The Role of Nurse Practitioners

The Role of Nurse Practitioners
SECTION A (1 page minimum)
Critical thinking and clinical reasoning
Critical thinking and clinical reasoning are terms used to describe complex and
comprehensive thought processes nurse practitioners use routinely in practice. Develop
a definition for each term.
SECTION B (2 page minimum)
Scope of practice
The scope of practice for RNs and NPs varies greatly. There are also variations in scope
of practice for RNs and NPs from state to state. Review the scope of practice for RNs
and NPs in The state of Maryland and describe the differences.

Critical Thinking and Clinical Reasoning

In clinical practice, critical thinking and clinical reasoning are two terms used to
describe complex and comprehensive thought processes nurse practitioners use routinely.
Understanding these two terms can be done on getting to their definition. Critical thinking on
nursing includes reasoning both outside and inside of the clinical setting. Therefore, critical
thinking is a set of information, belief producing, and generating skills in clinical expertise
(Darlington, 2009). It is also the process based on intellectual commitment of using those
skills to guide behavior. Critical thinking in nursing includes both clinical judgment and
clinical reasoning that involve a purposeful, informed, outcome-focused thinking which, is
focuses on safety and equality hat employs constant self-correcting and striving to improve

(Pagana, 2010 ). Clinical thinking in nursing can also take the dimension of carefully
identifying and notifying the key problems, issues, and risks improved in clinical practice.
Finally, critical thinking in nursing practice is based on applied logic and creativity that is
grounded in specific knowledge, experience, and skills.
Clinical reasoning in nursing is the thinking through which a nurse practitioner takes
through various aspects of patient care to arrive at a reasonable decision regarding the
prevention, diagnosis, or treatment of a clinical problem to a specific patient (Gaberson,
Oermann & Shellenbarger, 2015). This through taking analysis of patient history, taking and
conducting a physical exam, ordering laboratory tests and diagnostic methodologies,
designing a safe and effective treatment regimens, preventive initiatives as well as providing
education and counseling (Arnold & Boggs, 2011). Therefore, clinical reasoning needs
critical thinking skills, traits and abilities that are mostly not taught in schools and colleges
for the nurse practitioners.


Arnold, E., Boggs, K. (2011). Interpersonal relationships: professional communication
skills for nurses. St. Louis: Saunders.
Darlington, R. (2009). How to think critically. Retrieved January 6, 2011, from .
Gaberson, K. B., Oermann, M. H., & Shellenbarger, T. (2015). Clinical teaching strategies in

Pagana, K. D. (2010). The nurse’s communication advantage: How business-savvy
communication can advance your career. Indianapolis, IN : Sigma Theta Tau
International .

Scope of practice of registered Nurse (RN) and Nurse Practitioners (NP)
Not only do registered nurse and nurse practitioners differ on their education, they
also differ on their scope of practice. This is mainly attributed to state of Maryland. In the
state of Maryland, NP is independently responsible and accountable for the continuous and
comprehensive management of a broad range of health care that comprises counseling and
promotion, and maintenance of health to the patients in Maryland related hospitals. NP have
also the mandate in use of research skills and using critical thinking to devise ways in which
to facilitate provision of quality services to patients (Citizen Advocacy Center, 2010). The

state of Maryland gives that NP should be highly insured due to the specialty of job they
engage in. This is per according to Nurses Service Organization (NSO), which gives that
nurse practitioners should be insured of their malpractices.
Nurse practitioners have also the responsibility to prevent illness and disabilities of
patient to the concerned state, and to collaborate or consult with other caregivers and
community resources for a holistic and effective provision of quality services (Institute of
Medicine (U.S.) & Robert Wood Johnson Foundation, 2011). On licensure, NPs in Maryland
have to pass NCLEX-RN and an additional certification needed to become an APRN. In
addition, NPS in Maryland have to get further licensure at from the government. The
government of Maryland requires NPs to work with a doctor for a certain period to get their
license. The Nurse Practitioners should also give referral to other health care providers and
community resources to ensure that the objective of the state of Maryland in providing health
care to patients is affected. The state of Maryland gives credit to NPs in that locality to
specialize in certain activities in Hospital in Maryland. Using The American Nurses
Credentialing Center, the state of Maryland give Nurse Practitioners in this locality a
certification exam that can be used as a proxy measure for NPs licensure or designation,
therefore, it is not a voluntary but a requirement. Nurse practitioners and registered Nurses
have different identification numbers as according to Identification Standard (NPI) (Ryan,
Riff & Hansen-Turton, 2013). NPs can do all of the things that an RN can do in Maryland,
but enjoy the advantage of ordering diagnostic tests and interpret those results. In Maryland,
NPs are allowed to prescribe medications to patients.
The RNs in Maryland have also distinct roles. An RN’s practice in Maryland includes
maintenance and prevention of all possible illness. This responsibility extends to diagnosing
human responses to actual or potential health problems. In the state of Maryland, RNs have a
role in administering, teaching, delegation, and evaluation of health and nursing practice

(Declercq, 2009). The national board of nursing in Maryland gives that the respective RNs
should also engage in providing supportive and restorative care and nursing treatment,
medication administration, teaching, health counseling, case finding and experiencing
changes in the normal health processes. RNs in this state also have the role in analyzing
results of certain tests; operate medical machinery as well as administering medication (Ryan,
Riff & Hansen-Turton, 2013). More often, RNs have responsibilities to help patients with
follow-up care and educating them about medical conditions. However, RNs in Maryland
cannot prescribe medications, but enjoy the privilege of providing input into a patient’s care
program. The state of Maryland does not give licensure to RNs to have certification in certain
specialty. Therefore, they can involve themselves in many activities in health care settings in


Citizen Advocacy Center. (September 2010). Scope of Practice FAQs for Consumers:
Advanced Practice Registered Nurses (APRNs).
Declercq, E. (January/February 2009). Births Attended by Certified Nurse-Midwives in the
United States in 2005. Journal of Midwifery and Women’s Health. 54(1), pp. 95-96.
Institute of Medicine (U.S.)., & Robert Wood Johnson Foundation. (2011). The future of
nursing: Leading change, advancing health. Washington, D.C: National Academies

Ryan, S., Riff, J., & Hansen-Turton, T. (2013). Convenient Care Clinics: The Essential Guide
to Retail Clinics for Clinicians, Managers, and Educators. New York: Springer
Publishing Company.

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