Dunn L
West Midlands Regional Health Authority, Birmingham.
J Adv Nurs. 1997 Apr;25(4):814-9. doi: 10.1046/j.1365-2648.1997.1997025814.x.
Advanced nursing practice in the United States of America has evolved over the past decades in two related but distinct directions:- the nurse 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 the specialised nursing care requirements of increasingly complex patients. Thus, nurse practitioners became synonymous with primary and clinical nurse specialists with specialised, acute care. There is evidence that there is an advanced practice role for both the CNS and the NP and that much of the knowledge, skills and competencies are shared depending on the clinical situation. There have been successes and failures in the development of the two roles. The clinical nurse specialists have a more respectable image among the powerful nursing education elite, but nurse practitioners are widely recognised by consumers and other health care professionals and are valued by cost-conscious managers as a viable, cheaper alternative to physicians. The literature suggests it may well be time to take the best attributes of the two roles and merge them under the term 'advanced nurse practitioner'.
在过去几十年里，美国的高级护理实践朝着两个相关但不同的方向发展：一是执业护士（NP），二是临床护理专家（CNS）。这种双角色的演变是为了回应社会对增加获得负担得起的优质初级卫生保健的需求，同时也是为了满足日益复杂的患者对专业护理的需求。因此，执业护士成为了初级护理和具有专业急性护理能力的临床护理专家的代名词。有证据表明，临床护理专家和执业护士都有高级实践角色，并且根据临床情况，许多知识、技能和能力是共享的。这两个角色的发展既有成功之处，也有失败之处。临床护理专家在有影响力的护理教育精英中享有更受尊敬的形象，但执业护士得到了消费者和其他医疗保健专业人员的广泛认可，并被注重成本的管理人员视为替代医生的可行且更便宜的选择。文献表明，或许是时候汲取这两个角色的最佳特质，并将它们合并为“高级执业护士”这一称谓了。
