe sex and sexually transmitted diseases
- *prescribing and evaluating physical and occupational therapy services
The Great Debate
Because in most states the precise dividing line between a certified nurse practicioner and a physician is growing increasingly fuzzy, some physicians have expressed concern that nurses may soon be expected to regularly handle cases for which they are not qualified. For example, many doctors acknowledge that a family nursing practitioner can assess, diagnose, treat and manage single-system disorders as well as a physician. However, they remain adamant that these nurses do not have the necessary knowledge and training to treat extremely complex cases involving multiple organ systems unless they do so under a superivising physician. This is a controversial debate that is unlikely to be resolved soon.
What, then, sets family nurses apart? At this point, the answer to this question is more opinion than fact. The work of a Certified Nurse Practitioner has historically involved a much greater emphasis on preventative medicine and health maintenance than is expected from physicians. The scope of family nursing practice rarely involves simple, straight lines from diagnosis to treatment. To the contrary, nurses frequently approach problems from multiple angles, involving the patient’s family, community and entire environment surrounding the patient. Many certified nurse practitioners have a much more integrated, holistic approach to health care that stresses the importance of patient self-monitoring as an effective tactic for preventing health problems and diagnosing potentially serious illnesses at the earliest, most treatable stages.