NR510 week 6 discussion 2
Discussion Part Two (graded)
Inconsistent regulation of APN role and scope prevent a seamless healthcare
system in which APN
... [Show More] can practice.
Discussion Question:
What evidence-based strategies should be implemented to achieve continuity
between state regulatory boards? Provide evidence for your response.
Topic responses
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Meghan Mills
Part 2
What evidence-based strategies should be implemented to achieve
continuity between state regulatory boards? Provide evidence for
your response.
The APRN Consensus Model as described in a 2008 report by the APRN
Joint Dialogue Group, is a model for APRN regulation and is, “the product of
substantial work conducted by the Advanced Practice Nursing Consensus
Work Group and the National Council of State Boards of Nursing (NCSBN)
APRN Committee” (p. 5). Under the APRN Consensus Model, also known as
the APRN Model of Regulation or APRN Regulatory Model, the four roles of anAPRN include CRNA, CNM, CNS, or CNP and, “APRNs are educated in one of
the four roles and in at least one of six population foci: family/individual
across the lifespan, adult-gerontology, neonatal, pediatrics, women’s
health/gender-related or psych/mental health” (APRN Joint Dialogue Group,
2008, p. 10). By implementing the APRN Consensus Model at perhaps the
federal level, continuity between state regulatory boards may be achieved,
“The APRN Regulatory Model applies to all elements of LACE. Each of these
elements plays an essential part in the implementation of the model” (APRN
Joint Dialogue Group, 2008, p. 7). According to the APRN Consensus Model
report from the APRN Joint Dialogue Group (2008), some expectations for
LACE include boards of nursing nationwide giving licensure to APRNs in the
categories of CRNA, CNM, CNS, or CNP within a specific population foci; that
the boards of nursing be solely responsible for the licensure of APRNs
providing licenses to graduates of accredited graduate programs only, and
requiring completion of a national certification examination prior to licensure.
The report also states all boards of nursing will license APRNs as,
“independent practitioners with no regulatory requirements for collaboration,
direction, or supervision” (APRN Joint Dialogue Group, 2008, p. 14).
Reference
APRN Joint Dialogue Group. (2008). Consensus model for APRN regulation:
Licensure, accreditation, certification & education. Retrieved
from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_J
uly_2008.pdf
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Instructor Duncanreply to Meghan Mills
RE: Part 2
MeghanYes! Having identical licensure requirements and education standards would
improve consistency between state boards. Hopefully, this ongoing effort will
improve licensure from state to state.
Dr. Duncan
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Jose DelAcruz
8/9/2016 12:37:24 PM
Discussion Part Two
Hello Dr Duncan and Class
Evidence-based strategies to be implemented to achieve continuity between state regulatory
boards
DeNisco & Barker (2013) assert that, to achieve continuity between regulatory boards
there are various strategies that have to be put in place for instance; communication is a very
effective tool for boards to achieve the right outcome. Constructive communication should start
with the board members when they raise any concern regarding the welfare of the health care
system, patients or the nurses themselves. Any complains that may arise have to be taken
positively and communicated as first as they are noted and acted upon with immediate effect.
Corporation is another strategy that has to be adopted and implemented. To achieve a good
health care system and patient safety, there has to be togetherness between the members of the
board. The patients’ needs have to be put on the fore front and attended to accordingly.
Yee et al, (2013) indicate that policy initiatives may be another strategy that may be used
by regulatory boards so as to help minimize the physician supervision of nurses as it seems to
hinder the NP’s ability to practice the fullest extent of the education and the training that they
have undergone. The physicians and other health professionals should be full partners with the
nurses and this will significantly help in redesigning the health care system. Reeves et al, (p.2,
2013) indicate that inter professional education where members of more than one health
profession should learn interactively together so as to be able to improve inter professional
collaboration or the well-being of all patients should also be implemented. This is because such
interventions have shown various positive incomes like improved patient satisfaction, reducedsignificantly medical errors that occur and improved health outcome of people with specific
chronic diseases (Tappen, 2015).
Jose
References
DeNisco, S. & Barker, A. (2013). Advanced practice nursing: evolving roles for the
transformation of the profession. Burlington, Mass: Jones & Bartlett Learning. Retrieved from
https://books.google.com/books?id=YGSSHUlMTaEC&pg=PA249&dq=regulatory+boards+in+
health+care+systems&hl=en&SA=X&ved=0ahUKEwjmyKj8n7TOAhVRahoKHSCtBqUQ6AEI
LDAE#v=onepage&q=regulatory%20boards%20in%20health%20care%20systems&f=false>
Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional
education: effects on professional practice and healthcare outcomes (update). Cochrane
Database of Systematic Reviews, 3. doi: 10.1002/14651858.CD002213.pub3.
Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers. Retrieved from
https://books.google.com/books?hl=en&lr=&id=DnyUCgAAQBAJ&oi=fnd&pg=PR1&ots=NLq
wVgktLt&sig=WU06DUVm6Q9PYwKxPyMtpaC8OfM&redir_esc=y#v=onepage&q&f=false>
Yee, T., Boukus, E. L. L. Y. N., Cross, D., & Samuel, D. I. V. Y. A. (2013). Primary care
workforce shortages: nurse practitioner scope-of-practice laws and payment policies. National
Institute for Health Care Reform. Research Brief, 13. Retrieved from
http://www.floridanurse.org/arnpcorner/ARNPDocs/NIHCR_Research_Brief_No._13.pdf>
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Mijanou Marretta-Lewis
Discussion Part Two
Dr. Duncan and Classmates,
Varied stated regulations governing the nurse practitioner (NP) has created
barriers to practice within the full capability of education and clinical training
(American Association of Colleges of Nursing, 2011). As such groups as theAmerican Association of Nurse Practitioners (AANP) push on a national level
through government lobbying for full practice authority for all 50 states
there remains push back from the American Medical Association (American
Association of Nurse Practitioner (AANP), 2014, p.1). Sadly there are only
21 states and the District of Columbia that allow for full practice status
allowing them to diagnose, prescribe, evaluate patients, order, interpret
diagnostic tests, initiate and manage care and treatments as primary care
providers which include prescribing medication without the supervision of a
physician (Rudner Lugo, 2016).
The Unites States Institute of Medicine (IOM) in 2010 report, the Future of
Nursing, recommended regulations and policies is designed so as to facilitate
nursing practice to the full extent of their education and training in every
state. It was recommended by the IOM to reform the scope-of-practice
regulations for advanced practice nurses (APRNs) so that each state
conforms to the regulation of the APRN to the National Council of State
Boards of Nursing (NCSBN) Model Nursing Practice Act (IOM, 2010).
The template by the NCSBN for combining regulations among the states
wanted APRNs to be recognized licensed practitioners with full rights and
privileges, which included prescribing and equal pay (NCSBN, 2012). Sadly
this was not adopted nationally, the APRN regulations are governed at the
state level and they make the rules for the practice of the APRNs. Therefore
the United States has not instituted an evidence base to APRN regulation
and so there is a hodgepodge of varied regulations and standards for nurse
practitioners (Rudner Lugo, 2016).
Even though the APRN role has been in existence for the last 50 years with
nearly as much research to demonstrate safety and efficacy of the APRN,
many states like Ohio remain limited by regulations (Newhouse et al., 2011).
Nursing remains a predominately female role, however currently there are
nine percent men in the profession across the US. This leads to the belief
that the role of women in our society versus the state regulation governing
the four APRN roles appears to not accept women’s equality which are
directly associated with those states that restrict the updated status of the
APRN (Bobbit-Zeher, 2011). Today gender gaps continue with women
getting 21 cents less on the dollar than their male counter parts. In 2015,male NPs averaged a salary to $109,000, which women NPs made $100,000,
a difference of $9,000 per year (Muench, Sindelar, Bush & Buerhaus, 2015).
Due to the complexities of state regulations and the nursing practice, the
procedure for assessing APRN regulatory environments continues to vary.
The NCSBN maintains data that has been compiled from state boards of
nursing to measure the progress towards full professional practice and
authority for advanced nurses in each state and territory (NCSBN,
2015). Interestingly the states that supported the Equal Rights Amendment
have more women in the legislator and supported the nurse model practice
act and the IOM Future of Nursing (2010) recommendation.
It is the belief of this nurse that the attitudes towards women reflect and
directly influence the APRN regulations. Those states that supported the ERA
have a higher rate of APRNs full practice authority and those who opposed
the ERA have placed restrictions on the APRNs of their state. To enhance
the image of APRNs as male and female professionals who have ethics and
are strong and competent can be a positive stepping stone to partnerships
and grass-root efforts to establish political support to institute the IOM
recommendation of full authority for the APRN. Being a part of the AANP or
ones local state Nurse Practitioner Association will help to support the work
of those pushing for all of us to have full authority in our practices.
Mijanou
References
American Association of Colleges of Nursing (AACN). (2011).Essentials of
master’s education in nursing. Retrieved
from http://www.aacn.nche.edu/educationresources/MastersEssentials11.pdf
Association of American Medical Colleges Center for Workforce Studies.
(2013). 2013 state physician workforce data book. Retrieved
from https://www.aamc.org/download/362168/data/2013statephysicianwork
forcedatabook.pdf
Bobbitt-Zeher, D. (2011). Gender discrimination at work: Connecting gender
stereotypes, institutional policies, and gender composition of workplace,
gender & society. Gender & Society, 25(6), 764-786.
doi:10.1177/0891243211424741Institute of Medicine. (2010). Future of nursing, leading change, advancing
health. Washington, D.C.: National Academies Press. [Show Less]