Contemporary Issues in Advanced Nursing Practice: Evidence, Ethical Analysis and DNP Actions
Need help with this assignment?Get an original answer from a qualified tutor — from $10/page.
Get it written →Assignment focus
Discuss nine contemporary issues in advanced nursing practice: staffing, AI-supported clinical decision-making, health equity, telehealth, scope of practice, resource allocation, patient privacy, workplace safety and access to care. For each issue: (1) how it affects nursing, with interdisciplinary evidence; (2) an ethical analysis from the perspective of advanced nursing practice; and (3) one action a DNP-prepared nurse could reasonably take.
Introduction
Advanced practice nurses and Doctor of Nursing Practice (DNP)-prepared leaders work where clinical care, organizational systems and health policy meet. The issues that shape their practice rarely stay inside one profession. Staffing affects physician workload and pharmacy safety, artificial intelligence (AI) depends on data scientists and informaticists, and access to care depends on policymakers and payers. For this reason, each issue below is examined using interdisciplinary evidence and a structured ethical analysis based on the principles of autonomy, beneficence, nonmaleficence and justice, and on the Code of Ethics for Nurses (American Nurses Association [ANA], 2025). It ends with one realistic, evidence-based action for a DNP-prepared nurse.
Summary of the nine issues
| Issue | Central ethical tension | DNP action |
|---|---|---|
| Staffing | Patient safety vs. financial pressure | Acuity-based staffing with an outcomes dashboard |
| AI-supported decisions | Efficiency vs. bias, transparency and accountability | Local validation and bias monitoring before and after go-live |
| Health equity | Equal vs. equitable care | Social-needs screening with closed-loop referrals |
| Telehealth | Convenience vs. the digital divide | Hybrid model with digital-access screening |
| Scope of practice | Access vs. professional boundaries | Outcome data and policy brief for full practice authority |
| Resource allocation | Greatest good vs. fairness to individuals | Transparent, interdisciplinary allocation protocol |
| Patient privacy | Data sharing vs. confidentiality | Privacy and cybersecurity quality-improvement program |
| Workplace safety | Duty to care vs. duty to self | Comprehensive workplace violence prevention program |
| Access to care | Need vs. geography and cost | NP-led community or mobile clinic |
1. Staffing
Effect on nursing and interdisciplinary evidence
Nurse staffing is one of the most researched predictors of patient outcomes. In a landmark study, each additional patient added to a hospital nurse’s workload was associated with a 7% increase in 30-day mortality and higher rates of burnout and job dissatisfaction (Aiken et al., 2002). Shortages have worsened since the COVID-19 pandemic. National survey data estimated that about 100,000 registered nurses left the workforce during the pandemic, and hundreds of thousands more reported intending to leave (Martin et al., 2023). The effects reach across disciplines: inadequate staffing is linked to missed care, medication errors, delayed rescue, longer stays and higher costs, which matters to physicians, pharmacists, hospital finance leaders and health economists alike. For advanced practice nurses, short staffing also means heavier panels, less time per patient and less time for teaching and quality work.
Ethical analysis
The central dilemma is between nonmaleficence and justice on one side and organizational financial pressure on the other. Assigning nurses unsafe workloads predictably increases harm, yet leaders face limited budgets and labor markets. From the advanced practice perspective, the DNP nurse is often both a clinician who feels the moral distress of unsafe care and a leader who helps make staffing decisions. The ANA (2025) Code of Ethics holds nurses responsible for establishing and maintaining practice environments that support safe, quality care. Staffing is therefore an ethical obligation, not just an operational one.
DNP action: Lead the implementation of an acuity-based staffing model through a shared-governance staffing committee, and link it to a dashboard of nurse-sensitive outcomes (falls, pressure injuries, failure to rescue, turnover). This turns staffing from a budget line into measurable patient-safety data that administrators can act on.
2. AI-supported clinical decision-making
Effect on nursing and interdisciplinary evidence
AI tools now predict sepsis and deterioration, draft documentation, triage messages and support diagnosis. These tools promise efficiency, but evidence from medicine and computer science shows real risks. When a widely used proprietary sepsis prediction model was externally validated, it performed much worse than its developer reported. It missed about two-thirds of sepsis cases while producing many false alerts (Wong et al., 2021). In another study, an algorithm used to manage the care of millions of patients underestimated the needs of Black patients, because it used past health care spending as a stand-in for illness (Obermeyer et al., 2019). For nurses, AI changes workflows and increases alert fatigue. It also creates automation bias: the tendency to trust the algorithm over one’s own clinical judgment.
Ethical analysis
AI raises concerns about accountability, transparency, justice and autonomy. If an AI recommendation contributes to harm, who is responsible: the developer, the organization or the clinician who followed it? Advanced practice nurses remain professionally accountable for their decisions and cannot hand clinical judgment to a “black box.” Biased training data can widen health disparities, which violates justice. Patients may not know that AI influenced their care, which raises questions about informed consent. The ANA (2022) position statement on AI emphasizes that technology must support, not replace, nurses’ clinical judgment and the caring relationship.
DNP action: Serve on or lead an AI governance committee that requires every clinical AI tool to be locally validated before go-live, with performance and bias monitored afterward. Results should be broken down by race, ethnicity, sex and language, and the committee should give clinicians clear guidance on when to override the tool.
3. Health equity
Effect on nursing and interdisciplinary evidence
Health equity means everyone has a fair and just opportunity to be as healthy as possible. Evidence from public health, sociology and medicine shows that social determinants of health (income, housing, education, food security, transportation and structural racism) drive a large share of health outcomes. Disparities remain stark. In 2023, the maternal mortality rate for Black women in the United States was about 3.5 times that of White women (Hoyert, 2025). The Future of Nursing 2020–2030 report named nurses as central to achieving health equity, through their presence in communities, schools and primary care, and their focus on the whole person (National Academies of Sciences, Engineering, and Medicine [NASEM], 2021).
Ethical analysis
The key principle is justice, specifically the difference between equal care (the same resources for everyone) and equitable care (resources matched to need). A dilemma arises when organizations treat all patients “the same” while some patients face barriers that make the same care less effective. From the advanced practice perspective, DNP nurses have both the clinical knowledge and the leadership position to see and address system-level inequities. Not acting while knowing a disparity exists conflicts with the ANA (2025) commitment to promote health and reduce disparities.
DNP action: Implement a standardized social-needs screening program, such as one using the PRAPARE or AHC tool, with closed-loop referrals to community resources. Track quality metrics broken down by race, ethnicity and language to identify and close gaps.
4. Telehealth
Effect on nursing and interdisciplinary evidence
Telehealth use grew sharply during the COVID-19 pandemic. In early 2020, telehealth visits rose by about 154% compared with the same period in 2019 (Koonin et al., 2020). Virtual visits, remote patient monitoring and virtual nursing models now help APRNs manage chronic disease, mental health and postpartum care, and they reduce travel for rural patients. Evidence from medicine, informatics and health services research shows that telehealth can match in-person care for many conditions. It also shows a digital divide: older adults, rural residents, low-income households and patients with limited English proficiency are less likely to have broadband, devices or digital skills. Telehealth also raises practical issues for APRNs: licensure across state lines, reimbursement rules that change frequently, and difficulty doing physical examinations remotely.
Ethical analysis
Telehealth balances beneficence (convenience, continuity, access) against justice (the risk of leaving behind patients without technology) and nonmaleficence (missed findings without a physical exam, and privacy risks on home devices). For the advanced practice nurse, the dilemma is deciding when virtual care is clinically appropriate and making sure that a “virtual first” approach does not become “virtual only” for patients who need in-person care.
DNP action: Design a hybrid care model that screens patients for digital access and literacy at intake, offers audio-only and in-person options, and tracks telehealth outcomes and use by age, rurality, race and language to make sure the program narrows access gaps rather than widening them.
5. Scope of practice
Effect on nursing and interdisciplinary evidence
Nurse practitioners’ scope of practice varies by state, from full practice authority to reduced or restricted practice that requires physician supervision or collaboration agreements. Research from health economics and health services shows that NPs provide quality of care comparable to physicians for many primary care services, and expanding their scope is associated with better access, especially in rural and underserved areas (Kurtzman & Barnow, 2017). The U.S. Department of Veterans Affairs granted most APRNs full practice authority in 2016. Organized medicine has raised concerns about training differences and care fragmentation, so this remains an active interprofessional and policy debate.
Ethical analysis
The ethical tension is between access and justice (allowing qualified APRNs to meet unmet needs) and nonmaleficence (making sure that clinicians practice within their competence). Restrictive laws can reduce access without clear safety benefits, which harms patients in shortage areas. From the advanced practice perspective, APRNs must also practice within their own education and competence and seek collaboration and referral when needed. Full practice authority does not mean practicing alone.
DNP action: Collect and publish outcome data from APRN-led care in the DNP’s own organization, such as quality measures, patient satisfaction and access times. Turn the data into a policy brief or testimony for state legislators and the board of nursing that supports evidence-based scope-of-practice reform.
6. Resource allocation
Effect on nursing and interdisciplinary evidence
Health care resources are limited: ICU beds, ventilators, staff, medications and specialist time. The COVID-19 pandemic forced many states to adopt crisis standards of care. Ongoing drug shortages, such as of chemotherapy agents, IV fluids and ADHD medications, require daily allocation decisions. Bioethics and public health literature describes allocation frameworks built on values such as maximizing benefit, treating people equally and giving priority to the worst off (Emanuel et al., 2020). Some triage scores were criticized for disadvantaging people with disabilities and patients from communities of color, which shows how allocation tools can reproduce inequity.
Ethical analysis
Resource allocation brings utilitarian reasoning (doing the greatest good for the greatest number) into conflict with egalitarian and justice-based concerns (fairness to each individual and protection of vulnerable groups). Bedside nurses and APRNs often carry out allocation decisions they did not make, which causes moral distress. From the advanced practice perspective, the DNP nurse has a duty to make sure allocation decisions are transparent, consistent, evidence-based and free from discrimination, and that individual clinicians are not left to make them alone.
DNP action: Co-lead an interdisciplinary allocation committee with nursing, medicine, pharmacy, ethics and patient representatives. The committee writes a transparent protocol for scarce resources, such as drug shortages, with clear criteria, an appeals process and equity review.
7. Patient privacy
Effect on nursing and interdisciplinary evidence
Electronic health records, patient portals, mobile apps and telehealth have increased the volume and value of health data, and the risk to it. The 2024 cyberattack on Change Healthcare exposed the data of about 190 million people, the largest health care data breach in U.S. history, and disrupted claims and pharmacy services nationwide (U.S. Department of Health and Human Services [HHS], 2025). Information technology, law and cybersecurity research all show that human factors, such as phishing, weak passwords and inappropriate record access, cause many breaches. The 21st Century Cures Act’s information-blocking rules also mean patients may see test results in their portal before their clinician has discussed them. For nurses, privacy issues include social media, conversations in hallways and “curiosity” access to records.
Ethical analysis
Privacy reflects the principles of autonomy (control over one’s own information) and fidelity (keeping the trust patients place in clinicians). The dilemma for advanced practice is balancing the benefits of data sharing, such as care coordination, research, AI and patients’ right to their own records, against the risks of exposure and misuse. This is especially sensitive for reproductive health, mental health, substance use and immigration-related information. The ANA (2025) Code commits nurses to protecting patient privacy and confidentiality.
DNP action: Lead a privacy and cybersecurity quality-improvement project that includes phishing-simulation training, regular audits of EHR access, and a protocol for preparing patients for immediate release of test results, such as advance guidance on what results may show and when to expect a follow-up call.
8. Workplace safety
Effect on nursing and interdisciplinary evidence
Health care is one of the most dangerous industries for workplace violence. Health care and social assistance workers experienced about 73% of all nonfatal workplace injuries caused by violence in the United States (U.S. Bureau of Labor Statistics, 2020). Nurses, especially in emergency departments and behavioral health, face verbal abuse, assault and threats. Many incidents go unreported. Evidence from occupational health, psychology and security research links workplace violence to burnout, post-traumatic stress, absenteeism and nurses leaving the profession, which feeds back into staffing shortages. The Joint Commission introduced workplace violence prevention standards for hospitals in 2022.
Ethical analysis
Workplace safety creates a tension between the nurse’s duty to care for all patients, including aggressive or agitated ones, and the nurse’s duty to self. The ANA (2025) Code of Ethics states that nurses owe the same duties to themselves as to others, including preserving their own safety and wellbeing. A culture that treats violence as “part of the job” violates nonmaleficence toward staff. From the advanced practice perspective, DNP leaders must design systems that protect staff while preserving dignified, trauma-informed care for patients in crisis, who are often acting out of illness, fear or pain.
DNP action: Implement a comprehensive workplace violence prevention program. It should include an EHR behavioral risk flag, de-escalation training for all staff, simple incident reporting, post-incident support, and quarterly review of incident data with security and leadership.
9. Access to care
Effect on nursing and interdisciplinary evidence
Many Americans cannot get timely, affordable care. Rural hospitals and obstetric units have closed. More than a third of U.S. counties are maternity care deserts with no birthing hospital or obstetric provider (March of Dimes, 2024). More than 25 million people were disenrolled from Medicaid during the 2023–2024 “unwinding” after the public health emergency (KFF, 2024). Health policy and economics research consistently links lack of insurance and distance to care with delayed diagnosis, more emergency department use and worse outcomes. Nurses, and especially NPs and certified nurse-midwives, are a key part of the solution in rural, school-based, retail and community health settings.
Ethical analysis
Access to care is fundamentally a question of distributive justice: whether health care is allocated by need or by geography, income and insurance status. It also involves beneficence, because care that cannot be reached cannot help. From the advanced practice perspective, the ethical concern is that APRNs are trained and willing to fill access gaps but are often limited by reimbursement, scope-of-practice rules and funding. This calls on DNP nurses to act as advocates beyond the bedside.
DNP action: Develop an NP-led community or mobile clinic in partnership with a federally qualified health center or local health department, targeting a mapped area of need such as a maternity care or primary care desert. Include benefits navigation to help patients enroll in or re-enroll in Medicaid.
Conclusion
The nine issues discussed are staffing, AI, health equity, telehealth, scope of practice, resource allocation, privacy, workplace safety and access to care. They are deeply connected. Unsafe staffing undermines safety and equity. AI and telehealth can either expand access or widen disparities, and scope-of-practice and allocation decisions determine who receives care at all. In each case, interdisciplinary evidence shows that these are system problems that need system solutions, and ethical analysis shows that the principles of justice, beneficence, nonmaleficence and respect for persons are at stake. DNP-prepared nurses are well placed to lead that change. They combine clinical expertise with skills in evidence translation, quality improvement and policy advocacy, and they can turn ethical commitments into practical, measurable improvements for patients, nurses and communities.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987–1993. https://doi.org/10.1001/jama.288.16.1987
American Nurses Association. (2022). The ethical use of artificial intelligence in nursing practice [Position statement]. American Nurses Association.
American Nurses Association. (2025). Code of ethics for nurses. American Nurses Association.
Emanuel, E. J., Persad, G., Upshur, R., Thome, B., Parker, M., Glickman, A., Zhang, C., Boyle, C., Smith, M., & Phillips, J. P. (2020). Fair allocation of scarce medical resources in the time of Covid-19. New England Journal of Medicine, 382(21), 2049–2055. https://doi.org/10.1056/NEJMsb2005114
Hoyert, D. L. (2025). Maternal mortality rates in the United States, 2023. NCHS Health E-Stats. National Center for Health Statistics.
KFF. (2024). Medicaid enrollment and unwinding tracker. https://www.kff.org
Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., Antall, P., McCabe, B., Zelis, C. B. R., Tong, I., & Harris, A. M. (2020). Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR, 69(43), 1595–1599.
Kurtzman, E. T., & Barnow, B. S. (2017). A comparison of nurse practitioners, physician assistants, and primary care physicians’ patterns of practice and quality of care in health centers. Medical Care, 55(6), 615–622.
March of Dimes. (2024). Nowhere to go: Maternity care deserts across the US (2024 report). March of Dimes.
Martin, B., Kaminski-Ozturk, N., O’Hara, C., & Smiley, R. (2023). Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. Journal of Nursing Regulation, 14(1), 4–12.
National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. The National Academies Press. https://doi.org/10.17226/25982
Obermeyer, Z., Powers, B., Vogeli, C., & Mullainathan, S. (2019). Dissecting racial bias in an algorithm used to manage the health of populations. Science, 366(6464), 447–453. https://doi.org/10.1126/science.aax2342
The Joint Commission. (2021). R3 Report Issue 30: Workplace violence prevention standards. The Joint Commission.
U.S. Bureau of Labor Statistics. (2020). Fact sheet: Workplace violence in healthcare, 2018. U.S. Department of Labor.
U.S. Department of Health and Human Services. (2025). Change Healthcare cybersecurity incident frequently asked questions. Office for Civil Rights.
Wong, A., Otles, E., Donnelly, J. P., Krumm, A., McCullough, J., DeTroyer-Cooley, O., Pestrue, J., Phillips, M., Konye, J., Penoza, C., Ghous, M., & Singh, K. (2021). External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA Internal Medicine, 181(8), 1065–1070. https://doi.org/10.1001/jamainternmed.2021.2151
Get a plagiarism-free answer to this question
Send us your instructions and we’ll match you with the best writer in your subject.
- 100% human-written, zero AI
- Turnitin report included
- Confidential — we never share your data
- Free revisions & refunds