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NR 510
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NR 510 Week 3 Case Study: Organizational Behavior and Business Influences and Advanced Practice
NR 510 Week 3 Case Study: Organizational Behavior and Business Influences and Advanced Practice Nursing You are a family nurse practitioner (FNP) employed... [Show More] as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could behelpful. Your contract is up for renewal in 3 months. You are highly … with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend. Discussion Question: What negotiation strategies should you use to propose a contract renewal? How does your role asa 1099 contractor benefit the practice over the W2 employees? What evidence will you present tothe practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may … willing to provide under your contract.Use logical reasoning, and provide evidence based rationales for your decisions.Keep in mind that your negotiation terms and conditions must … within the legal scope of practice for an ANP. Answer Dear Class and Dr, As a 1099 independent contractor Family Nurse Practitioner (FNP) in the last two years in a busy primary care setting with a desire to maintain my current role, the strategy that I would use to begin the process of negotiation is to understand the difference between W2 employee versus independent contractor, and then bring it to the table for an effective and professional discussion. I would also include examples, and strengths I contributed to the facility in the last two years during the discussions with the providers group. In addition, it is also important during the renewal negotiation process to tackle the importance of revenue that I contributed to the facility. Based on my personal experience, I learned that being a full time W2 employee I receive several benefits the FNP or independent contractor don’t have such as 401k (matched by employer), health insurance, malpractice insurance (covered by employer), paid time off (PTO). That is why the organization will benefit from independent contractor as they don’t have to provide benefits such as the benefits mentioned above that W2 employee must have during active employment within the facility. The evidence that I will present to reinforce my value in the practice that relates to the patient satisfaction and revenue is my length of employment, positive patient relationships, as well as colleague’s positive relationship and number of patient’s referrals. As a devoted independent contractor, it is seen in my work ethic for the last two years which the organization benefited from. My professional relationship with my patient promotes positive patient health outcomes, therefore it helps improves patient satisfaction causes more referrals, leading to increases facility’s revenues. Although, my main proposal is to continue as a leader and one of the main revenue contributors to the organization by increasing my productivity. For example, instead of seeing 15 patient a day, I would increase the number of patients to 20 a day. I would also discuss the utilization of the fee-for-service practice. This practice provides reimburses to the organization based on specific services that the healthcare professional provides to the patient thus generating larger number of organizations revenue (Kwak, 2014). Another important factor for a successful contract renewal is to show that I am an asset in my current role because I can be the primary care provider and accommodate as many patients as I can especially when Doctors are busy (Aktan, 2015). Another aspect in contract renewal is to keep in mind that in our health care industry today, Aktan (2015) stated that highest patient satisfaction largely contributes to the success of the organization. Therefore, I would present this as evidence of my devotion to my profession. I would collect all the positive patient satisfactions and referrals made by my patient to this organization and to me as their primary care provider. I would collect the data showing the revenues made by this organization while I was employed for the last two years and if possible, point out the individual contribution made by the independent contractor. I think that by analyzing the patient satisfaction score as well as the revenues will be helpful in the process of my contract renewal. References Aktan, N. (2015). Patient experiences in ambulatory care and physiologic and functional health care outcomes as they relate to physician and non-physician providers. Community Medicine & Public Health Care, 2(1), 1-3. doi:10.24966/cmph-1978/100002 Kwak, J.P. (2014). Employees versus independent contractors: Why states should not enact statutes that target the construction industry. Journal of Legislation, 39(2), 295-316. doi:10.1016.2015.11.026 Student Response Hello Jenna, Thank you for your response, I currently work at a rehab facility where patient satisfaction is paramount. At our facility, Increased patient satisfaction means providing high quality of safe patient care and their family. We use patient stay surveys the day before discharge and we collect them at discharge day. This way patient and family will be able to participate and give their true reflection of care that the staff and our facility provided to them. Then, every month in our meetings, our nurse manager will give us the whole month patient satisfaction including the percent of recommending our facility to others. So far, we are always at above 98% patient satisfaction score and at 97% recommendations score. I believe that this score shown to affect the number of patient admitted in our facility, since I started working in this facility (5 years ago) we are always close to a full house, we have patients that stated “ I choose to come here because my friend was here last year when she had a stroke and she recommended me this hospital because the staff are excellent”. At some point we had patient waitlist because we were full and couldn’t take another patient. I think that the reputation of providing high quality of patient care helps generates increase revenue. I am sure that patient satisfaction will be helpful in 1099 contract negotiation because it reflects the important value of the staff. As I have said high quality of care leads to high patient satisfaction score thus increasing recommendations generating more and more patient which means generating more revenues. Regards, Tuto Instructor Response Thursday Jul 25 at 7:58pm Hi Tuto, Coming in prepared for contract negotiation is paramount, as well as having your agenda on how to increase revenue will surely give the impression that you want to be part of the team rather than just a plain employee. Preparation is key when it comes to contract negotiation. Good post! Hello Dr Regalado, Thank you so much for your feedback. I agree that having the agenda ready prior contract negotiation will be helpful, I also believe that if you love and value your role within that particular facility, it will reflect on your work, patient satisfaction, and also colleagues’ relationships. I also believe that the contract renewal will come down to my good moral character as a person. Good moral character includes honesty, respectful, reliability, nonjudgmental and professionalism. I think that the aspect of good moral character that could help with the contract renewal would be the positive relationship among other staff. If I have the best relationship with my coworker as I have right now at my current job, they will more likely to rehire or keep me as their employee. According to Pouramini & Fayyazi (2015), positive employee relationships is one of the key elements of a successful organization. In addition, positive employee relationship creates positive work environment which increases productivity, loyalty, reduced to zero conflict, embraces equality and sets goals. Ultimately, increased in productivity among employee generates more revenues to the organization (Pouramini & Fayyazi, 2015). Regards, Tuto Reference Pouramini, Z., & Fayyazi, M. (2015). The relationship between positive organizational behavior with job satisfaction, organizational citizenship behavior, and employee engagement. International Business Research, 8(9), 1-15. doi:10.5539/ibr.v8n9p57 [Show Less]
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NR 510 Week 1: Introduction and NP Practice
NR 510 Week 1: Introduction and NP Practice DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ... [Show More] ed.). Retrieved from https://bookshelf.vitalsource.com • Part I—Professional Roles for the Advanced Practice Nurse • Part IV—Theoretical Foundations, Research, and Evidence-Based Practice Buppert, C. (2015). Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from https://bookshelf.vitalsource.com • Chapter 1—What is a Nurse Practitioner? Journal Readings American Association of Colleges of Nursing. (2011). The Essentials of Master's Education in Nursing. The Consensus Model on APRN Regulation (Links to an external site.) NONPF Competencies Introduction and NP Practice Historical Development of Advanced Practice Nursing The road to advanced practice for nurses in the United States has required patience, dedication, and advocacy (Barker, 2009). The historical development of the role dates back to 1965 when nurse Loretta Ford and physician Henry Silver, from the University of Colorado, suggested that a nurse practitioner (NP) could best alleviate the primary care shortage (especially in the area of pediatrics) and developed a pediatric nurse practitioner plan of study. Their efforts were met with much resistance from both the nursing and medical communities (Hain & Fleck, 2014). Nurses thought such a role was "playing doctor," whereas physicians thought such a role was "practicing medicine without a license." However, the early work by Ford and Silva paved the way for advanced practice nursing (Buppert, 2011). Eventually four advanced practice nursing (APN) roles emerged, that of the Certified Nurse Midwife/CNM (Avery, Germano, & Camune, 2010; Kelley, & Klopf, 2008), Certified Nurse Practitioner/CNP (Baker, 2010; Dierick-van Daele et al., 2010; Frisch et al., 2010; Goroll, & Mulley, 2009; O'Neill, Moore, & Ryan, 2008), Clinical Nurse Specialist/CNS (LaSala, Connors, Pedro, & Phipps, 2007), and Certified Nurse Anesthetist/CRNA (Galvin, Dewan, & Rockoff, 2009). In 2017, APNs can further specialize within these roles to include expertise in Mental Health, Geriatrics, Acute Care, and Palliative Care (Hain & Fleck, 2014). Some important professional organizations that contributed to early role development include the American Association of Nurse Anesthetists (AANA) and the American Association of Nurse Practitioners (AANP), both with a largely clinical focus; the American College of Nurse Practitioners (ACNP), with a largely legislative focus; and the National Organization of Nurse Practitioner Faculty (NONPF), with a largely educative focus. Initially, many nurse practitioners were actually prepared through certificate programs, much like the nurse anesthetist of that day. Historically, nurses would complete intensive diploma nursing programs at a given hospital and then move on to complete hospital-based certificate programs as a nurse clinician or nurse anesthetist. As nurse clinician programs grew in popularity, and as the minimum level of entry began to move to university-based education, the hospital certificate programs moved as well, leading to specialty education at the graduate level in order to obtain advanced practice credentials. Despite the movement from generalist to specialist education, the commitment remains first to nursing, then to specialization such as the advanced practice role, and then to sub-specialty role development such as the role of the nurse practitioner (Kass-Wolff & Lowe, 2009). In addition, a wide and differing variety of professional preparation requirements, continuing education mandates, and/or standards of practice exist that are unique to each state (Yoder-Wise, 2012). Credentialing remains a confusing discussion among APNs and even more confusing to laypersons, other healthcare professionals, legislators, and payers (Bishop, 2014). With the emergence of these APN roles, delivery of healthcare in the year 2017 has progressed past augmenting care in traditional MD/DO practices. APNs are now practicing in such diverse settings from the operating room to owning their own practices where the delivery of care is independent of physician oversight. Even with the diversity of care delivery models, state governance of APN practice continues to differ widely with regard to scope of practice, level of autonomy and individual certification requirements (IOM, 2011). Credentialing The APN and public alike continue to suffer from role confusion, partly due to the unstandardized format for credentials that vary based on type of APN and certification body. Eunice Cole, past president of the American Nurses Association, once clarified the issue in writing, recommending that one only list the highest earned degree in a given discipline, followed by licensure, state designations, national board certifications, and concluding with honorary awards (Smolenski, 2009). To summarize, the degrees earned appear first (these are credentials such as MSN or PhD that can never be taken away). Next, licensure information appears (these are credentials such as RN or ARNP that is regulated by the state). Certification credentials then follow (these are credentials that aren't necessarily regulated, like APRN, BC from the American Nurses' Credentialing Center [ANCC], which is earned through testing and renewal, or NP-C from the American Academy of Nurse Practitioners [AANP], which is likewise earned through testing and renewal). Finally, honorary credentials would follow, such as FAANP. Specialization Initially, the role of the NP was limited to primary care (Goroll & Mulley, 2009). The role of the APN now manifests at graduate-level entry, the objective of which is to blend preparation regarding primary care, education, administration, informatics, case management, and/or role specialization. The notion of role specialization encompasses a concentration within a selected field regarding a given aspect of nursing, whereas an expanded role includes the notion of acquiring new practice knowledge and skills. Role specialization can include a focus in geriatric care, palliative care and mental health. Advanced practice nursing provides the nurse with the opportunity to make a larger contribution to person, environment, health, and nursing. Advanced practice nursing offers a graduate foundation that utilizes advanced skills, knowledge, and integrative abilities in assessment, planning, diagnosis, implementation, and evaluation of healthcare. A sophisticated level of skills, knowledge, and integrative abilities offered at the point of care contributes to improved health outcomes. The advanced practice nurse builds on advanced pathophysiology, pharmacology, and health assessment skills, knowledge, and integrative abilities to intervene on behalf of the person to restore, maintain, and/or promote health at a higher level than the generalist nurse. The advanced practice nurse is a specialist in healthcare delivery. Unfortunately, clear definitions for the various roles of CNM, CNP, CNS, and CRNA have been blurred by various state definitions that confuse the roles and often obfuscate their intended meaning. For example, in some states the definition of Certified Registered Nurse Practitioner (CRNP) has been specifically used to refer to all four advanced practice roles of CNM, CNP, CNS, and CRNA (Lowe, 2010). Such state definitions reveal further confusion with regard to role separation, competency, emphasis, approach, and variation. This confusion extends to nurse educators, providers, reimbursement, and even the public. In addition, a lack of clarity regarding initial role preparation versus current certification serves to further frustrate accreditors, consumers, and employers alike. More recent attempts to designate direct care versus indirect care roles have only heightened this frustration. Philosophical and Theoretical Perspectives According to Cody (2011), "philosophical and theoretical perspectives" for advanced practice nursing require an additional perspective that suggests it is insufficient to expect that advanced practice competencies are limited to advanced skills, knowledge, and integrative abilities. The need for statistical skills in order to evaluate the level and quality of evidence is foundational for application of evidence to the point of care (Straus, Glasziou, Richardson, & Haynes, 2011). The need for a strong philosophical and theoretical foundation for evidence-based practice cannot be understated, which we will learn as we progress through this course Systematic Inquiry and Evidence-Based Practice Would it shock you to learn that "there is increasing concern that most current published research findings are false" (Ioannidis, 2007, p. 124)? Evidence-based practice (EBP) is a concept that is often found in the literature but is frequently misunderstood. For example, at the minimum, EBP requires systematic inquiry (as opposed to integrative review of literature) and both leveling and grading of the quality of evidence (AGREE, 2001; GRADE, 2000). Moreover, EBP is a process that fosters adoption of the most effective patient care innovations and discarding of the ineffective ones so that clinical decisions are made on the best evidence related to patient outcomes. The Magnet Recognition Program of the American Nurses Association Credentialing Center mandates a systematic inclusion of evidence-based practice as the basis for clinical decision-making. You will strengthen your skills in the evidence-based practice by employing a disciplined approach. EBP includes the following steps. 1. Asking clinical questions 2. Searching the literature on a topic of concern 3. Reading best evidence and critiquing research literature 4. Implementing best evidence in educational and healthcare practices As a nurse leader, you must be aware of possible barriers to adoption of EBP innovations. You will need to implement EBP strategies to facilitate practice change in the advanced practice setting (Straus, Glasziou, Richardson, & Haynes, 2011). Organizational Barriers to EBP Who are the decision makers? In some organizations, nurses do not sit on the committees or belong to the groups that have formal decision-making power. If this is a characteristic of the organization, the nurse leader should ensure that nurses are represented in all major decision-making bodies. One strategy that can be successful is for the nurse leader to participate in revisions of the mission statement of the organization to ensure inclusion of values important to nurses and quality patient care. Does the structure support EBP? The nurse leader can create structures focusing on efficient internal communication in the organization. In general, a decentralized administrative structure and shared governance, including unit-level committees that share responsibility for research, create better opportunities within the organization for support of EBP. A basic need related to structure within the organization is provision of adequate resources and personnel so that nurses can participate. EBP can be very time-consuming. The nurse leader sets the agenda and priorities for the department of nursing and can influence these for the entire organization Is EBP a performance expectation? Participation in EBP activities can be included in responsibilities of nursing staff, in annual performance appraisals, and as criteria for raises. Another motivator that can be implemented at the organizational and department level is that participation in EBP activities becomes a method for advancing on a career ladder. Nurse leaders can also develop a budget line that includes monetary grants for EBP projects and for pilot studies, research studies, and development of setting-specific protocols. Is there resistance to change? In addition to this human tendency, some nurses do not have the skills to implement evidence-based practice, especially in reading, understanding, and critiquing research evidence. Another issue is that nurses who want to adopt innovations may feel isolated and may not know how to implement change in their settings. These issues should suggest to the nurse leader that methods to support and educate nurses in all aspects of evidence-based practice are important. Strategies include starting journal clubs and research committees that are multi-disciplinary in membership to develop skills in reading research and implementing evidence-based practice innovations. Nurses can be sent to research or other relevant conferences, and experts can be brought into the organizations for consultation. These last two strategies improve the external communication of the organization. The nurse leader can support individual nurses and groups of nurses as adopters of EBP by creating a climate that supports EBP by giving permission to ask clinical questions. What is the organizational culture? Some barriers related to the innovation parallel the characteristics identified by Rogers in her diffusion of innovation theory (as cited in Alligood, & Tomey, 2010; Crow, 2006; Rogers, 2003). The nurse leader should ensure that potential innovations are high on the organizational culture, as found in the characteristics suggested by Rogers above. An additional barrier, related to research evidence, is that there may not be credible research with consistent findings available to support the development and adoption of an innovation. The nurse leader can support EBP by ensuring that the strongest available evidence is used as the basis for all policies and procedures used in the care of patients. This will demonstrate the value placed on EBP and will demonstrate the relevance of evidence in day-to-day practice, assisting in cultural adaptation. Is the staff research savvy? Communication barriers include the difficulty in reading research evidence, especially quantitative analyses. The leader will need to identify a group of nurses who can understand and interpret research findings to all of the staff to ensure that EBP is fostered. Outcomes 1 Analyze the development of advanced practice nursing roles from a historical perspective including the impact of advanced practice nursing on the healthcare delivery system from the perspective of selected current reports (i.e., LACE, IOM, etc.)(PO 3) Weekly Objectives • Discuss the role of the NP in your state, re:scope of practice, autonomy, education. 2 Critically analyze how healthcare systems and APN practice are organized and influenced by ethical, legal, economic and political factors. (PO 4) Weekly Objectives • Identify scope of practice that is specific to individual states. • Apply current work experience to the APN roles. Week 1: Summary and Planning Ahead Summary In week 1, we got to know a bit more about each other, the state you will practice in after graduation and specifics with regards to NP practice. You will find it interesting how different the rules and regulations are very different state by state. You will be exploring this in much greater detail with your weeks 6 & 7 assignments. Key Points • Understood the diversity of your fellow students! • Began to understand the LACE document located in the course and how it pertains to NP practice in your state. • In weeks 6 & 7, you will need this information in order to complete the Professional Development Plan and recorded LACE presentation. Planning Ahead During WEEK 2 you will take a closer look at all 4 APN roles in your state. You will also discuss work environment, level of accountability, patient population, salary, and scope of practice for each of the APN roles. You will provide your personal Pro and Con list for each role and provide appropriate citations. You will also describe your rationale for choosing the CNP advanced practice role versus any of the other three and your plans for clinical practice after graduation. You will decide if your idea of NP practice has changed after researching this for your state. Open up week's 6 & 7 assignments and begin to understand the requirements for those two lengthy assignments [Show Less]
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NR 510 Week 2 Discussion: Advanced Practice Nursing
NR 510 Week 2 Discussion: Advanced Practice Nursing In week one, you discussed your scope of practice in your current state as a nurse practitioner. Now, ... [Show More] explore the four APN roles in your state (CNP, CNS, CRNA & CNM). • Discuss work environment, level of accountability, patient population, salary, and scope of practice for each of the APN roles. Provide your personal Pro and Con list for each role and provide appropriate citations. • Describe your rationale for choosing the CNP advanced practice role versus any of the other three. What are your plans for clinical practice after graduation? Has your idea of NP practice changed after researching this for your state? ANSWER • Discuss work environment, level of accountability, patient population, salary, and scope of practice for each of the APN roles. Provide your personal Pro and Con list for each role and provide appropriate citations. o CNP – Certified Nurse Practitioner – is a licensed, independent practitioners who practice in ambulatory, acute, and long-term care as primary and or specialty care providers. There are several different pathways that CNP can take including, Psych, gerontological, pediatrics, neonatal, or the woman’s health with advanced certifications in these areas. The scope of practice for CNP can vary in depth from state to state. However, in general, the scope of practice includes assessment, diagnosis, development of treatment plans, implementation and evaluation along with prescribing medications and ordering diagnostic testing (McClelland, 2014). In my state, a CNP earns anywhere from $110,985 to $129,935 yearly. Pros: job outlook, power to make a difference in the lives of patients, 5 days a week, 8 hours a day schedule available, mentor opportunities, a lot of practice settings available, competitive income. Cons: competition, lots of government regulations, bias against the profession, somedays on-call is required and lack of full autonomy in some states. o CNS – Clinical nurse Specialist – is an advanced-practice nurse who provides patient care and consultation services for a variety of health care areas. These professionals typically practice medicine, conduct research and manage staff within a specific type of patient population, medical specialty or setting. CNS is also responsible for diagnosing and treating health/illness states, disease management, health promotion, and prevention of illness and risk behaviors among individuals, families, groups, and communities (McClelland, 2014). In my state, a CNS earns anywhere from $148,651 to $160,902 yearly. Pros: More specialty areas to choose from, a lot of job opportunities. Cons: extensive education requirements, expensive education. o CRNA – Certified Registered Nurse Anesthetist – is an advanced practice registered nurse who practices both autonomously and in collaboration with a variety of health providers on the interprofessional team to deliver high-quality, holistic, evidence-based anesthesia and pain care services (Cahill, Alexander, & Gross, 2014). CRNAs serve both healthy and severely ill patients for a wide variety of procedures, in different settings, including hospital surgical suites, obstetrical delivery rooms, critical access hospitals, acute care, pain management centers, ambulatory surgical centers, and the offices of dentists, podiatrists, ophthalmologists, and plastic surgeons (McClelland, 2014). In my state, a CRNA earns $215,530 on average, yearly. Pros: Excellent pay, job security, professional respect, autonomy, job satisfaction. Cons: Lengthy prerequisites, higher probability of facing a malpractice lawsuit, longer hours of work, plus call time, Boredom due to sitting through lengthy surgical procedures, professional and academic competition. o CNM – Certified nurse Midwife – assists women in all stages of pregnancy, childbirth and post-delivery. They also work closely with obstetricians and gynecologists in diagnosing and treating women with acute and chronic illnesses. CNM also assists women in family planning services, preconception care, prenatal and postpartum care, childbirth and care of the newborn. CNMs can practice in many different locations, including home, hospital, birth center and a variety of ambulatory care settings, including private offices and community and public health clinic (McClelland, 2014). In my state, a CNM earns between $88,800 to $127,940 yearly. Pros: noncompetitive, fast growing, a chance to provide care to women and care at the beginning of life. Cons: long working hours, high-stress situations, unpredictable hours. • Describe your rationale for choosing the CNP advanced practice role versus any of the other three. What are your plans for clinical practice after graduation? Has your idea of NP practice changed after researching this for your state? I choose CNP practice because I am interested in working alongside of physicians and diagnosing patients, connecting with patients and making a difference in their lives. I enjoy working with people in general and being an NP can allow me to do that. My plans for clinical practice after graduation is to work in an emergency department. I used to work in the emergency department as an EMT. I currently do not work in the emergency department, although, I miss working in the busy ER. I believe that ER is where my heart is. I enjoy living in the moment and being in stress with the adrenaline rush. My idea of NP practice has not changed after researching for my state because I have a lot of family friends that are NPs in California. Even though, the practice might be limited. However, they all love their jobs and they enjoy being an NP. While working as an EMT in the ER, I was able to shadow an NP and became fascinated with the work they do especially in the busy ER. Which is what led me to pursue this career field. Reference: Cahill, M., Alexander, M., & Gross, L. (2014). Research-Article: The 2014 NCSBN Consensus Report on APRN Regulation. Journal of Nursing Regulation, 4, 5–12. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1016/S2155-8256(15)30111-3 McClelland, M. (2014). A Guide to Advanced Practice Registered Nurse Roles. MEDSURG Nursing, 10–14. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a2h&AN=113313797&site=eds-live&scope=site [Show Less]
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NR 510 Week 8 Reflection on Achievement of Outcomes
NR 510 Week 8 Reflection on Achievement of Outcomes Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this... [Show More] course have prepared you to meet the MSN program outcome #4, the MSN Essential II, and the NP Core Competencies #2. Program Outcome #4 Integrate professional values through scholarship and service in health care. (Professional identity) MSN Essential II: Organizational and Systems Leadership Recognizes that organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making, effective working relationships, and a systems perspective. NP Core Competencies # 2 Leadership Competencies 1. Assumes complex and advanced leadership roles to initiate and guide change. 2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care. 3. Demonstrates leadership that uses critical and reflective thinking. 4. Advocates for improved access, quality and cost effective health care. 5. Advances practice through the development and implementation of innovations incorporating principles of change. 6. Communicates practice knowledge effectively both orally and in writing. 7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus. This course introduces students to the role development of today's advanced practice nurse (APN) leader in society and healthcare organization systems from the perspective of primary and acute care. Students will explore, analyze, apply, and evaluate diverse aspects of ethical and legal decision-making standards specific to APN scope of practice. Topics include the standards and regulations governing the practice of APNs in diverse settings. The course emphasizes strategies and processes that foster implementation of visionary leadership, diffusion of innovation, and change within an organization. Dr. Hankins and class, This course has taught me the role development of today’s advanced practice nurse leader in society and the healthcare industry. Throughout the past eight weeks, we explored ethical and legal decision-making standards specific to APN scope of practice, as well as practice laws and regulations governing the practice of APNs in diverse settings. This course has helped reflect on the master’s essentials, the nurse practitioner’s core competencies, and program outcomes. Program Outcome #4: Professional Identity During the majority of our course, we achieved this outcome of professional identity by analyzing how healthcare systems and APN practice are organized and influenced by ethical, legal, economic, and political factors. We explored how different leadership styles influence healthcare delivery. We also learned about the barriers that exist to the APN practice, how to negotiate a contract and salary, how to approach workplace conflict, liability issues, promoting teamwork, and the LACE principles of the APN role. Through evaluation of clinical cases and research, I was able to integrate professional values and thus, develop professional identity. Understanding the barriers to the APN provides better insight of what I expect to encounter as a future healthcare professional and how I can best overcome these barriers. Some of the barriers include state practice and licensure, physician-related issues, prescriptive authority, and job satisfaction (Hain & Fleck, 2014). It would be in my best interest to participate and contribute to legislation to expand the role of the APN. This can be achieved through both local and national levels with professional organizations. Another example includes understanding the current efforts to achieve continuity of state practice laws with the Consensus Model LACE. Because of the importance of APRNs in caring for the current and future health needs of patients, the education, accreditation, certification and licensure of APRNs need to be effectively aligned in order to continue to ensure patient safety while expanding patient access to APRNs. MSN Essential II: Organizational and Systems Leadership According to the American Association of Colleges of Nursing (2011), the MSN Essential II refers to the importance of leadership in the promotion of quality and safe care deliver. In this course, we learned to apply leadership skills to an array of clinical cases. Managing conflict in the workplace is a time consuming but necessary task for healthcare leaders. Conflicts can lead to emotional distress that can impact productivity, morale, and patient care (Klinkhamer, 2015). As a future leader, it is essential to manage workplace conflicts in a professional manner and promote healthful environments. I learned that this type of leadership positively influences the organization. Learning strategies of effective communication skills and teamwork is another example that furthered my understanding of the importance to deliver safe efficient patient care. Promoting a healthier work environment through professionalism, teamwork, and active listening increases patient satisfaction and patient safety (Scully, 2015). NP Core Competencies The nurse practitioner core competencies were fulfilled by this course through the assigned readings, practice knowledge through discussion posts, research, and reflective thinking skills. One of the competencies explores the advanced leadership role to initiate and guide change. In order to do so, I learned that self-reflection is a strategy to initiate change by analyzing my professional goals, as well as my strengths and weaknesses. This was accomplished through the APN professional development paper during week 6. Another example includes collaborating with patients, the community, and other healthcare disciplines. I learned that effective communication and critical thinking are necessary to improve teamwork and medical outcomes. To become a proficient leader, I learned that collaborating with healthcare professionals helps advocate for the patient and improves the quality of patient care. This course certainly helped me to accomplish the use of critical thinking skills to solve clinical and ethical cases, apply practice knowledge both orally and in writing through the APN professional development paper and the LACE oral presentation, and influence my desire to participate in professional organizations in hopes of expanding the APN role. References American Association of Colleges of Nursing. (2011). The essentials of master’s education in nursing. Retrieved from http://www.aacnnursing.org/Portals/42/Publications/MastersEssentials11.pdf Hain, D., & Fleck, L. M. (2014). Barriers to NP practice that impact healthcare redesign. Online Journal of Issues in Nursing, 19(2), 5. doi:10.3912/OJIN.Vol19No02Man02. Klinkhamer, F. (2015). School nurse team leaders’ experience and management of workplace conflict. British Journal of School Nursing, 10(7), 337-347. Scully, N. J. (2015). Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), 439-444. Hi Jamie, Thanks so much for your final post! I agree with you that the cases that were presented throughout the course reflected suboptimal organizational structure. The ethical and legal implications of these cases promoted poor quality of care and initiated a variety of discussion responses from our fellow classmates. Implementing the appropriate strategies to ameliorate these situations are critical to promoting healthful work environments and increasing patient safety. I also agree with your comment about the importance of actively participating in professional organizations. After learning in depth about differing state practice regulations, it is our responsibility as future healthcare providers to advocate and expand the role of the APN. Hi Kim, Thanks for your final post! I absolutely agree with your first comment about the importance of understanding the limitations and advancements of the APN. Often times, we focus on the role and the scope of practice that we forget to acknowledge that boundaries and barriers still exist in this profession. While you originally thought that all of the states grant full practice authority, I thought the opposite. I knew that the state of New Jersey, where I reside, had reduced practice authority and thought all the states had similar reduced practice laws for APN. I was actually surprised that one-third of the United States has full practice authority! That gives me hope that continued efforts and progress will achieve full practice authority in the near future. I'm glad that this gave you more motivation to actively participate in an APN organization! APNs have struggled historically to perform to the fullest extent of their education and training, and we need more efforts and support in expanding the role. [Show Less]
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NR 510 Week 7 Assignment: Recorded LACE PowerPoint – Slide Notes
NR 510 Week 7 Assignment: Recorded LACE PowerPoint – Slide Notes Slide 2: LACE Model: The model identifies the essential elements of APRN regulat... [Show More] ion as licensure, accreditation, certification, & education (LACE). Licensure refers to the authority to practice as an independent practitioner. The APRN education program must be accredited. The APRN must be certified in the APRN role by a national board. The LACE Model defines advanced practice nursing (APRN) & delineates four roles: clinical nurse specialist (CNS), certified nurse practitioner (CNP), certified registered nurse anesthetist (CRNA), & certified nurse midwife (CNM). Advanced education builds on the pre-licensure preparation for RNs & occurs at the role & population level, which then prepares the individual for initial certification. The LACE Model specifies educational program requirements & the program is accredited accordingly. Slide 3: The APRN Consensus Model: The APRN Consensus Model was authored by a number of national professional advanced practice nursing organizations & was created to provide guidance for states to adopt uniformity in the regulation of advanced practice registered nurse roles. This model makes a clear distinction between acute care & primary care practice preparation, noting that acute care focused, & primary care focused Nurse Practitioner programs have distinct competencies based on the consensus model as well as specific certification processes. All c&idates must first earn a Master of Science in nursing or doctoral degree from an accredited nursing education program in the United States. While the length of the program varies across APRN roles & specialties, a minimum 2-year full-time course of study should be expected. The typical APRN curriculum includes health promotion &/or health maintenance; advanced health assessment, physiology/pathophysiology, & pharmacology; & research, ethics, policy, finance, & organization of health care delivery. APRN students also must successfully complete extensive clinical practicum learning experiences. Following degree conferral, the graduate obtains national certification by passing an examination administered by a recognized certifying body, such as the American Nurses Credentialing Center. After becoming certified, the APRN follows the procedure in his or her state to become authorized for APRN practice. No uniformity in the nurse practice act exists across the United States. Slide 4: California Licensure Considerations: California's advanced practice nurses are under the jurisdiction of the California Board of Registered Nursing (BRN). In order to be certified as an advanced practice nurse, a practitioner must also be licensed as a registered nurse. The Board recognizes the following graduate-level advanced specialty areas: Nurse Anesthetist (NA) Nurse Practitioner (NP) Nurse-Midwife (NMW) Clinical Nurse Specialist (CNS) Psychiatric/ Mental Health Nurse (PMH) A nurse can become an NP by 1) completing an in-state program recognized by the Board as meeting st&ards 2) earning certification through an accepted organization or 3) completing an equivalent program. In order to be certified by equivalency, a nurse will need to verify clinical experience & clinical competency in provision of primary care services. Clinical competency will be verified by both a licensed physician & a licensed nurse practitioner. Slide 5: Washington Licensure Considerations: Washington State’s Advanced Registered Nurse Practitioners (ARNPs) are regulated by the Nursing Care Quality Assurance Commission, a part of the Washington Department of Health (DOH). ARNP is a broad license category that includes three advanced nursing roles: Nurse Practitioner (NP), Certified Nurse Midwife (CNM), & Certified Registered Nurse Anesthetist (CRNA). Of these, NP is the most common specialty. Applicants that are educated in a commission approved Washington state nursing education program & applying for initial licensure must first: (1) Successfully complete a commission approved nursing education program. For applicants from a commission approved registered nurse program who are applying for a practical nurse license: (a) Complete all course work required of commission approved practical programs (2) Required courses not included in the registered nurse program may be accepted if the courses were obtained through a commission approved program. (b) Be deemed as capable to safely practice within the scope of practice of a practical nurse by the nurse administrator of the c&idate's program. (2) Complete seven clock hours of AIDS education as required (3) Successfully pass the commission approved licensure examination Slide 6: Illinois Licensure Considerations: Illinois advanced practice nurses are licensed by the Illinois Department of Financial & Professional Regulation (IDPR). Illinois recognizes the following advance practice roles: Certified Nurse Practitioner Certified Clinical Nurse Specialist Certified Nurse Midwife Certified Registered Nurse Anesthetist An Illinois advanced practice nurse must hold RN & APN licensing. The National Council for State Boards of Nursing lists Illinois as a state with pending nurse compact legislature. Currently, however, a nurse must hold his or her primary RN licensure in Illinois. The licensing agency will require official graduate transcripts & a copy of the qualifying certification. I. A person shall be qualified for licensure as an advanced practice nurse if that person: (a) has applied in writing to the Department & has not violated any provisions (b) Also, they must hold a current license to practice as a registered nurse in Illinois; (c) has successfully completed requirements to practice as, & holds a current national certification as, a nurse midwife, clinical nurse specialist, nurse practitioner, or certified registered nurse anesthetist from the appropriate national certifying body (e) & finally, has successfully completed a post-basic advanced practice formal education program in the area of his or her nursing specialty. Slide 7: California Accreditation Considerations: Restricted Practice: State practice & licensure law restricts the ability of an NP to engage in at least one element of NP practice. The outside state requires supervision, delegation, or team management by an outside health discipline for an NP to provide patient care. ACEN - Accreditation Commission for Education in Nursing CCNE - Commission on Collegiate Nursing Education CNEA - Commission for Nursing Education Accreditation Slide 8: Washington Accreditation Considerations: A Washington program will seek accreditation through an agency recognized by the Council on Higher Education Accreditation or the United States Department of Education. The American Nurses Credentialing Center, which offers a variety of certifications for nurse practitioners, lists among the requirements, 500 hours of clinical work under faculty supervision. The ANCC m&ates discrete courses in advanced physiology, health assessment, & pharmacology. Full Practice: State practice & licensure law provides for nurse practitioners (NPs) to evaluate patients, diagnose, order & interpret diagnostic tests, initiate & manage treatments-including prescribing prescriptions-under the exclusive licensure authority of the state board of nursing. Slide 9: Illinois Accreditation Considerations: Advanced practice nurses (APNs) may fulfill new roles in the redesigned health system, provided that the law allows them to practice to the full extent of their education & training. Eliminating the requirement for a collaborative agreement between APNs & physicians is a viable mechanism for increasing primary care capacity & reducing health care costs. Under a reformed scope of practice, public & private insurers could choose to reimburse APNs directly for their services, as opposed to reimbursing them as a part of clinics or physician practices. It would also allow consumers to choose a non-physician health professional as their primary care provider. It is in the interest of the state of Illinois & the greater healthcare community to allow advanced practice nurses to provide unrestricted, safe, quality health care services to the residents of Illinois. Reduced Practice: State practice & licensure law reduces the ability of NPs to engage in at least one element of NP practice. State requires a regulated collaborative agreement with an outside health discipline in order for the NP to provide patient care. American Nurses Credentialing Center (ANCC) Illinois Society for Advanced Practice Nursing (ISAPN) American College of Nurse Practitioners American Academy of Nurse Practitioners Slide 10: Certification Considerations: California: The Board of Registered Nursing (BRN) certifies public health nurses & advanced practice nurses. Advanced practice nurses include nurse practitioners, nurse-midwives, clinical nurse specialists, & nurse anesthetists. The BRN also maintains a listing of psychiatric/mental health nurses. In each of these categories, the individual must first have a California registered nurse license before obtaining the certificate. The BRN then issues a furnishing number to a nurse practitioner that allows him or her to "order" or furnish drugs & devices to patients using approved st&ardized procedures. A nurse practitioner with a furnishing number may obtain a Drug Enforcement Administration (DEA) registration number if they want to order controlled substances as needed for patient care. Washington: The student will need pass a national certification examination at some point after educational requirements have been met. Washington has approved four nurse practitioner certification organizations: -American Nurses Credentialing Center -American Academy of Nurse Practitioners -Pediatric Nursing Certification Board -National Certification Corporation for Obstetric, Gynecological, & Neonatal Nursing Illinois: A prospective advanced practice nurse will need to pursue an examination-based certification. An Illinois RN who has graduated from an advanced practice program & has applied to take a qualifying national certification examination may be authorized to practice pending certification. The graduate will need to apply for a temporary permit. The licensing agency will need documentation from the certifying agency, identifying the date that the nurse will sit for examination. Slide 11: Education Considerations: The education domain is central to APRN professional practice. The APRN assesses learning needs & uses educational strategies to promote knowledge development of students, peers, nursing staff, & interdisciplinary colleagues. The APRN uses professional expertise to develop educational programs & resources that address specific patient- & family-learning needs. APRNs also educate the public on pertinent healthcare issues related to specialty care practice & the APRN role. California: The nurse practitioner is a registered nurse who possesses additional preparation & skills in physical diagnosis, psychosocial assessment, & management of health & illness needs in primary health care. Washington Education: Programs include diagnostic theory & health management, advanced coursework in physiology, health assessment, & pharmacology, & clinical & didactic preparation for the advanced practice role. Students will receive no fewer than 500 hours of patient care under faculty oversight. Illinois: A prospective advanced practice nurse must earn a graduate degree or post-master certificate. The individual must complete a program that offers preparation for advanced practice certification. An APN who seeks licensing in a second advanced practice specialty will not need to complete a second graduate degree but will need to complete whatever additional education is necessary to qualify for the desired certification. Slide 12: Evidence-based Strategies should be implemented to achieve continuity between state regulatory boards…some examples are: Removing Scope-of-Practice Barriers Advanced practice registered nurses (APRNs) should be able to practice to the full extent of their education & training. To achieve this goal, the committee recommends the following actions. Enable Nurse Practitioners (NPs) To Practice to the Full Extent of Their License By amending current statutes or directing the Centers for Medicare & Medicaid Services to revise outdated rules & manuals, Congress should take action to remove obsolete limitations in federal laws & regulations that do not recognize nurse practitioners’ advanced education & clinical preparation to furnish the full range of services they are licensed to provide. Another strategy would be to Enable Nurse Practitioners (NPs) to Participate Fully as Members of Hospital Medical Staffs. This can be done by amending Medicare Conditions of Participation to Require Hospitals to Consider NPs for Appointment to Medical Staffs. Current proposed Medicare regulations allow hospitals to consider nurse practitioners for appointment to medical staffs & granting of clinical privileges, but the rules fail to ensure that NPs will be evaluated, & that the evaluation will be done objectively in a timely manner with clear explanations & a right to appeal a hospital’s decision. Last strategy would be to Improve Patient Access to Medicare Skilled Nursing. This can be done by Authorizing Nurse Practitioners (NPs) to Perform Admitting Examinations & Monthly Patient Assessments. Current recommendations are that Congress should pass legislation to amend Medicare conditions of participation for skilled nursing facilities to authorize nurse practitioners to provide admitting examinations & required monthly visits for Medicare beneficiaries in skilled nursing facilities. Slide 13: Arizona is a Full Practice State & allows NPs to practice independently: Full Practice: State practice & licensure law provides for nurse practitioners (NPs) to evaluate patients, diagnose, order & interpret diagnostic tests, initiate & manage treatments-including prescribing prescriptions-under the exclusive licensure authority of the state board of nursing. For 97 years: The Arizona Nurses Association (AzNA) has been leading the way to advance the nursing profession for a healthy Arizona. As the only nurses’ organization representing the interests of all 85,000 Arizona RN’s we have most recently used our voice, volunteers & resources to try to modernize State regulations governing APRNs. In March 2015 there was a historic merger of forces, specialty associations representing Nurse Practitioners, Nurse Anesthetists, Nurse Midwives & Clinical Nurse Specialists created a collaborative group; the Arizona Coalition of Advanced Practice Nurses, to share resources & communication strategies. In April of 2017, Governor Doug Ducey signed bill SB1336 which allowed Advanced Practice Nurses to practice to the full extent of their education & training while increasing patient accessibility of safe, cost-effective care. My opinion regarding independent NP practice is all positive. I believe that APNs should be able to practice to their full availability because their scope of practice allows for them to be trained in this manner. It is a huge resolution to the future conflict of a provider shortage & it also helps to cut health care costs for everyone. I think it’s only a matter of time before every state in the US passes this law & allows for all NPs to practice independently. We all have a voice, therefore we ALL need to use it. Footprints in History are Not Made Sitting Down; 1 in 79 Arizonans is a Registered Nurse! \ [Show Less]
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NR 510 Week 6 Assignment: APN Professional Development Plan Paper
NR 510 Week 6 Assignment: APN Professional Development Plan Paper Advanced Practice Nurse Professional Development Plan Student Name NR 510: Leaders... [Show More] hip & Role of the Advanced Practice Nurse Advanced Practice Nurse Professional Development Plan Introduction to the APN Professional Development Plan APN Scope of Practice The scope of practice of advanced practice registered nurses can differ from state-to-state. There are many differing rules & regulations for nurse practitioners that are not congruent throughout the states. Throughout this piece, the scope of practice for nurse practitioners practicing in West Virginia will be under review. In 2008, a Consensus Model for Advanced Practice Registered Nurse Regulation was developed through the work of the Advanced Practice Nursing Consensus Work Group & the National Council of State Boards of Nursing APRN Committee. This model recognizes four advanced practice roles including certified registered nurse anesthetist, certified nurse-midwife, clinical nurse specialist, & certified nurse practitioner. The model works to endorse licensure of APRNs as independent practitioners within the United States. The Consensus Model for APRN Regulation identifies the four essential elements to APRN regulation as licensure, accreditation, certification, & education (Ward, 2015). In order to become a nurse practitioner, one must first hold licensure as a registered nurse. Registered nurse licensure is a prerequisite to advanced practice registered nurse licensure. In most cases, a nurse will hold both RN & APRN licensures simultaneously. Before obtaining licensure, a prospect nurse practitioner must complete an accredited graduate nursing program in order to earn either their Master’s of Science in Nursing or Doctor of Nursing Practice. The program must either be accredited by the Council for Higher Education Accreditation or the U.S. Department of Education (“Advanced Practice Registered Nurse Requirements in West Virginia,” 2017). Throughout the graduate program, the nurse must complete courses focusing on advanced health assessment, advanced pathophysiology, & advanced pharmacology (Ward, 2015). Depending on the specific practice role & intended population focus, program content can slightly vary. Following graduation, the nurse must then seek licensure & national certification. The regulatory agency for nurse practitioners in West Virginia is the Board of Examiners for Registered Professional Nurses. The certification examination will be given by the Board of Examiners for Registered Professional Nurses & will be consistent with the APRNs role & population focus (“Advanced Practice Registered Nurse Requirements in West Virginia,” 2017). The scope of practice of nurse practitioners in the state of West Virginia includes the scope of practice of a registered nurse with additional responsibilities. These additional components include conducting an advanced assessment, ordering & interpreting diagnostic procedures, establishing primary & differential diagnoses, & prescribing, ordering, administering, & dispensing therapeutic measures. The APRN must comply with the st&ards for registered nurses & to the st&ards of the national professional nursing associations that are recognized by the State Board of Nursing (National Council of State Boards of Nursing, 2012). In West Virginia, nurse practitioners practice under a reduced practice regulatory structure. This means that state practice & licensure laws require the nurse practitioner to obtain a career-long regulated collaborative agreement with another healthcare provider. A collaborative relationship involves the nurse practitioner working with a qualified physician through written agreement to allow the advanced practice nurse to prescribe medications under their authority. This can limit the ability of the nurse practitioner to engage in at least on element of practice (American Association of Nurse Practitioners, 2017). Prescriptive authority refers to the ability of the APRN to prescribe medications without collaborating with a physician. There are not yet any nationwide regulations that governs the prescriptive authority of nurse practitioners throughout the United States. Rather, each state independently governs how the nurse practitioner can function (Woten, 2016). In the state of West Virginia, the nurse practitioner must collaborate with a physician in order to prescribe medications. In order to be eligible to prescribe medications, the nurse practitioner must be at least eighteen years of age & must have completed forty-five recent contact hours of coursework in advanced pharmacology & clinical management of drug therapy (“Advanced Practice Registered Nurse Requirements in West Virginia,” 2017). Some classes of medications cannot be prescribed by nurse practitioners in West Virginia including Schedules I & II controlled substances, anti-neoplastic medications, radiopharmaceuticals, & general anesthetics. Schedule III controlled substances that are prescribed by a nurse practitioner shall be limited to a thirty-day supply without refills (“West Virginia Scope of Practice Policy,” 2017). In order to obtain prescription privileges, the nurse practitioner must submit a separate application to the board of nursing for prescription writing privileges & must also provide verification of a collaborative agreement with a physician (“Advanced Practice Registered Nurse Requirements in West Virginia,” 2017). Personal Assessment Self-assessment for nurse practitioners is a valuable method to evaluate & strengthen advanced practice. Benner’s Novice to Expert Model is a useful self-assessment tool for all healthcare professionals. Benner’s Model is designed to emphasize the skill acquisition of healthcare professionals. The model embodies five phases of professional practice from novice to expert (Benner, 2001). Ongoing experience of the nurse practitioner changes an individual’s perception of situations. When beginning my career as a nurse practitioner, I will be starting out at the novice level of practice. It can take time & experience to transition into further levels of practice as a new advanced practice nurse. As a future nurse practitioner, I want to mainly focus on providing excellent patient care to each patient I treat. I want to further develop my advanced assessment skills in order to properly & efficiently assess, diagnose, & treat my patients. I also hope to further my clinical pharmacology education regarding certain antibiotics & other medications that I will be prescribing. I very much look forward to being able to treat my patients while collaborating with a physician. While West Virginia’s APRN regulations may be restrictive, I believe it will be beneficial to work closely with a physician as a new nurse practitioner. This will help me learn certain methods & feel more secure about my decisions as a novice practitioner. The thing I fear most about my new role is the possibility of significant error. Error in the healthcare environment is very serious, as patients’ lives & well-beings are at stake. While I already have this responsibility as a registered nurse, I believe there is more significant responsibility as an APRN. In order to counteract this, I plan to use evidence-based practice to treat my patients & be sure to further collaborate with the physician or other providers when I am unsure of a situation. I hope to gain many things from my new experience as a nurse practitioner. For example, I hope to be able to gain the trust & validity from my patients. I also hope to be able to gain the confidence to someday independently treat patients without the collaboration of a physician, pending legislative changes. Adapting to the new role of a nurse practitioner will be stressful & trying. In order to cope with stress, I will need to have methods to effectively manage & work through stressful situations. My most often used coping mechanism is physical activity. I believe exercise is the most powerful stress reliever in my life. As a new APRN, I will be sure to make time in my busy schedule to incorporate exercise & physical activity. Another stress coping mechanism I often utilize is music therapy. I find listening to relaxing music allows me to calm down & manage my stress more effectively. Finally, I also manage stress by talking it out with somebody I am close with. I feel that my friends & family are very effective in helping me manage my stress. They have helped me throughout nursing school & continue to help me throughout graduate school, as well. As a new nurse practitioner, I have many goals to achieve throughout my first year of practice. During my first month of practice, I simply hope to become comfortable in my practice setting & with my fellow coworkers. I believe developing a sound relationship with my collaborative physician will be very important to my success. Throughout my second & third months of work, I hope to continue to strengthen my relationships with my coworkers & patients. I hope to gain the trust of my patients & gain the reputation as a qualified & educated practitioner throughout my first year as a novice nurse practitioner. When completing self-assessments of your practice, it is important to be aware of your strengths & weaknesses as a practitioner. I believe my most significant strength as a practitioner will be my people-skills & my ability to communicate with my patients & coworkers. I think this is especially beneficial throughout patient assessments to gather all of the important information needed for the focused assessment. Proper communication skills are absolutely necessary when collaborating with other providers & delegating tasks to other professionals. Lapses in communication can directly or indirectly cause harm to the patient. I believe my biggest weakness as a new practitioner will be my slight lack of confidence. I feel that I may be too quick to double-check everything with the physician. However, this will not be appropriate as a nurse practitioner. I hope to overcome this weakness & become more confident as a practitioner as I continue my education. Networking & Marketing Strategies The American Association of Nurse Practitioners is a full-service national professional organization for nurse practitioners of all specialties. The AANP provides members with continuing education, up-to-date news regarding important healthcare topics, advocacy at both the state & national level, & other resources to promote professional growth. The AANP contains a Nurse Practitioner Job Center to assist practitioners with finding employment. They allow the practitioner to find jobs based on location, specialty, & job setting. The organization also holds career fairs to further assist practitioners (American Association of Nurse Practitioners, 2017). The Advanced Practice Registered Nurse Congress of West Virginia is a state-based organization that also assists nurses & nurse practitioners with finding employment. The APRN Congress works under the West Virginia Nurses Association & the American Nurses Association to advocate for nurse practitioners of West Virginia. Their web page contains a career center link to assist practitioners in employment opportunities (West Virginia Nurses Association, 2018). One major marketing strategy for the nurse practitioner is to promote communication techniques & strategies. The Institute of Medicine emphasizes the importance of the nurses’ ability to master the use of communication technology tools in order to collaborate & support the continuity of care. These skills help promote the overall health of the nation. Promoting & utilizing telehealth can also help provide care to patients in more rural areas who do not have immediate access to healthcare providers (Gray & Rutledge, 2014). By marketing technology & communication skills, the nurse practitioner will be able to prove their value in healthcare settings & rural environments, as well. One networking strategy that is useful for nurse practitioners is becoming involved within professional organizations. Not only do professional organizations advocate for the APRN professions, but they also give practitioners the opportunity to interact with & network with other practitioners throughout the nation. This provides future & current nurse practitioners with the ability to share their thoughts & receive support from other professionals in their field throughout the organization. Professional social networking can also be beneficial for practitioners if used appropriately. Conclusion 1. Write your Curriculum Vitae (CV). Refer to the template on pages 772-773 in DeNisco & Barker (2015). Your CV should not exceed 2 pages in length. 2. When concluding the paper, summarize important aspects of the APN professional development plan. References Advanced Practice Registered Nurse Requirements in West Virginia. (2017). Retrieved from https://www.nursinglicensure.org/np-state/west-virginia-nurse-practitioner.html#education American Association of Nurse Practitioners. (2017). State Practice Environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment#west-virginia Benner, P. (2001). From Novice to Expert: Excellence & power in clinical nursing practice. Upper Saddle River, NJ: Prentice Hall Health. Gray, D., & Rutledge, C. (2014). Using new communication technologies: An educational strategy fostering collaboration & telehealth skills in nurse practitioners. The Journal for Nurse Practitioners, 10(10), 840-844. http://dx.doi.org/10.1016/j.nurpra.2014.06.018 National Council of State Boards of Nursing. (2012). APRN Model Act & Rules. Retrieved from https://www.ncsbn.org/2012_APRN_Model_&_Rules.pdf Ward, C. (2015). It's time to recognize APRN practice nationally. Medsurg Nursing, 24(4), 210-211. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26434031&site=eds-live&scope=site West Virginia Nurses Association. (2018). APRN Congress. Retrieved from http://www.wvnurses.org/Main-Menu-Category/APRN-Congress West Virginia Scope of Practice Policy: State Profile. (2017). Retrieved from http://scopeofpracticepolicy.org/states/wv/#tab-nurse-practitioners Woten, M. (2016). Advanced Nursing Practice & Prescriptive Authority. CINAHL Nursing Guide. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T904682&site=eds-live&scope=site [Show Less]
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NR 510 Week 5 Discussion: Conflict at the Office
NR 510 Week 5 Discussion: Conflict at the Office Leadership is not room. It is multifaceted & must be communicated as a stated plan to effect a change. Or... [Show More] ganizational leaders provide a vision & move others toward a common goal. This vision also reinforces the importance of teamwork in the workplace. According to Buppert (2015), quality improvement & patient safety are inextricably intertwined. A work environment that supports teamwork & respect for other people is essential to promote patient safety & quality of care. Unprofessional behavior is disruptive & adversely impacts patient & staff satisfaction, the recruitment & retention of healthcare professionals, communication, teamwork & undermines a culture of safety. Unprofessional behavior is therefore unacceptable. Discussion Question: In this scenario, what evidence-based organizational strategies & management skills might you employ to resolve co-worker conflict? Reflect on conflict resolution strategies specifically for healthcare. How does teamwork increase patient safety? Provide evidence & rationales to support your decisions. Provide evidence & rationale to support your decisions. Answer When I hear the term conflict, I most often associate it with something negative in nature. However, after this week’s discussion, the experience of dealing with conflict can lead to positive outcomes as well. Conflict that is managed effectively can lead to personal & organizational growth. DeNisco & Barker (2015) state, “Conflict is a natural process of interprofessional teamwork, which can lead to positive or negative group functioning, depending on leadership style” (p. 139). Facing conflict in a leadership role is routine, therefore it is imperative for leaders to be cognizant of the basic components & learn the essential skills of conflict management. We all have different personalities, cultures, beliefs & values, & ways of performing tasks, which makes it that much easier for conflict to arise. If conflict is not managed effectively, it can negatively impact the healthcare professional’s ability to provide safe, high quality patient care & escalate into violence in the workplace (Longo, 2010). Because of this, healthcare professionals need to be aware of the ways in which conflict can escalate & be prepared to prevent or manage it in the workplace. Most often I would think of patient safety initiatives as efforts to reduce the risk of falls, infection, & medication errors, just to name a few. But the way healthcare professionals interact with each other is also an important factor to consider. When conflict & even disruptive behaviors are not resolved or ignored by leadership, healthcare professionals may leave their place of employment, or even leave the profession entirely (Johansen, 2012). This can also have an adverse effect on patient care & safety, creating a shortage of skilled professionals. According to DeNisco & Barker (2015), nurses most often utilize passive-aggressive methods to resolve conflict, such as avoidance, withholding, smoothing over, & comprising. What evidence-based organizational strategies & management skills might I employ to resolve co-worker conflict? One way to address conflict management is through mediation, which is used when both parties involved in the conflict seek to have a neutral third party guide them to reaching a neutrally satisfying agreement (Oore, Leiter, & LeBlanc, 2015). In these situations, an experienced mediator can be employed to establish a private environment for the individuals to discuss the situation & assist in guiding them towards a workable solution. I may also engage in coaching by introducing education that emphasizes on team building & refining the relationships among the employees. Leaders can minimize escalating conflict by educating nurses to learn how to effectively resolve conflict themselves. This can be accomplished through case scenarios & working with the education department on role-playing exercises (Johansen, 2012). As healthcare professionals, it is our duty & responsibility to minimize conflict & increase our efficiencies teamwork. Teamwork is built on the solid foundation of collaboration & communication. When teamwork is present in the health care setting, patients are receiving safe, high quality care, because healthcare professionals (nurses, physicians, pharmacists, etc.) are integrating additional knowledge, skills & competencies from fellow professionals. Effective teams can also recognize potential problems, therefore reducing the number of medical errors & working towards the common goal of patient safety. References DeNisco, S.M., & Barker, A. M. (2015). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Retrieved from https://bookshelf.vitalsource.com Johansen, M. L. (2012). Keeping the peace: Conflict management strategies for nurse managers. Nursing Management, 43(2), 50-54. doi:10.1097/01.NUMA.0000410920.90831.96 Longo, J. (2010). Combating disruptive behaviors: Strategies to promote a healthy work environment. The Online Journal of Issues in Nursing, 15(1), 1-3. doi:10.3912/OJIN.Vol15No01Man05 Oore, D. G., Leiter, M. P., & LeBlanc, D. E. (2015). Individual & organizational factors promoting successful responses to workplace conflict. Canadian Psychology, 56(3), 301-310. doi: 10.1037/cap0000032 [Show Less]
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NR 510 Week 1 Assignment: Practicum Process
NR 510 Week 1 Assignment: Practicum Process Students-Name Practicum Process Welcome from the Practicum Team & the FNP Practicum Proces... [Show More] s Welcome to the course! This announcement contains important information on getting started with your practicum placement for your upcoming NR-511 course. This is a student driven process & your prompt attention to the procedures below will increase the likelihood that you will be placed at a practicum site in time for NR-511. Locating a practicum site is not an easy process due to the competition with other programs who are also seeking student placement. Therefore, it is imperative that you begin the process now. The practicum team is here to assist you with your practicum placement & will support you through all of the steps toward getting approval to register for NR-511. If you completed this process while in NR-503 & submitted a practicum application as directed, then this does not apply to you. This applies to students who have not already submitted a practicum application. Now that you are in NR510, it is essential that you begin the process immediately by completing the following steps in this order: • Review the FNP Student H&book if you have not already done so. The h&book outlines the practicum process, including the student & practicum coordinator expectations. The h&book can be accessed at the following link: http://www.chamberlain.edu/docs/default-source/current-students/msn-fnp-practicum-h&book.pdf?sfvrsn=8 (Links to an external site.)Links to an external site. • Review PowerPoint presentation, MSN FNP Practicum Preparation, located in the Course Resource section of the course. • If you have any questions, please reach out to your FNP Practicum Coordinator. You can locate the name of your FNP Practicum Coordinator (PC) by reviewing the following document in the Course Resource section of the course, Communicate with Your Practicum Coordinator. The PCs are listed by state. Simply locate your state of residence & there, you will find the name of your PC & their contact information. The form also contains deadlines for reaching out to your practicum coordinator, which is based on the session that you plan to begin your first practicum course. [Show Less]
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NR 510 Final Exam Week 8 – Question and Answers (Latest)
NR 510 Final Exam Week 8 – Question and Answers (Latest) Chamberlain College of Nursing NR 510 Final Exam Week 8 – Question and Answers (Latest) Ques... [Show More] tion 1.1. What is the most commonly reported symptom of cancer treatment? (Points : 2) Nausea Fatigue Hair loss Weight loss Question 2.2. Where are Langerhans cells found? (Points : 2) Skin Intestinal lining Kidney Thyroid Question 3.3. An infant has a crescendo-decrescendo systolic ejection murmur located between the second and third intercostal spaces along the left sternal border. A wide fixed splitting of the second heart sound is also found. These clinical findings are consistent with which congenital heart defect? (Points : 2) Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect Question 4.4. Which statement is true concerning a fungal infection? (Points : 2) Fungal infections occur only on skin, hair, and nails. Phagocytes and T lymphocytes control fungal infections. Fungal infections release endotoxins. Vaccines prevent fungal infections. Question 5.5. A hypersensitivity reaction that produces an allergic response is called: (Points : 2) Hemolytic shock Anaphylaxis Necrotizing vasculitis Systemic erythematosus Question 6.6. What period follows depolarization of the myocardium and represents a period during which no new cardiac potential can be propagated? (Points : 2) Refractory Hyperpolarization Threshold Sinoatrial (SA) Question 7.7. Which renal change is found in older adults? (Points : 2) Sharp decline in glomerular filtration rate Sharp decline in renal blood flow Decrease in the number of nephrons Decrease in urine output Question 8.8. Cystic fibrosis is caused by which process? (Points : 2) Autosomal recessive inheritance Autosomal dominant inheritance Infection Malignancy Question 9.9. What is the most common predisposing factor to obstructive sleep apnea in children? (Points : 2) Chronic respiratory infections Adenotonsillar hypertrophy Obligatory mouth breathing Paradoxic breathing Question 10.10. What is the major virus involved in the development of cervical cancer? (Points : 2) Herpes simplex virus type 6 Herpes simplex virus type 2 Human papillomavirus Human immunodeficiency virus Question 11.11. Which normal physiologic change occurs in the aging pulmonary system? (Points : 2) Decreased flow resistance Fewer alveoli Stiffening of the chest wall Improved elastic recoil Question 12.12. Which cancer originates from connective tissue? (Points : 2) Osteogenic sarcoma Basal cell carcinoma Multiple myeloma Adenocarcinoma Question 13.13. Which blood cells are the chief phagocytes involved in the early inflammation process? (Points : 2) Neutrophils Monocytes Eosinophils Erythrocytes Question 14.14. An infant diagnosed with a small patent ductus arteriosus (PDA) would likely exhibit which symptom? (Points : 2) Intermittent murmur Lack of symptoms Need for surgical repair Triad of congenital defects Question 15.15. Which type of microorganism reproduces on the skin? (Points : 2) Viruses Bacteria and fungi Protozoa and Rickettsiae Mycoplasma Question 16.16. During an infection, why do lymph nodes enlarge and become tender? (Points : 2) B lymphocytes proliferate. The nodes are inflamed. The nodes fill with purulent exudate. The nodes are not properly functioning. Question 17.17. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? (Points : 2) Norepinephrine Epinephrine Cortisol Adrenocorticotropic hormone (ACTH) Question 18.18. The area of the kidneys that contains the glomeruli and portions of the tubules is called the: (Points : 2) Medulla Cortex Pyramids Columns Question 19.19. In which structure does B lymphocytes mature and undergo changes that commit them to becoming B cells? (Points : 2) Thymus gland Regional lymph nodes Bone marrow Spleen Question 20.20. Research has shown a link between cancer and which sexually transmitted disease? (Points : 2) Syphilis Gonorrhea Human papillomavirus Pelvic inflammatory disease Question 21.21. Which vitamin improves the absorption of oral iron taken to treat iron deficiency anemia in children? (Points : 2) A B C E Question 22.22. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune process involving antibodies attacking which type of cells? (Points : 2) Neutrophils Eosinophils Platelets Basophils Question 23.23. An infant has a continuous machine-type murmur best heard at the left upper sternal border throughout systole and diastole, as well as a bounding pulse and a thrill on palpation. These clinical findings are consistent with which congenital heart defect? (Points : 2) Atrial septal defect (ASD) Ventricular septal defect (VSD) Patent ductus arteriosus (PDA) Atrioventricular canal (AVC) defect Question 24.24. The tonic neck reflex observed in a newborn should no longer be obtainable by: (Points : 2) 2 years 1 year 10 months 5 months Question 25.25. What is the function of erythrocytes? (Points : 2) Tissue oxygenation Hemostasis Infection control Allergy response Question 26.26. Clinical manifestations of Parkinson disease are caused by a deficit in which of the brain’s neurotransmitters? (Points : 2) Gamma-aminobutyric acid Dopamine Norepinephrine Acetylcholine Question 27.27. The BRCA1 and BRCA2 mutations increase the risk of which cancer in women? (Points : 2) Ovarian Lung Uterine Pancreatic Question 28.28. Which term is also used to refer to paradoxic sleep? (Points : 2) Non-REM Light REM Delta wave Question 29.29. Which person is at the greatest risk for developing delirium? (Points : 2) An individual with diabetes celebrating a 70th birthday A depressed Hispanic woman An individual on the second day after hip replacement A man diagnosed with schizophrenia Question 30.30. Which term is used to describe an intestinal obstruction caused by the invagination of the ileum into the cecum and part of the ascending colon by collapsing through the ileocecal valve? (Points : 2) Congenital aganglionic megacolon Malrotation Intussusception Volvulus Question 31.31. The mucosal secretions of the cervix secrete which immunoglobulin? (Points : 2) IgA IgE IgG IgM Question 32.32. A blunt force injury to the forehead would result in a coup injury to which region of the brain? (Points : 2) Frontal Temporal Parietal Occipital Question 33.33. Acute glomerulonephritis (AGN) may be accompanied by a positive throat or skin culture for which bacteria? (Points : 2) Staphylococcus aureus Streptococcus Pseudomonas aeruginosa Haemophilus Question 34.34. How can glaucoma cause blindness? (Points : 2) Infection of the cornea Pressure on the optic nerve Opacity of the lens Obstruction of the venous return from the retina Question 35.35. Aldosterone directly increases the reabsorption of: (Points : 2) Magnesium Calcium Sodium Water Question 36.36. How does the release (increase) of epinephrine raise body temperature? (Points : 2) The release of epinephrine causes shivering. It affects muscle tone. It raises the metabolic rate. It increases and strengthens the heart rate. Question 37.37. Which assessment finding characterizes Osgood-Schlatter disease? (Points : 2) Lateral epicondylitis of the elbow Inflammation of the anterior cruciate ligament Bursitis of the subscapular bursa in the glenohumeral joint Tendinitis of the anterior patellar tendon Question 38.38. Using a fan to reduce body temperature is an example of which mechanism of heat loss? (Points : 2) Evaporation Radiation Convection Conduction Question 39.39. Which statement is true regarding the major difference between male and female sex hormone production? (Points : 2) Luteinizing hormone has no apparent action in a man. In a man, sex hormone production is relatively constant. Estradiol is not produced in a man. In a man, gonadotropin-releasing hormone does not cause the release of follicle stimulating hormone. Question 40.40. Which clinical manifestations would be expected for a child who has complete trisomy of the twenty-first chromosome? (Points : 2) Widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair An IQ of 25 to 70, low nasal bridge, protruding tongue, and flat, low-set ears High-pitched voice, tall stature, gynecomastia, and an IQ of 60 to 90 Circumoral cyanosis, edema of the feet, short stature, and mental slowness Question 41.41. What is the function of the mucus secreted by the Bartholin glands? (Points : 2) Enhancement of the motility of sperm Lubrication of the urinary meatus and vestibule Maintenance of an acid-base balance to discourage proliferation of pathogenic bacteria Enhancement of the size of the penis during intercourse Question 42.42. What syndrome, characterized by an absent homologous X chromosome with only a single X chromosome, exhibits features that include a short stature, widely spaced nipples, and webbed neck? (Points : 2) Down Cri du chat Turner Klinefelter Question 43.43. The secretion of adrenocorticotropic-stimulating hormone (ACTH) will result in the increased level of which hormone? (Points : 2) Thyroxine Insulin Cortisol. Antidiuretic hormone Question 44.44. The data reporting that sickle cell disease affects approximately 1 in 600 American blacks is an example of which concept? (Points : 2) Incidence Prevalence Ratio Risk Question 45.45. Which condition is considered a clinical cause of amenorrhea? (Points : 2) Disorder in the endometrium Obstruction of the fallopian tubes Lack of physical exercise Failure to ovulate Question 46.46. What is the first sign of puberty in girls? (Points : 2) Breast enlargement Growth of pubic hair Menstruation Vaginal discharge Question 47.47. What term is used to identify the condition that exists when the urethral meatus is located on the undersurface of the penis? (Points : 2) Hypospadias Epispadias Hyperspadias Chordee Question 48.48. The presence of a zygote having one chromosome with the normal complement of genes and one with a missing gene is characteristic of which genetic disorder? (Points : 2) Cri du chat Down syndrome Klinefelter syndrome Turner syndrome Question 49.49. Obesity acts as an important risk factor for type 2 diabetes mellitus by: (Points : 2) Reducing the amount of insulin the pancreas produces Increasing the resistance to insulin by cells Obstructing the outflow of insulin from the pancreas Stimulating the liver to increase glucose production Question 50.50. In scoliosis, curves in the thoracic spine greater than how many degrees result in decreased pulmonary function? (Points : 2) 40 50 60 80 Question 51.51. The failure of bones to ossify, resulting in soft bones and skeletal deformity, characterizes which disorder? (Points : 2) Osteogenesis imperfecta Rickets Osteochondrosis Legg-Calvé-Perthes disease Question 52.52. Which type of fracture usually occurs in an individual who engages in a new activity that is strenuous and repetitive? (Points : 2) Stress Greenstick Insufficiency Pathologic Question 53.53. It is true that myasthenia gravis: (Points : 2) Is an acute autoimmune disease. Affects the nerve roots. May result in adrenergic crisis. Causes muscle weakness. Question 54.54. Which clinical manifestations are associated with fibromyalgia? (Points : 2) Hot, tender, and edematous muscle groups bilaterally Fasciculations of the upper and lower extremity muscles Exercise intolerance and painful muscle cramps Sensitivity at tender points and profound fatigue Question 55.55. Which type of diarrhea results from lactose intolerance? (Points : 2) Secretory Motility Osmotic Small volume Question 56.56. Which change is a result of puberty and defends the vagina from infection? (Points : 2) The pH stabilizes between 7 and 8. A thin squamous epithelial lining develops. Vaginal pH becomes more acidic. Estrogen levels are low. Question 57.57. Which dietary lifestyle choice has been associated with a decreased risk for developing colon cancer? (Points : 2) Increased consumption of dairy produces Increased consumption of foods containing vitamin C Decreased consumption of foods high in fat Decreased consumption of artificial food coloring Question 58.58. Which type of ion directly controls the contraction of muscles? (Points : 2) Sodium Potassium Calcium Magnesium Question 59.59. At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder? (Points : 2) Esophageal atresia Congenital aganglionic megacolon Pyloric stenosis Galactosemia Question 60.60. Which water-soluble vitamin is absorbed by passive diffusion? (Points : 2) Vitamin B6 Vitamin B1 Vitamin K Folic acid Question 61.61. The common property among the three types of medications used to treat depression is that they: (Points : 2) Increase neurotransmitter levels within the synapse. Increase neurotransmitter levels in the presynapse. Decrease neurotransmitter levels in the postsynapse. Decrease neurotransmitter levels within the synapse. Question 62.62. Which pancreatic enzyme is responsible for the breakdown of carbohydrates? (Points : 2) Trypsin Amylase Lipase Chymotrypsin Question 63.63. What anchors articular cartilage to the underlying bone? (Points : 2) Sharpey fibers Collagen fibers Glycoproteins Elastin fibers Question 64.64. The absence of which major hormone is a determinant of sexual differentiation (wolffian system) in utero? (Points : 2) Estrogen Progesterone Growth hormone Testosterone Question 65.65. Which hormone is linked to an increase in appetite during puberty? (Points : 2) Inhibin Leptin Activin Follistatin Question 66.66. What is the first indication of nephrotic syndrome in children? (Points : 2) Periorbital edema Scrotal or labial edema Frothy urine Ascites Question 67.67. Neurofibrillary tangles characterize which neurologic disorder? (Points : 2) Dementia syndrome Delirium Alzheimer disease Parkinson disease Question 68.68. What is the most common opportunistic infection associated with acquired immunodeficiency syndrome (AIDS)? (Points : 2) Non-Hodgkin lymphoma Kaposi sarcoma Toxoplasmosis Cytomegalovirus Question 69.69. What causes the crystallization within the synovial fluid of the joint affected by gouty arthritis? (Points : 2) Reduced excretion of purines Overproduction of uric acid Increase in the glycosaminoglycan levels Overproduction of proteoglycans Question 70.70. Thyroid-stimulating hormone (TSH) is released to stimulate thyroid hormone (TH) and is inhibited when plasma levels of TH are adequate. This is an example of: (Points : 2) Positive feedback Negative feedback Neural regulation Physiologic regulation Question 71.71. Transcription is best defined as a process by which: (Points : 2) DNA polymerase binds to the promoter site on ribonucleic acid (RNA). RNA directs the synthesis of polypeptides for protein synthesis. RNA is synthesized from a DNA template. ?? A base pair substitution results in a mutation of the amino acid sequence. Question 72.72. Which medical diagnosis is characterized by tissue degeneration or irritation of the extensor carpi radialis brevis tendon? (Points : 2) Lateral epicondylitis Medial tendinitis Bursitis Lateral tendinitis Question 73.73. What is the target tissue for prolactin-releasing factor? (Points : 2) Hypothalamus Anterior pituitary Mammary glands Posterior pituitary Question 74.74. Loud snoring, a decrease in oxygen saturation, fragmented sleep, chronic daytime sleepiness, and fatigue are clinical manifestations of which sleep disorder? (Points : 2) Obstructive sleep apnea Upper airway resistance syndrome Somnambulism Narcolepsy Question 75.75. What directly causes ovulation during the menstrual cycle? (Points : 2) Gradual decrease in estrogen levels Sudden increase of LH Sharp rise in progesterone levels Gradual increase in estrogen levels [Show Less]
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NR510 Week 4 Organizational Change and Ethical-Legal Influences In Advanced Practice Nursing Case
NR510 Week 4 Organizational Change and Ethical-Legal Influences In Advanced Practice Nursing Case Study You are a family nurse practitioner employed in a ... [Show More] busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice. Discussion Question: What are the potential ethical and legal implications for each of the following practice members?: Medical assistant Nurse Practitioner Medical Director Practice • What strategies would you implement to prevent further episodes of potentially illegal behavior? • What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice. ANSWER Dr. Distler and Peers, In this situation, I would thoroughly investigate the situation about the prescription. I would look in the patient’s chart for any documentation regarding the phone call and prescription. I would speak with the other nurse practitioners and the medical doctor. Once it was clear that the prescription given was not done so by another licensed healthcare provider within the office, then I would address the issue with Stephanie the medical assistant (MA). MAs work with the medical doctor, physician assistant, nurse practitioner, and nurses mostly in clinics, ambulatory care centers, and outpatient facilities. MAs administrative duties consist of computer data entry and retrieval, operating telephones, making sure correspondence and billing are handled appropriately. The clinical duties of a MAs include updating or receiving medical history of patients, preparing and assisting the licensed provider with examinations, performing venipuncture procedures and transmitting prescription refills as directed. The MA is an unlicensed professional or allied health provider who offer both administrative or clinical support under supervision to the medical doctors, physician assistants, and nurse practitioner in an ambulatory care or clinical setting (Gray, Harrison, & Hung, 2016). Stephanie had clearly operated out of her scope of practice. Medical assistants may only call in routine refill prescriptions that are exactly as before with no changes under the direct supervision of a medical doctor, PA, or NP. The medical assistant may not call in new prescriptions or prescriptions that have changes. In speaking with Stephanie, I would need to clarify if this was an isolated event. If this was intentional or if Stephanie was unclear of her specific job functions. I would let Stephanie know that this is an ethical issue because she called in a new prescription and it is not authorized in her scope of practice. This situation could cause for legal ramifications in the event an issue that arises from a pharmaceutical mistake. American Association of Medical Assistance (AAMA) Prohibited Conduct states, “ As assistant acting beyond the scope of this chapter may be: (1) considered to be engaged in the unlicensed practice of medicine; and (2) subject to all applicable penalties and fines in accordance with Health Occupations Article, §§14-602 and 14-607, Annotated Code of Maryland, and COMAR 10.32.02. (AAMA)”. With this being said, if Stephanie knowingly called in a prescription without the authorization of another licensed healthcare provider, disciplinary actions up to and including termination would take place. If this situation was an unintentional incident, then Stephanie face a written warning with education provided and any future incidents or issues would lead to termination. Title 10 MARYLAND DEPARTMENT OF HEALTH. Chapter 12 Delegation of Acts by a Licensed Physician to an Assistant Not Otherwise Authorized under the Health Occupations Article or the Education Article http://www.aama-ntl.org/docs/default-source/legal/md-regulations.pdf?sfvrsn=4 Gray, CP., Harrison, MI., & Hung, D. (2016). Medical Assistants as Flow Managers in Primary Care: Challenges and Recommendations. https://www.ncbi.nlm.nih.gov/pubmed/27356444 Hycenta, I totally agree with your response in the clarification of job description of the medical assistant (MAs). Stephanie was clearly wrong in calling in the prescription for the patient and she was aware that this was not a part of her job description as stated in the second part of the case study. Communicating with the physician or even the office manager (if one) was not considered in this situation. Continued education and training should be a priority and implemented at this time. Because of the severity of the issue, I stated in my initial post that “disciplinary actions up to and including termination would take place. If this situation was an unintentional incident, then Stephanie face a written warning with education provided and any future incidents or issues would lead to termination.” Haimanot, In your response you pointed out that “Stephanie may have acted in some ways under pressure” which I can agree with you. Also another interesting point you made was Stephanie “might even be to shield busy providers from receiving another call”. I also agree that that could have been another concern of Stephanie’s. Stephanie and all other staff would need to be reintroduced to their job descriptions and their scope of practice. Stephanie or any of the other staff should not feel pressured into making poor decisions and cause or create unethical situations and unnecessary legal issues for the clinic and other healthcare providers. Because Stephanie knew better but decided to practice unlawfully, there should be some measure of disciplinary action taken. Thank you for those great points you added to the discussion. [Show Less]
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