The roles of advanced care providers consist of numerous competencies, which represent the nature of work and serve as the basis for the profession of advanced care providers. However, the competencies, which are required for performing the roles of different advanced care providers, vary greatly. There are two big groups of advanced care providers direct and indirect. Each group incorporates several professions. The competencies of different professions may have specific features even within each group. However, the biggest difference is in the competencies of direct and indirect advanced care providers (Hamric, Hanson, Tracy, & OGrady, 2013). This paper will compare and contrast the competencies within the roles of family nurse practitioner and nurse administrator/executive. The family nurse practitioner is the example of the direct advanced care provider while the nurse administrator is the example of the indirect advanced care provider. Moreover, the paper will investigate the similarities and differences in the implementation of particular competencies within the mentioned roles.
In fact, it is essential to set the distinctions between the roles of direct and indirect advanced care providers. The direct role assumes working with patients directly and taking care of them in patient facility settings or at home. On the contrary, the indirect role does not require the direct contact with patients. The nurse can work in the nurse administration and perform administrative job. Of course, this type of work influences the overall quality of care provided to patients. However, the indirect care providers do not provide the primary care to the patients, and they usually do not contact the patients at all.
In spite of the differences related to the involvement of direct patient care, there are both similar and contrasting competencies for two roles. According to the American Organization of Nurse Executives (AONE, 2015), the competencies of the executive nurse are divided into five groups leadership, communication, professionalism, business skills and health care environment knowledge. The core competence is the leadership that is guided by the competencies in the four remaining groups. The leadership competencies include the following: change management, planning of succession, fundamental thinking skills, systems thinking and personal journey disciplines. The leadership competencies of the executive nurse require solid critical thinking, assessment of the situations, and implementing changes based on the leadership analysis. Similarly to the executive nurse, the family nurse practitioner also has to possess leadership competencies. The Population-Focused Nurse Practitioner Competencies (PFCTF, 2013) provide the set of leadership skills for the family nurse. In particular, the Family Nurse Practitioner has to collaborate with other professions in order to work out the mutual respect. Moreover, the family nurse has to work with other nurse representatives and other health care specialists in order to meet special patient care needs. The role of the family nurse here is to organize the work process of different parties with an aim to address the needs of patients. Besides, the family nurse has to engage in continuous professional development to advance the performance of the team. Thus, both executive and family nurse should possess leadership competencies. At the same time, the leadership competencies of two roles differ to a certain extent. The leadership competencies of an executive nurse are directed towards developing leadership in nursing personnel, evaluating systems and offering new solutions, implementing change and working as an HR leader in workforce analysis and evaluation. The leadership of the family practitioner is directed towards the organization of a better care for patients through promoting leadership and mutual respect in interprofessional teams organized to serve patients needs.
The second group of competencies that is important both for direct and indirect roles consists of the policy competences and knowledge of the healthcare practice. The direct role distinguishes two groups of competencies policy competencies and health delivery system competencies. The indirect role unites these competencies in one group under the tag knowledge of heath care environment. The similarity between two roles is the fact that both of them need to understand the health care system, its peculiarities and specific features in order to ensure that the patient-centered care is realized in the most effective manner. Both roles require the knowledge of legal issues, reimbursement policy, financial options, and health care delivery models. The difference between two roles is the fact that direct provider analyzes the system from the patients point of view as it deals with patients, looks at their behavior and attitudes. The indirect provider has to look from the view of the system, develop the assessment tools and programs for analysis, advocate the interests of nursing staff and deal with many stakeholders, ensure the compliance of the delivery systems with the current legislation, partake in the development of improved delivery systems, know the basics of organizational financial planning, etc. Actually, it looks like both direct and indirect providers should possess adequate knowledge of the health care environment and legislation. However, the knowledge of direct care providers is mostly applied in relations with patients and other representatives of the nursing team. The knowledge of indirect care provider is applied within the administrative level, nursing team, external stakeholders and governors (PFCTF, 2013; AONE, 2015).
The third group of competencies that is shared by both direct and indirect care providers represent professionalism. The indirect role assumes such groups of professional competencies as personal and professional accountability, career planning, ethics, and advocacy. The direct role expects to fulfill both ethics competencies and independent practice competencies. Thus, both professions have to conform to the existing norms of professional ethics. Both jobs require high level of personal accountability. Other competencies within the professionalism group differ significantly. For example, the indirect role should take care of the career planning and promote professional certification for staff, advocate the health issues within the community, coach nurses, etc.. The professional competencies of direct provider include providing care and treating patients, prescribing medications, planning and offering palliative care, influencing family health decisions, explaining features and possibilities of the healthcare system to families, identifying the risk factors, communicating the existing risk factors to patients and their families, addressing the cultural diversity when dealing with patients, etc. (PFCTF, 2013; AONE, 2015).
There are obvious distinctions in the implementation of the core competencies within the roles of the executive nurse and family registered nurse practitioner. The main similarity in the implementation of the core competencies is the fact that both roles require relevant education and certification. The person cannot implement the competencies without the Master-level education. The second similarity in the implementation of the competencies is the fact that both roles implement their competencies within the health care facility. The third similarity is that implementation of the competencies is directed towards ensuring and promoting the patient-centered approach to healthcare. However, the implementation of the core competencies in direct and indirect roles is associated with essential differences. In fact, the family nurse implements a greater part of the core competencies within the communication and relationship with patients and their families. The part of competencies is implemented within the interaction with colleagues. For example, the family nurse diagnoses and treats patients, prescribes medications, provides care and consulting, suggests insurance opportunities, and provides palliative care and end-of-life services in the area of professionalism. So, the nurse is expected to implement professional attitude, knowledgeability, ethical and cultural approach. Thus, the main target of implementation of the core competencies is patient group (Hamric et al., 2013). On the contrary, the executive/administrative nurse implements the professional competencies within the group of colleagues, team and external units, such as governing boards, educational institutions, financial entities (insurance companies), various types of NGOs and charitable organizations. Besides, the professional competencies of the indirect care providers could be implemented in the areas that do not interfere with people at all, for example, preparation of the career-testing, educational materials, assessment-tools, improvement plans, development of new health-care delivery models, etc. In fact, this work is often treated to be behind-the-scenes job but it is as important as the direct care as it influences the work of the medical facility and has the direct influence on the patient outcomes (PFCTF, 2013; AONE, 2015).
In conclusion, it is significant to state that the main difference between the direct advanced health care provider and indirect advanced health care provider consists in interaction with the patients. This paper compared the peculiarities of competencies needed to possess within the roles of family advanced practiced registered nurse and administrative/executive nurse. The family nurse is a direct role that assumes working directly with patients (diagnosing, treating, prescribing drugs, educating, providing palliative care). The executive nurse is an indirect role that expects to perform administrative work of preparing educational materials, improving the health care delivery system, developing and implementing assessment tools, advocating nursing profession and the needs of patients at the governance bodies, representing nursing team in cooperation with external organizations and parties. There are both similarities and differences in competencies needed for both roles. For example, both roles require such groups of competencies as leadership, professionalism, and knowledge. However, the leadership of the direct provider should concentrate on organizing the team towards the improvement of patient outcomes, serving as a leader in dealing with patient cases. The leadership of the indirect provider consists in system thinking, promoting valuable changes in models, strategic planning, etc. The paper also provided the analysis of the similarities and differences in implementing the core competencies within the direct and indirect roles. In spite of several similarities, the main obvious difference consists in target group/subject. The competencies of the family practitioner are directed towards patients. The competencies of an indirect provider are oriented towards the nursing staff, external stakeholders and non-human issues (preparing plans, educational materials, developing schedules, assessment plans, etc.)