The project would lead to the creation of effective means of delivering quality health services by shifting from service driven to consumer driven practices; improving the traditional roles of nurses; transforming doctors and patients; recognizing patients’ rights for personal choices and informing them about their health condition, problems, or options; reassessment of ethical, structural, and cultural aspects of the nursing profession; ensuring quality education for nurses; developing a codes of ethics and conduct; improving nursing research; enhancing the competencies of nurses; promoting feminism and policy and legislation for equal opportunities; and emphasizing what nurses should do rather than what they should not do. In other words, radical changes were seen as necessity for the improvement of the nursing profession in the health service industry.
Shaping the culture and organization of nurses throughout the world would have an undeniable effect on the quality of their performance (Lumby & Picone, 2000, p. 40). Buhagiar (1992) and Nelson (1992) argue that nurses must make it clear that talking about ‘nurse practitioners’ or ‘advanced practice’ is referring to the practice of nursing itself instead of the concept of ‘new age’ profession. Due to the different roles that can be associated with nursing profession, the use of adjectives for nursing practice like advanced, independent, or extended implies that nurses are embracing roles that are beyond the clearly identified nursing territory (Lumby & Picone, 2000, p. 41).
Therefore, the roles of nurse should be clearly defined in order to avoid the detrimental and negative impacts of in the nursing profession. The ambiguity of nursing roles should be eliminated in order to prevent the nursing profession from poaching the roles of other professionals and maintain specific standards for nursing competencies. Role of family nurse practitioners and advanced practice nurses Advanced practice nurses (APNs) have been required to provide high-quality and cost-effective health services to patients and their families as a response to the changing demands of health consumers and the necessity of major shifts in the healthcare system (Gabay & Wolfe, 1997; Mundinger et al. , 1999; Pinkerton & Bush, 2000; Cooper, 2001 in Hales et al. , 2004).
Although the primary focus of the changes in the health service industry is on NPs in the field of primary care, APNs in the different specializations, like the clinical nurse specialists and the psychiatric nurse practitioners, have also received increasing attention in the mental health arena (Society, 1997; Baradell & Bordeaux, 2001; Puskar & Bernado, 2002 in Hales et al. , 2004). While NPs in the primary care setting have shifted to the improvement of the primary care environment, psychiatric-mental health APNs, on the other hand, have transformed the mental health industry into a new environment with technology and infrastructure that reduced the cost and increased the quality of service they provide (Simpson et al. , 2001; Pearson, 2002 in Hales et al. , 2004).
The expansion of the roles of community health nurses and nurse practitioners has included the addition of addressing children’s, families’ and communities’ health care needs the primarily focuses on health promotion and disease prevention practices. Research (Williams, Bollella, & Wynder, 1994 in Fleming, Green, & Martin, 2000) suggests that health promotion should be encouraged as early as possible and people should practice it as an integral part of their family life since lifestyle choices normally begin in the childhood stage. In addition, adults who provide or prepare meals for children must know the importance of nutrition and be educated in order to know the different heart-healthy foods.
Community health nurses and nurse practitioners are responsible in recognizing the pivotal role in successfully implementing health care guidelines to prevent health risks, like cardiovascular diseases, initiating regular exercise programs at home and in schools; stimulating children’s perceptions of empowerment; planning interventions to ensure that various communities reflect healthy attitudes and behaviors, especially by parents, families, and other adults to influence young individuals, developing programs for health promotion attitudes; and stimulating the development of a healthy lifestyle behavior in adults as well as children, as they are indicated the objectives of Healthy People 2000 National Objective (USDHHS, 1994).