The Evolution of the Nursing Profession
The nursing profession holds numerous opportunities for specialization. Nurses who specialize have the ability to become experts in their specific field, to influence nursing practice, and to improve overall health outcomes. Nursing specialties differ depending on the degree the individual holds. An associate degree or bachelor’s degree nurse can specialize in areas such as burn care nursing, cardiac care nursing, flight nursing, forensic nursing, genetics nursing, hospice nursing, infection control nursing, and the list goes on. A master’s degree advanced practice nurse is educated as either a certified nurse practitioner, a certified registered nurse anesthetist, a certified nurse midwife, or a clinical nurse specialist. Advanced practice nurses may also choose to specialize in areas such as critical care, diabetes care, hematology-oncology, neonatal intensive care, neurology, pulmonology, and so many more. In this paper, I will discuss the evolution and the future vision and goals of the forensic nursing role and the role of a nurse practitioner.
Although TV shows like NCIS and CSI do not include forensic nurses in their casting, these nurses play a major role in real-life forensic cases (Jackson, 2011). Forensic nursing was not recognized as a nursing specialty until 1995 (Tracy & O’Grady, 2019). Forensic nursing is defined by the International Association of Forensic Nurses (IAFN) as “the application of forensic science—combined with the biological and psychological education of the registered nurse—in the scientific investigation, evidence collection and preservation, analysis, prevention, and treatment of trauma and death-related medical issues” (Jackson, 2011). A forensic nurse cares for patients who have been victims of violence, assault, sexual abuse, etc. “They address the bio-psycho-socialspiritual needs of patients affected by violence and trauma to promote physical and psychological health and recovery” (Valentine, 2018). “Forensic nurses use the nursing process to provide compassionate, holistic care” (Valentine, 2018). Like other nursing professions, forensic nursing has many subspecialties incorporated in a variety of different healthcare settings. These healthcare settings may include places such as the coroner’s office, jails and prisons, mental health hospitals, emergency departments, trauma hospitals, schools, and lawyer’s offices. Forensic nursing is not a standalone specialty. It also incorporates the forensic science, public health, and criminal justice professions.
Currently, an associate’s or bachelor’s degree registered nurse has the ability to become a forensic nurse by participating in an additional certification program. However, “forensic nursing is advancing as a discipline and a specialty within nursing” (Drake, et al., 2018). In upcoming years, the evolution and future of forensic nursing hopes to develop into an advanced forensic nursing role. “Like all nurses, forensic nurses have much to gain by attaining higher levels of education and preparation so they can deliver optimal patient care and promote the profession” (Jackson, 2011). “Consistent with the newness of any specialty, forensic nursing is experiencing challenges including role clarity, scope of practice, and, importantly, lack of a solid comprehensive evidence base for what forensic nurses do in response to interpersonal violence, death, and incarceration” (Drake, et al., 2018).
When comparing the forensic nursing role and the role of a nurse practitioner, the two roles are very different; however, they do have a few similarities. First are foremost, both healthcare providers serve to support and advocate for their patients. Both forensic nurses and nurse practitioners assess, diagnose, plan, implement, and evaluate their patients after any trauma, injury, or illness (International Association of Forensic Nurses & American Nurses Association, 2015). Both nursing figures utilize evidence-based research to guide treatment regimens (International Association of Forensic Nurses & American Nurses Association, 2015). Furthermore, in the weeks after any trauma, injury, or illness both professions follow up with the patient to see if further referral to specialized care is necessary (Drake, et al., 2018). In addition, both forensic nurses and nurse practitioners coordinate aftercare, including the prevention of other illnesses and education on health promoting behaviors.
With the aging population, the need for healthcare continues to rise and nurse practitioners (NPs) have become a vital component of the healthcare team. A nurse practitioner holds either a master’s degree or doctorate degree in nursing practice. The educational program includes didactic coursework in addition to approximately 700 hours of clinical coursework. Once the educational program is completed, NPs must pass the American Nurses Credentialing Center (ANCC) Nurse Practitioner board certification examination (Hass, 2016). Nurse practitioners are educationally prepared to interview and assess patients to determine a diagnosis, to order lab work and imaging to understand the extent of an illness, and to prescribe medications and other non-pharmacologic interventions to help treat or cure a disease. In primary care, “nurse practitioners can perform most services that physicians provide” (Rosenberg, 2018). Unfortunately, the scope of practice for NPs varies from state to state, limiting their ability to provide care to patients that they were educated to provide. Currently there are twenty-three states with full practice authority, sixteen states with reduced practice authority, and 12 states with restricted practice authority (Mack, 2018). Because nurse practitioners are so crucial to the healthcare team, the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation was developed to bring uniformity to the APRN roles and scope of practice from state to state. The incorporation of the Consensus Model for APRN Regulation will make primary healthcare more available to patients across the country, thus improving patient overall health and well-being.
The future is bright for both the forensic nursing specialty and the nurse practitioner specialty. Unfortunately, violence of all types is continuing to rise in the United States, increasing the need for forensic nurses and the aging population is creating an increased need for primary healthcare providers. Without a sufficient number of nurses in these specialties, communities will be underserved. There will always be a need for healthcare, thus the nursing profession is one that will continue to grow and develop.
References
Drake, S. A., Koetting, C., Thimsen, K., Downing, N., Porta, C., Hardy, P., . . . Engebretson, J. (2018). Forensic nursing state of the science. Journal of Forensic Nursing,14(1), 3-10.
Hass, V. (2016). Physician assistants and nurse practitioners are not interchangeable. Journal of the American Academy of PAs,29(4), 9-12.
International Association of Forensic Nurses, & American Nurses Association. (2015). Forensic nursing: Scope and standards of practice. 1-64.
Jackson, J. (2011). The evolving role of the forensic nurse. American Nurses Association Journal,6(11).
Mack, R. (2018). Increasing access to health care by implementing a consensus model for advanced practice registered nurse practice. The Journal for Nurse Practitioners,14(5), 419-424.
Rosenberg, J. (2018, June). Nurse practitioners play an increasing role in primary care
[Web blog post].
Tracy, M. F., & O’Grady, E. T. (2019). Hamric and Hanson’s advanced practice nursing: An integrative approach (6th ed.). St. Louis, MO: Elsevier.
Valentine, J. L. (2018). Forensic nursing: Overview of a growing profession. American Nurse Today,13(12), 42-44.
