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HealthNovember 30, 2021

How advanced practice nurses can expand their skills to make improvements in patient care outcomes

By: Pegge Bell, PhD, RN, WHNPCarolyn Hart, PhD, RN, CNE
The American Association of Colleges of Nursing (AACN) established nine essential competencies established that have shaped the curriculum of most APN/APRN academic programs.

These competencies are comprised of: (1) a nursing practice based on knowledge of science and humanities, (2) population health, (3) health policy and advocacy, (4) informatics and technology, (5) communication and collaborative practice, (6) systems-based leadership, (7) quality and safety, (8) evidence-based practice, and (9) advanced nursing practice. With a growing interest in the improvement of patient care outcomes to demonstrate the quality of care, advanced practice nurses must apply these competencies to assure they are integral to the achievement of their organization’s goals.

Expanded nurse leadership skills

The nine competencies presented above require an expanded level of leadership as advanced practice nurses establish their careers. How can advanced practice nurses build on these competencies to meet organizational goals — and the goal of improving patient care outcomes? Here are some areas in which advanced practice nurses can expand their skills to make improvements in patient care outcomes.


The translation of research to improve the delivery of care is vital to achieving benchmarks for patient care outcomes. With so many project findings disseminated by DNP graduates, replication of those studies in terms of population, methods, and/or interventions are propelling evidence-based practices to the forefront. Advanced practice nurses should be leaders in translating research — and in asking the questions that require further investigation. They need to build on the skills they learned from the DNP project and become inquisitive — asking why and why not. They must use data to answer questions related to what is happening, why is it not working, what is the effect on patients/nurses/staff, what must be done to address the patient, process, and procedures that lead to better outcomes.


Entrepreneurs are risk-takers who can think out-of-the-box to solve problems by creating new services or products. Advanced practice nurses face resource challenges everyday — as do their patients. They must explore how they can turn these challenges into opportunities to create new methods to serve their patients. Entrepreneurs embrace technology to deliver care, maintain patient records, and create tools to survey patients for health indicators. The exploration of required services to open or expand clinical services often leads to entrepreneurial roles, especially if the costs of these services can be offset with grants or external funding.

Change influencer

There are numerous factors that are currently driving the need for change in the US healthcare system. Access problems, high costs, disparities in care, new quality indicators, a growing elderly population, and a pandemic that overtook the healthcare system. The success of any change will be the ability of the change agent to influence successful change. Planning the change and getting the team ready for change is just half the equation. The change must be implemented, monitored, measured, evaluated, and then sustained. Advanced practice nurses should develop successful strategies for sustaining change when it is demonstrating it contributes to improved patient care outcomes.


Innovative thinking can lead to new ways to improve healthcare delivery and emphasizes how thinking “out of the box” can promote necessary change. Disruptions prompt advanced practice nurses to think of alternate ways of delivering care, ways to cut costs, and ways to improve care delivery. For example, the pandemic and the need for social distancing led to greater reliance on technology. Many APRNs now see patients exclusively via telehealth — especially if there are barriers to access. As leaders, advanced practice nurses should create a culture at work that appreciates innovative thinking from all team members if the US is to improve the patient care experience, the health of populations, and reduction in the cost of healthcare.

Carolyn Hart and Pegge Bell are the authors of Advancing Nursing Practice: Exploring Roles and Opportunities for Clinicians, Educators, and Leaders, 1e.

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Pegge Bell, PhD, RN, WHNP
Dean, College of Health Sciences at Barry University
Dr. Bell began her nursing career after completing an ADN in 1973 from what is now Columbus State University in Georgia. Her clinical experience has since focused on maternal-child services. She completed her BSN in 1976 at Georgia Southwestern University and the MSN from the University of Alabama in Birmingham in 1979. After years of teaching maternal-child nursing, she then assumed academic leadership positions. She completed her PhD at the University of Virginia where she chose the Complex Organizations in Nursing specialization. Returning to an academic position she took the opportunity to complete the women’s health nurse practitioner post-MSN certificate. This allowed her to have a faculty practice, opening a new family planning clinic at a local high school, a collaboration with the Arkansas Department of Health. Dr. Bell held several academic administrative positions and used that knowledge to lead the development of Sigma’s Emerging Educational Administrator Institute, while also serving as consultant for Sigma’s Maternal Child Health Academy sponsored by Johnson and Johnson. She values her legacy of developing nursing leaders and continues to be available for her past mentees.
Carolyn Hart, PhD, RN, CNE
Associate Professor and Chair of Nursing at Barry University
Dr. Hart received her diploma in nursing from the Lancaster General School of Nursing in Lancaster, Pennsylvania. Most of her bedside experience in nursing was in the Trauma-Neuro ICU at Lancaster General where she credits her nursing expertise to the mentorship of senior nurses in that unit. In 2002, she received the Weidman Award in Nursing Excellence. Dr. Hart continued her studies and obtained a BSN from Chamberlain College of Nursing in 2008 and an MSN in Nursing Education from South University in 2009. In 2012, she graduated from the University of Missouri in Kansas City with a PhD in Nursing. Her dissertation topic was development of the Persistence Scale for Online Education in Nursing. Dr. Hart is the only nurse to have attended all three Sigma Theta Tau International Leadership Academies. As a result of these experiences, she specializes in developing new nursing programs that are innovative in meeting the needs of students and communities.
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