Preparation for negotiating scope of practice for acute care nurse practitioners.

The Acute Care Nurse Practitioner (ACNP) is an NP educated and trained to provide advanced nursing care to acutely and critically ill patients (National Panel for ACNP Competencies, 2004). Requirements for national certification include successful completion of formal education and training in the specialty area of practice, master’s or higher in nursing, a minimum of 500 h of supervised clinical practice in the specialty area, and core content in advanced pharmacology, advanced pathophysiology, advancedhealth assessment, differential diagnosis anddisease management, and health promotion and disease prevention (American Nurses Credentialing Center, 2006). ACNPs practice in a variety of settings, including acute and critical care settings such as intensive care units, urgent care, clinic settings, and subacute care (Kleinpell, 2005). Components of the ACNP role include patient care management for patients with acute, critical, and complex chronic illness, diagnostic reasoning to formulate the plan of care, and evidenced-based and research-based clinical practice (American Association of Critical Care Nurses, 2006). The scope of practice of the ACNP includes conducting history and physical exams, diagnosis and treatment, ordering and interpreting of diagnostic tests, performing noninvasive and invasive diagnostic, therapeutic, and interventional measures and tests, prescribing medications, providing counseling, teaching, and referrals (National Panel for ACNP Competencies, 2004). Longitudinal research on over 400 ACNPs has shown that while the ACNP role has developed, challenges in practice remain, including securing recognition and support for the role (Kleinpell). As a result, negotiating scope of practice for ACNP practice can be challenging. ACNPs entering the job market or relocating must be able to promote their personal and professional attributes to potential employers. Inmany cases, healthcare providers may be unfamiliar with the scope of practice of the ACNP. This places the responsibility of educating the potential employer on theACNP (Selph, 1998). TheACNP should be familiar with the laws and regulations governing the scope of practice in the state in which he or she plans to practice (American Academy of Nurse Practitioners Committee on Practice, 2002). Prior to planning negotiations, the ACNP should determine the type of practice and environment in which theywould like towork. The ACNP should research theorganization tofind the answers for the questions listed in Table 1 (American Academy of Nurse Practitioners Committee on Practice). The type of practice (i.e., hospital, clinic, or private) will ultimately determine the level and scope of practice.