Adult Gerontology

Advanced Practice Nurse

(APN).

Presented by : Melissa A. Makhoul

Rasha M. Itani
 Outline

I. Introduction
1. Definition of Advanced Practice Nursing (APN).
2. History of Advanced Practice Nurses (APNs).
3. Roles of CNS vs. Roles of NPs
4. Consensus APRN regulatory model .
5. Adult Gerontology APNs.
6. History of merging Adult and Gerontology .

II. Adult Gerontology clinical nurse specialist (CNS)

7. Definition .
8. Settings.
9. Curricular and Education Program.
10. Certifications.
 Outline (Cont’)

III. Adult Gerontology Nurse Practitioner (NP)

1. Definition .
2. Settings.
3. Curricular and Education Program.
4. Certifications.
IV. Competencies of Adult Gerontology CNSs and NPs.
V. Standard of practice of Adult Gerontology CNSs and NPs.
VI. Scope of practice of Adult Gerontology CNSs and NPs.
 Outline (Cont’)

VII. Current Issue.

VIII. Situation in Lebanon
IX. Conclusion .
X. References .
XI. Guest Speaker
 I. Introduction

1. Definition of Advanced Practice Nurses (APNs) :

APNs are Registered Nurses educated at Masters or post
Masters level and in a specific role and patient population.
APRNs are classified to CNS ,Nurse anesthesia, nurse midwife,
or nurse practitioner. They are prepared by education and
certification to assess, diagnose, and manage patient problems,
and order tests at a more higher level.

(Association, 2016)
&
(“APRNS in the U.S,” 2016)
 What is a Clinical Nurse Specialist?
(CNS).

 A Registered Nurse who holds a Masters or a PHD .

 Provides expert nursing care, implements evidence based
intervention and influences the delivery of care within the
health care system.
 They may also be prepared in a post-master’s certificate
program to practice as a CNS for a specialty population.
 CNS is an APN who practices in three areas as mentioned by
Lewandowski and Adamle (2009) ; (1) manage the care of
complex populations , (2) educate and support nursing and
staff, (3) facilitate change in health care system.
 Direct care of patients is the primary feature that
differentiate the CNS practice .
(“Hamric, Spross & Hanson,”2014)
 What is a Nurse Practitioner (NP)?

 NPs, are certified Registered Nurses, who have extended

their practice and skills beyond their previous profession
boundaries, and who holds a Masters’ of Science in Nursing
Degree at minimum. Doctor of nursing practice is required.
 NP’s can be primary care or acute care practitioners

(“General Practice Advanced Nurse Practitioner Competencies”,2015).

 Primary vs. Acute Care Nurse
Practitioners (Dumas, Finnegan,
Kapustin, & Melander,
2011)

▪ Fall under the same definition of the NP.

▪ The same education level required .
▪ Differences are :
 In Practice Settings:
• Acute NPs: In Hospitals.
• Primary NPs : In Communities.
 In Providing Care:
• PCNP provides care for most health needs and
coordinates additional health care services and
Continuous care
• ACNP focuses on restorative care characterized by
rapidly changing clinical conditions . Provides Care for
unstable chronic conditions, complex acute illnesses, and
critical illnesses.
 Primary vs. Acute Care Nurse
Practitioners (Cont’)

▪ Both might treat patients with similar conditions. However,

the severity and instability of presenting symptoms might
help to define the needed provider at any given time.
▪ We might have possible overlap of both roles .

(Dumas, Finnegan, Kapustin, & Melander, 2011)

 Primary vs. Acute Nurse practitioners
(Cont’)
For example :
 Patient admitted for hospitalization to the ER with an Acute
Asthma exacerbation :
 ACNP : stabilizes and manages the patient’s asthma
symptoms.
 Assesses the patient’s ongoing primary care needs .
 Then, refer to the PCNP for long-term management.
 The PCNP: serves as the first contact to coordinate the
ongoing primary care needs of the patient.
 Similarly, if Patient admitted to a primary care setting :
 PCNP provides immediate stabilization.
 PCNP transfers to the hospital where the ACNP would
manage the patient.

(Dumas, Finnegan, Kapustin, & Melander, 2011)

 I. Introduction (Cont’)

2.History of Advanced Practice Nurse (APN):

▪ The Advanced Practice Nurse was set out in the 1980’s.
▪ Since then, the APN has increasingly been used to identify
the Certified Registered Nurse Anesthetists (CRNAs),
Certified Nurse Midwives (CNMs), Clinical Nurse Specialists
(CNs), and Nurse Practitioners (NPS) .
▪ We will be focusing in this presentation on Clinical Nurse
Specialists and Nurse Practitioners.

(“Hamric, Spross & Hanson,”2014)

 History of Clinical Nurse Specialist
(CNS)

▪ They were identified in practice in the late 19th century and,

in the 1930s and 1940s.
▪ Nurse specialists grew in number in the US.
▪ By the 1960s, Clinical Nurse Specialists (CNSs) were firmly
established in the Nursing Profession.

(“The development of advanced nursing roles,” 2012)

 History of Nurse Practitioner

▪ When a physician shortage arose in the 1960’s, it became

evident that the limitations on the nurses were limiting the
access to health care.
▪ Some physicians and nurses joined forces to solve the
problem, and the answer was the NP. The first NP’s began
to practice in the 1960’s.
▪ NPs started not to only make nursing diagnoses but also
medical ones. After that, a body of law emerged governing
NP licensure and scope of practice.

(“What is a Nurse Practitioner?,” 2007)

 I. Introduction (Cont’).

3. Roles of CNS vs. Roles of NPs:

 CNS: From a middle range of Services (consultation,
research, education administration, coordination of care,
case management direct care within definition of registered
nurse ) to a narrow patient base (people under the care of a
medical specialist).
▪ NP: From a broad range of services (evaluation, diagnosis,
treatment, education, risk assessment, health promotion,
case management, coordination of care, counseling) to a
wide base of patients.

(“What is a Nurse Practitioner?,” 2007)

 I. Introduction (Cont’)

4. Consensus of APRN Regulatory Model:

▪ This model was finalized in 2008.
▪ It provides definitions of advanced practice registered nurses.
▪ It provides the requirements for the four APRN components
(LACE) .
▪ L Licensure.
▪ A Accreditation .
▪ C Certification .
▪ E Education .

(“Hamric, Spross & Hanson,”2014)

 APRN REGULATORY MODEL
▪ APRN SPECIALTIES

▪ Focus of practice beyond role and population focus

▪ linked to health care needs

▪ Examples include but are not limited to: Oncology, Older Adults,
Orthopedics, Nephrology, Palliative Care


POPULATION FOCI
Licensure occurs at Levels of Role &

Family/Individual Adult- Women’s Psychiatric-

Neonatal Pediatrics
Across Lifespan Gerontology* Health/Gender- Mental Health
Related
Population Foci

      
APRN ROLES

Nurse Nurse- Nurse

Clinical Nurse
Anesthetist Midwife Practitioner
Specialist
*

(“Adult-Gerontology Clinical Nurse Specialists Competencies,” 2010)

 I. Introduction (Cont’)

5. Adult Gerontology APNs:

▪ The APRN regulatory model combines Adult and Gerontology as a
single population that ranges from adults to elderly.
▪APNs will be educated , skilled, certified and competent at an
advanced level for caring and meeting the growing needs for both the
Adult and Gerontological population.
▪APNs will be given either “Adult-Gerontology Clinical Nurse
Practitioner”, or “ Adult- Gerontology Clinical Nurse Specialist”.

(Cowen & Moorhead, 2014)

 I. Introduction (Cont’)

6. History of merging Adult and Gerontology:

▪ In 2008 , the newly National APRN regulatory Model merged
the Adult and Gerontology in a single population foci.
▪ Before the foundation of the new APRN regulatory Model,
Adult and Gerontology ANPs were separated and had
different programs.

Why?

(Resnick, 2010.)
 I. Introduction (Cont’)

6. History of merging Adult and Gerontology (cont’):

▪ In 2008, only 137 students in 62 programs became advanced
NPs in Geriatric. Whereas, 1,171 students in 145 programs
became advanced NPs in Adult.
▪ Increase need for Geriatric APNs.
▪ Adult APNs were being exposed for as many older population
as Geriatric APNs.

(Resnick, 2010.)
 I. Introduction (Cont’)

6. History of merging Adult and Gerontology (cont’):

▪ After the decision was taken, several stakeholders worked
together and contributed to this change such as The John A.
Hartford foundation, the American Association of Colleges
of Nursing, the Hartfort Institute for Geriatric Nursing at
NYC and the National Organization of Nurse Practitioner
Faculties.
▪ Establishment of the National Panel developed the
competencies and the academic education compulsory for
the Adult Gerontology APNs.

(Resnick, 2010.)
 I. Introduction (Cont’)

6. History of merging Adult and Gerontology (cont’):

▪ The competencies of the Panel served as a guidance map
that focused on :
 Health promotion, Health Protection and Disease
Prevention.
 Critically distinguish between the care of young, middle-
aged and older adults, particularly Screening.

(Resnick, 2010.)
II. Adult Gerontology Clinical Nurse
Specialist (CNS)
 1. Definition

▪ Hold a Master's, Postgraduate, or Doctoral Degree from an

Adult-Gerontology Clinical Nurse Specialist Program
accredited by the Commission on Collegiate Nursing
Education (CCNE) or the Accreditation Commission for
Education in Nursing (ACEN) (formerly NLNAC | National
League for Nursing Accrediting Commission).

(Center, 2016)
 2. Settings

The Adult Gerontology CNSs care for patients in diverse

settings, including:

 Adult Day Health care facilities.

 Home Health Agencies.
 Hospitals.
 Nursing Homes.
 Skilled Nursing facilities.
 Long term facilities.
 Outpatient Medical Practices.
 In Research, Administration and Education.
 Case Managers or Consultants.
(“Academic programs,” 2016)
3. Curricular and Education program
The Adult Gerontology CNS program delivers both Educational
and Clinical experience.
The Hunter College located in NYC, provides a CCNE- accredited
program in AGCNS. It prepares nurses to assume an advanced
practice role as an AGCNS. Nurses who gain this degree are
planning themselves for Advanced Practice positions in Medical-
Surgical specialties. According to Hunter College, the academic
and clinical program are the followings:

(Hunter, 2016)
3. Curricular and Education program
(Cont’)

 It can be accomplished by full-time students in under 4

years.
 Graduates of this program meet learning requirements
for specialty certification by the ANCC.
 The advanced clinical practicum placements are offered
in a variety of medical-surgical specialties.
 The Program Consists of 42 credits in total, in which 12
credits are for the Nursing Core courses, 9 credits for the
Advanced Practice core, 15 credits for the Specialization
Courses and finally 6 credits as elective courses.
 The program consists of 500 hours of supervised clinical
practice.

(Hunter, 2016)
3. Curricular and Education Program (Cont’)
▪ The faculty assesses the clinical experience of the student
by measuring its length, type and settings in order to
ensure that the CNS student is able to deliver care for the
adult gerontology population.
▪ Faculty serves as mentor and provides a variety of
experiences (virtual, case studies, simulation) to ensure
that the student is competent for the Adult Gerontology
CNS role.
▪ The program, encourages the student to focus on different
life stages, wellness and illness of the Adult Gerontology
population. In addition, it broadens the opportunities of the
students to grasp a full idea of the patients’ needs and
experiences.

(Hunter, 2016)
 4. Certifications

Graduates are arranged for the National Certification Examination

as an Adult-Gerontology Clinical Nurse Specialist through a
National Certifying Organization:

• AACN-AG is the credential awarded by AACN certification

corporation to those who meet eligibility requirements and pass
the AACNS AG exam as AGCNS.

(“AACN Certification Corporation,” 2016)

 4. Certifications (Cont’).

Prerequisites for the AACN-AG exam:

 RN or APRN licensure in the US.

 Completion of a graduate level advanced practice
education program which consists of :
▪ 500 supervised clinical practice hours
▪ A program through a college that provides a CCNE or
ACEN accredited masters or higher degree in nursing
with a concentration as an AGCNS.

(“AACN Certification Corporation,” 2016)

III. Adult Gerontology Nurse
Practitioner (NP).
 1.Definition

▪ Hold a master's, postgraduate, or doctoral degree from an

adult–gerontology primary care nurse/acute practitioner
program accredited by the Commission on Collegiate
Nursing Education (CCNE) or the Accreditation Commission
for Education in Nursing (ACEN) (formerly NLNAC | National
League for Nursing Accrediting Commission).
 2. Settings

The Adult Gerontology NPs care for patients in diverse

settings, including:
 In Private Practice.
 In Ambulatory Clinics .
 In Long term care facilities.
 In Community.
 Hospital Primary Clinics.
 In Patient’s Home.

(Hunter, 2016)
 3. Curricular and Education program

According to the Hunter College , the program focuses on

education and clinical practice:
 Student learn to apply expert knowledge and research
findings through coursework and 735 hours of supervised
clinical experience.
 The program consists of 42 credits in total, in which, 12
credits constitute the Nursing Core Courses, 9 credits for the
Advance Practice Core, 18 credits for the Specialization
Courses and finally 3 credits as Electives Courses.

(Hunter, 2016)
3. Curricular and Education program
(Cont’)
 Graduates of the program are qualified for New York
State NP certification and meet the educational
requirements for national board certification by the
American Nurses Credentialing Center and the American
Academy of Nurse Practitioners Certification Program.
 Graduates of AGNP programs are well prepared to offer
comprehensive primary care in ambulatory and
community-based settings.
 Like the AGCNS, The faculty assesses the clinical
experience of the student by measuring its length, type
and settings in order to ensure that the CNS student is able
to deliver care for the adult gerontology population.
 Life the AGCNS, the faculty serves as mentor and provides
a variety of experiences (virtual, case studies, simulation)
to ensure that the student is competent for the Adult
Gerontology CNS role.
(Hunter, 2016)
 4. Certifications

For the AGNPs there are four main Professional

Certifications and each of them must be renewed every five
years:
1. Certifications for Primary Care Specialty are offered by:
 The American Nurses Credentialing Center (ANCC).
 American Academy of Nurse Practitioners (AANP).

2. Certifications for Acute Care Specialty are offered by:

– American Association of Critical Care Nurses (AACN)
– AGACNP-BC (“board certified”) certifications.

(web, 2014)
 4. Certifications

Prerequisites :

 MSN or DNP from a program accredited by the

Commission on Collegiate Nursing Education (CCNE) or
the
Accreditation Commission for Education in Nursing, Inc.
(ACEN).
 Completing relevant coursework.
 Active RN.
 At least 500 clinical hours (supervised).
 Passing an exam.

(web, 2014)
 IV. Competencies of Adult Gerontology
CNSs and NPs

CNS vs NP
Central competency : Core competencies:
Direct care competencies Independent practice competencies
Core competency: Scientific foundation competencies
Consultation competencies Quality competencies
System leadership competencies Practice inquiry competencies
Collaboration competency Technology and information competency
Coaching competency Policy competency
Research competency Health delivery system competencies
Ethical decision making, moral agency and Ethics competencies
advocacy competency

(“Hamric, Spross & Hanson,”2014) (“Adult/Gerontology Clinical Nurse Specialists Competencies,” 2010)
 V. Standards of Practice: AGCNS &
AGNP
▪ The Standards of Care for the AGCNS and AGNP are build
upon the Generalist Standards of Care in Nursing’s Scope and
Standards of Practice.
• Should follow national standards of care that are appropriate
for practice in a particular setting
▪ The nursing process is used as a framework:
Standard 1 : Advanced Assessment
Standard 2: Differential Diagnosis
Standard 3: Outcomes Identification
Standard 4: Planning
Standard 5: Implementation
Standard 6: Evaluation

(“Nurse practitioner scope of practice,” 2016)

 V. Standards of practice: AGCNS &
AGNP (Cont’)
1. Advanced Assessment : Generates, collects, and integrates
data from a wide variety of sources to make appropriate
clinical judgments and
2. Differential diagnosis: Analyzes and synthesizes the
assessment data in determining differential diagnoses
3. Outcomes identifications :Identifies individualized goals
and outcomes for patients with acute, critical, and/or
complex chronic illness.
4. Planning: Independently develops an outcomes-focused
plan of care that prescribes interventions for patients
5. Implementation :Implements the interventions identified in
the interprofessional plan of care for patients
6. Evaluation : Evaluates the patient’s progress toward the
attainment of goals and outcomes.
(“Nurse practitioner scope of practice,” 2016)
 VI. Scope of practice : AGCNS and
AGNP

▪ The American Nurses Association defines the scope of

practice as the “who, what, where, when, why and how of
nursing practice.
▪ Represents the full range of practice privileges allowed by
certification and licensure
▪ Those activities that the AGCNS & AGNP are educated,
authorized, and competent to perform.

(“Scope of Practice for Nurse

Practitioner”, 2011).
 VI. Scope of Practice (Cont’)

CNS VS NP
Health promotion Health promotion
Holistic assessment Disease prevention
Application of health care policies Health education
Education of healthcare providers Counseling
Collaboration
Diagnosis/management
Laboratory results interpretation
Physical assessment
Access and use of information
Integration of evidence based practices
Screening
Decision making Laboratory/imaging
Integration of gaps in analyses Medications
Referral
(Bell, L. (Ed.),2012). (“Nurse practitioner scope of practice,” 2016)
 Restricted Activities for the NP

▪ Prescribe parental nutrition .

▪ Prescribe blood products.
▪ Order/Apply any form of ionizing radiation in medial
radiography / or nuclear medicine .

(“Nurse practitioner scope of practice,” 2016)

 VII. Current Issue

Adult Gerontology: An
Area of Debate.

(Selway, 2009)
 Should Adult and Gerontological
Population be merged or not? What
do you think?
(Selway, 2009)
B.Darlene Byrd, APN,CPC, Certified M.J Henderson,MS,RN,GNP-BC,
Family NP, member of the National Assistant Professor and
Council of States BON.- WITH Gerontology Coordinator, Past
President of the GAPNA- AGAINST

No duplication of Curriculum. The focus is lost in one Curriculum

leading to missing results.

More depth and knowledge in caring Faculties obliged to teach subjects

for Geriatric population. that they have no expertise in
Students lose  Geriatric patient
lose.
Does not prevent APRN to specialize Who will teach GNP for the next
in Gerontology. generation if colleges don’t?.

Eliminates two major concerns: A personal question: “if your mother

1- BON will have only one description aged 96 years old was admitted to
of scope of practice. the hospital, whom do your prefer to
2- APRN will have greater flexibility in take care of her?”.
job opportunities.

(Selway, 2009)
 VIII. Situation in Lebanon

Advanced Practice Nurses are not yet established in

Lebanon due to many contributing factors that need to be
resolved first.
▪ The information provided below are based on a presentation
done by Dr. Nuhad Dumit (Order of Nurses in Lebanon) in the
International Research Conference “ Development of
Evidence-Based Nursing In An Interdisciplinary Era:
Achievements And Prospects” , that took place at American
University of Beirut (AUB), on October 6 2016.
 VIII. Situation In Lebanon (Cont’)
In order to investigate issues around the nursing workforce in
Lebanon, Several studies were done by a research team led
by Dr. Fadi El-Jardali. These studied showed the following
issues:
▪ Nurse migration and retention is a major health workforce
issues confronting many health systems in Lebanon.
▪ Nurse migration is a product of poor management and lack
of effective retention strategies and sufficient knowledge
about the context, needs and challenged facing nursing.
▪ If retaining nurses is a problem, Lebanon will continue to
lose competent and skilled nurses.
▪ Linkages between job satisfaction, intent to leave and
migration in a country suffering from a nursing shortage.
▪ Addressing these challenges would require a strong and
coordinated action from governments, professional bodies,
policy makers and health managers.
 VIII. Situation in Lebanon (Cont)

The Order of Nurses is currently working on several projects

in order to improve Nursing Profession:
1. Scope of practice and competencies of nurses: They were
designed. They will be revised this year in order to start
implementing them. The nursing performance will be
evaluated on competencies. The Order has an ICN
consultant that is supporting it. Therefore, based on the
ICN frameworks, the order will adapt to the needs of the
profession and use these frameworks to make sure of the
nursing practice in Lebanon has certain standards that
everybody follows and it is being evaluated objectively.
 VIII. Situation In Lebanon(Cont’)

2. The other project is the National Program for capacity

retaining of bed side nurses and it is based on a National
study that is led by a team of a nursing faculty from
different universities (Saint-Joseph, Balamand, LAU, LU
and AUB). The order finished the learning need
assessment, now it is working on the analysis for the bed
side nurses, they will continue with the Nurse Managers
and based on that the order will design the national
program for capacity building and This is when research will
be used to establish the nursing profession. Finally, this is
only the few of the accomplishments of the Order of
Nursing in Lebanon.
 IX. Conclusion

▪ APNs play a vital role in the health care.

▪ Each CNS and NP Have a different role but sometimes the
roles overlap.
▪ Adult gerontology is one of many populations a CNS or an
NP can specialize in.
▪ AGCNS and AGNP have different competencies, and scope
of practice , but the same standards of care.
▪ AGCNS and AGNP have different program and certifications.
 X. Reference Page
▪ Increasing Gerontology education for nurses. (n.d). Retrieved October 2, 2016, from:
http://www.jhartfound.org/blog/increasinggerontologyeducation-for-nurses/?print=pri
nt

▪ Selway, J. (2009). In the consensus model for APRN regulation, should the Adult-
Gerontology population foci be combined? The Journal for Nurse Practitioners, 5(4),
262–263. doi:10.1016/j.nurpra.2009.02.008. Retrieved October 2, 2017, from:
http://search.proquest.com.ezproxy.aub.edu.lb/docview/1507245581?pq-origsite=sum
mon

▪ Association, the A. N. (2016, July 6). Advanced practice nurses. Retrieved October 2,
2016, from : http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses

▪ Adult-Gerontology Clinical Nurse Specialists Competencies. (2010, March ). Retrieved

October 2, 2016, from American Association of Colleges of Nursing,
http://www.aacn.nche.edu/geriatric-nursing/adultgeroCNScomp.pdf

▪ Cowen, P. S., & Moorhead, S. (2014). Current issues in nursing. Retrieved October 2,
2016 from https://books.google.com.lb/books?
id=zu4LBAAAQBAJ&pg=PA198&lpg=PA198&dq=merging+of+adult+and+gerontology
&source=bl&ots=eyQIRUI7bd&sig=uAuIThtEtHeLCFhoLXPqGdkSIeE&hl=en&sa=X&ve
d=0ahUKEwiJ896lr7vPAhXKtBQKHX0TDpEQ6AEIKDAE#v=onepage&q=merging
%20of%20adult%20and%20gerontology&f=false
 X. Reference Page (Cont’)

▪ Hunter. (2016, October 2). Hunter College - Acalog ACMS™. Retrieved October 2, 2016,
from http://m.catalog.hunter.cuny.edu/#programs_sub

▪ Ventures, S. (2014). Adult Gerontology acute care vs. primary care NP. Retrieved
October 2, 2016, from
http://www.nursepractitionerschools.com/faq/ag-acnp-vs-ag-pcnp

▪ Nurse practitioner scope of practice. (2016). Retrieved October 4, 2016, from

http://www.graduatenursingedu.org/nurse-practitioner-scope-of-practice/

▪ Hamric A.B., Spross J.A. & Hanson C.M., O’Grady E.T. (2014) 5th. Advanced Nursing
Practice: An Intergrative Approach. Philadelphia W.B. Saunders.

▪ Retrieved October 4, 2016, from http://

www.aacn.org/wd/practice/docs/acnp-scope-and-standards.pdf

▪ Bell, L. (Ed.). (2012). AACN SCOPE AND STANDARDS FOR ACUTE CARE NURSE
PRACTITIONER PRACTICE. Colombia: AACN Critical Care. Retrieved October 4, 2016,
from http://www.aacn.org/wd/practice/docs/acnp-scope-and-standards.pdf

▪ AACN Certification Corporation. (2016). Reterieved October 4, 2016 from

http://www.aacn.org/wd/certifications/content/accns-ag-faqs.pcms?menu=certification
#What_are_the_ACCNS-AG_eligibility_requirements_
 X. Reference Page (Cont’)
▪ General Practice Advanced Nurse Practitioner Competencies. (2015,
November). Retrieved October 12, 2016, from: file:///C:/
Users/mam118/Downloads/competencies-v2.pdf

▪ Scope of Practice for Nurse Practitioners (NPs). (2011, September).

Retrieved October 4, 2016, from
http://www.nurses.ab.ca/content/dam/carna/pdfs/DocumentList/Standards/
NP_ScopeOfPractice_Sep2011.pdf

▪ L, 2016, & reserved, all rights. (2003). Clinical nurse specialist (CNS)
certification requirements. Retrieved October 4, 2016, from
http://learn.org/articles/Clinical_Nurse_Specialist_CNS_Certification_Requir
ements_FAQs.html

▪ Adult Gerontology Primary Care Nurse Practitioners Competencies. (2010,

March). Retrieved October 12, 2016, from http://
www.aacn.nche.edu/geriatric-nursing/adultgeroprimcareNPcomp.pdf

▪ Academic programs. (2016). Retrieved October 2, 2016, from

https://nursing.ucsf.edu/programs/specialties/adult-gerontology-clinical-nur
se-specialist-ag-cns
 X. Reference Page (Cont’)

▪ The development of advanced nursing roles. (2012, June 8). Retrieved

October 5, 2016, from
https://www.nursingtimes.net/home/courses/the-development-of-advanced
-nursing-roles/5045780.article

▪ What is a Nurse Practitioner? (2007). . Jones and Bartletts. Retrieved October

5, 2016, from
http://www.jblearning.com/samples/0763749338/49338_CH01_Pass2.pdf

▪ Center, A. N. C. (2016). Adult-Gerontology clinical nurse specialist eligibility

criteria. Retrieved October 5, 2016, from
http://www.nursecredentialing.org/adultgerocns-eligibility

▪ APRNS in the U.S. (2016). Retrieved October 5, 2016, from

https://www.ncsbn.org/aprn.htm

▪ Dumas, M. A., Finnegan, L., Kapustin, J., & Melander, S. (2011). NATIONAL
ORGANIZATION OF NURSE PRACTITIONER FACULTIES. ACUTE CARE AND
PRIMARY CARE NURSE PRACTITIONER PRACTICE. Retrieved October 5, from

http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/imported/NPPri
maryCareAcuteCarePracticeFINAL.pdf
 XI. Guest Speaker

▪ Hera Tashjian, RN, MSN, CCNS 

▪ BSN graduate from AUB
▪ Has a Master’s Graduate as an Acute and Critical care
Clinical Nurse Specialist from Duke University.
▪ She has practiced as a Registered Nurse in Lebanon
and in the US in cardiac intensive care and step-down
units.
▪ She was the first nurse practicing as an APN at AUB
Medical Center (AUBMC) and in Lebanon; since then,
the nursing profession and education in Lebanon
have been evolving in order to include APNs in the
workforce.
 XI. Guest Speaker (Cont’)

▪ She has been involved in establishing shared Governance

systems at AUBMC since 2004.
▪ She has provided education, coaching, and guidance to
nurses in the councils throughout their development and
activities.
▪ She has been an active leader in preparing AUBMC Nursing
Services for Magnet designation, which was received in June
2009.
Thank you 