Running head: FINAL NURSING PAPER 1
FINAL NURSING PAPER 16
Final Nursing Paper
Seilin Gonzalez
South University
· Advanced Practice Roles in Nursing:
· Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice, primary care, education, administration, and health information. Distinguish between ANP and the APN.
Advanced nursing practice may be defined in regards to either role undertakings or competencies. Saleh, Alameddine & Mourad et al. (2015) assert that when defined based on competencies, advanced nursing practice is perceived as a set skills or capabilities that individuals in such a role must possess. In regards to role, Yee, Boukus, Cross & Samuel (2013) posit that this concept described a multiplicity of various roles, for example educator, clinician, consultant and researcher, rather than a particular distinctive role. It is however notable that as the nursing profession evolves the advanced nursing practice concept is also undergoing transformations.
There are notable differences between advanced nurse practitioners (ANP) and advanced practice nurses (APN). Masters (2015) asserts that one of the most significant distinguishing features is that APNs are the most highly trained/educated registered nurses and they possess either masters or doctorate nursing degrees. Moreover, Martinez-Gonzalez, Djalali & Tandjung et al. (2014) assert that while ANPs may have to work under the supervision of physicians, APNs fulfill roles for example as ordering laboratory test, prescribing medicines, diagnosing conditions and even interpreting lab results, which were initially only fulfilled by doctors. According to Gehring, Schwappach & Battaglia et al. (2013) the main features of ANP include the extensive use of critical thinking, practice transformation and clinical judgment. As a consequence, the main competencies that are commonly associated with ANP role include consultation, research, direct clinical practice, ethical decision making, leadership, guidance and expert coaching. On the other hand, the APN role is
· Describe the advance nursing practice role you aspire and briefly share the experiences and/or qualities you have that have influenced your decision. Include your personal philosophy.
The advance nursing practice role that I aspire is family nurse practitioner. I have always wanted to be a family nurse practitioner because I believe that this role will enable me to deliver high quality care to people of different demographics. As I was growing up, I witnessed someone I knew die a very slow and painful death due to a chronic condition that they had. I somehow felt that the nursing care they received, particularly in their last few days, could have been of higher quality and that the nurses handling their case should have been more compassionate and caring. It was then that I decided I would become a family nurse practitioner.
My personal philosophy as a nurse is based on the first nursing metaparadigm which is person. I am convinced that patients/clients have diverse experiences, perspectives and attitudes towards life and health which must all be considered in the delivery of high-quality care. As such, my principle is to approach each client or patient as a unique person with unique needs.
I possess several qualities which have influenced my decision to pursue a career as a family nurse practitioner. Firstly, my communication skills are exemplary; I am able to communicate through different channels, both verbal and non-verbal, while at the same time ensuring that I get valuable feedback from patients and/or clients. Secondly, I am emotionally stable and with a notable level of emotional intelligence; as indicated by Masters (2015) this quality is a very invaluable one particularly because nursing is a very stressful and demanding career where one may regularly find themself in tragic or highly emotive situations. Thirdly, I am a very empathetic person who reflexively shows compassion and rushes to the assistance of those who need it. According to Blackwell & Neff (2015) this quality will ensure that I am able to identify with patient/clients and consequently deliver high quality care. It is also beneficial in my career as a family nurse practitioner that I am a person who is both versatile and flexible. This means that I can easily adapt to different circumstances, and that I can successfully deliver high quality care to patients and clients of diverse backgrounds.
· Selected Advanced Practice Role:
· Identify the AP you interviewed and summarize the interview, which should/may include (if not in the interview, please address):
The advanced practice role that was interviewed is Angie Riddle who works as a nurse practitioner (NP) at CareHere LLC. CareHere LLC is a private healthcare organization specialized in the delivery of near-site and on-site primary care. Currently the facility has an estimated 200 wellness clinics in different American states. The organization delivers healthcare to more than 335,000 patients/clients across the country. One of the most important discoveries made during this interview is that the career success of any nurse in an advanced nursing role is determined by the degree of their professional fit. Riddle revealed that her professional fit for the NP role is satisfactory because she not only has masters and post master’s educational qualifications but also accreditation from reputable agencies such as the Adult/Gerontology Primary Care Nurse Practitioner Board.
· Examine regulatory and legal requirements for the state in which you plan to practice/work.
I plan to work in Florida State; the agency tasked with regulating nurses in Florida is the Florida Board of Nursing. The Florida Board of Nursing describes an advanced registered nurse practitioner (ARNP) in accordance with s. 464.003 of Florida laws which defines them as “any person licensed in [the] state to practice professional nursing and certified in advanced or specialized nursing practice” (para. 1). The three fields of specialization in nurses which are generally acknowledged in Florida are: certified registered nurse anesthetist, nurse practitioner (NP) and certified nurse midwife (CNM).There are several regulatory and legal requirements which I must satisfy in order to work in the state of Florida. According to Buppert (2017) these regulations govern issues such as education requirements, the authority to make prescriptions, scope of practice, renewal, suspension or revocation of license and standards of practice. In order to practice as a nurse in this state, one must possess both a registered nurse (RN) license and malpractice insurance. Secondly, Swan, Ferguson, Chang, Larson & Smaldone (2015) reveal that it is mandatory to have certification from a relevant specialty board. In regards to academic attainment, nurses practicing in Florida must have finished a post-basic and formal academic program (for at least an academic year) in order to be ready for advanced practice. In addition to this, they must also have graduated from a program which gives them an opportunity to pursue a master’s degree. Buppert (2017) asserts that since the 1st of July, 2006, all nurses desiring to receive advanced registered nurse practitioner certification in the state of Florida must first receive and submit national advanced practice nurse accreditation from a relevant board of nurse certification.
· Describe the professional organizations available for membership based on your selected role.
There are several professional organizations that are available for membership by family nurse practitioners in Florida. Examples of such organizations include the American Association of Nurse Practitioners (AANP), Florida Association of Nurse Practitioners (FANP), Florida Nurse Practitioner Network (FNPN) and the Central Florida Advanced Nursing Practice Council (CFANP). Goolsby & Dubois (2017) assert that membership to such bodies in beneficial for a nurse practicing in an advanced nursing role because enhances networking, policy, professional development, mentorship, engagement and advocacy.
· Identify required competencies (domains), including certification requirements for your selected role.
There are four main domains which are needed in a nurse practitioner’s scope of practice; under each of these four domains, are a set of competencies whose mastery and application is fundamental in the successful delivery of care.
i. Domain of professional responsibility and leadership
The important competencies under this domain include: the practitioner’s commitment to practice within an appropriate nursing model, be accountable in their practice, demonstrate and use nursing leadership to influence the health outcomes of clients/patients positively. The Nursing Council of New Zealand (2014) posits that under this domain the nurse practitioner is also expected to participate in processes of policy development, promote health outcome equity in a population, support and promote ethical decision-making and possess and apply an advanced level of knowledge and expertise when making decisions related to the delivery of care.
ii. Domain of management of nursing care
The required competencies under this domain in the role of a nurse practitioner include: skills in diagnostic decision-making and thorough assessment of client/patient health, ability to effectively deliver care in diverse contexts, involvement of client in decision-making processes and the use of theory and application of a formal approach in patient interventions (Saleh, Alameddine & Mourad et al., 2015). A nurse practitioner must also be creative and innovative in patient care, able to use information technologies to enhance their decision-making processes, record and document client participation and evaluation information and able to apply critical thinking in the process of making plans.
iii. Domain of interpersonal and interprofessional care and quality improvement
The most important nurse practitioner competencies associated with this domain are: respect and tolerance for patient diversity, active contribution to clinical collaboration, creation of therapeutic associations with clients and active engagement in processes of quality assurance. American Association of Nurse Practitioners (2014) asserts that under this domain, a competent nurse practitioner must also use evidence-based findings to influence the procurement of facility resources, create and review clinical standards and demonstrate a capacity for risk management.
iv. Domain of prescribing practice
Cotter, Renz, Bradway & Taylor (2013) reveal that under this domain competent nurse practitioners are those who are able to: understand regulations and legislative frameworks that govern practice, access and use third party evidence appropriately always consult and collaborate with client while giving then accurate information regarding their health at all times. It is also notable that as a FNP working in Florida, as in any other part of the country, it is also fundamental that I possess sufficient knowledge and understanding of legal decrees such as Nurse Practice Act, Baker Act and Signature Authority Bill which guide nursing practice (Florida Association of Nurse Practitioners, 2018).
· Describe the organization and setting, population, and colleagues with whom you plan to work.
I plan to work with Jackson South Medical Center in Miami, Florida. Jackson Health System (2018) reveals that this organization offers a diverse spectrum of healthcare services and handles approximately 37,000 emergency cases annually. An estimated 3,400 surgeries are also performed at the facility each year. The setting of Jackson South Medical Center is a notably state of the art because the facility has computerized most of its operation through the integration of information technology systems. The center has 230 certified acute beds and recently unveiled 7 new state of the art operating room suites (Jackson Health System, 2018). The colleagues with who I plan to work with at Jackson South Hospital are amongst the best nationally and globally because according to Jackson Health System (2018) the organization is “staffed by nationally respected, board-certified physicians and healthcare professionals who practice a wide array of specialties and subspecialties” (para. 1).
· Leadership Attributes of the Advanced Practice Role:
· Determine your leadership style
My leadership style is situational leadership style; this model of leadership was created by Paul Hersey and Ken Blanchard as they researched on the management of organizational behavior. Torres-Contreras (2013) asserts that the basic principle of this type of leadership is that there is no best style of leadership that can be applied satisfactorily and effectively in all the different situations that a leader encounters in their organization. As such, this type of leadership is an adaptive one which encourages me to evaluate all my team members, consider the different variables or factors at my place of work and consequently select the type of style of leadership that is best suited for the present circumstances and the goals that we endeavor to achieve as a team. Situational leadership has been very effective for me in different circumstance because it is become increasingly clear that successful leaders in the contemporary day cannot depend only on positional power.
A feasible example of an incident where I applied situational leadership is at Vitas Hospice University where I work as a case manager. One day there was a conflict regarding which team member would handle a particular case because both of the available team members claimed that their workload was too much and that the other should handle that particular case. Although, in other cases I would have applied transformational leadership style to inspire them on the importance of working selflessly to improve patient outcome, I felt that democratic leadership was more suitable. I invited both of them to give their opinions regarding how the issue was to be resolved; at the end, they decided that one of them would handle the current case and the other would handle the next case.
· Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop
Brewer, Kovner, Djuki, Fatehi, Greene, Chacko & Yang (2016) describe transformational leadership refers to the kind of leadership whereby a leader is charismatic and with the ability to influence their followers to accept and embrace their vision for the organization in order to work together towards attaining set goals. According to Brewer et al. (2016) the transformational style of leadership is built upon four main pillars namely: individualized consideration, idealized attributes, intellectual stimulation, and inspirational motivation. Although situational leadership is my ideal style, there are several leadership qualities that are depicted by transformational leaders which I possess. Firstly anytime I lead I ensure that I have a clear vision of the goals to be achieved; secondly, I possess high-level communication skills which enable me to communicate my vision clearly to all organizational members so that they understand how it is to be actualized; thirdly, is can inspire followers using my charismatic and eloquent nature; lastly, I am a courageous and self-motivated individual who possesses the resilience and determination required to successfully attain set goals.
· Apply the leadership style you will embrace in AP to one of the domains
In AP I will embrace situational leadership. When applied to a domain such as nursing care management or promoting health, this style of leadership is beneficial in several ways. This is mostly because as family nurse practitioner I must work collaboratively with others to ensure successful delivery of high-quality care. Firstly, as indicated by Torres-Contreras (2013), situational leadership will encourage the team members to develop effective workgroups; secondly, since leadership is based on situational factors and circumstances, it will make it for team to establish rapport and bring out the best in each of them.
· Health Policy and the Advanced Practice Role
Based on your program of study, review the literature and address the following:
· FNP/AGNP: Medicare reimbursement for NPs is 85%for the same health care that MDs receive at 100% reimbursement? Please address questions below and state your position on this mandate.
Although NPs and MDs share many duties, for example diagnosing, treating and following up on patients, NPs receive a lower medical reimbursement. While MDs are given 100% reimbursement of standard fees by Medicare, NPs receive 85%. My position regarding this issue is that it is not fair because; the main reason for this is that, as depicted by Phillips (2018), NPs as much time as MDs (or even more) with patients. Moreover, I feel that instead of basing reimbursement on the treating healthcare professional, it should be based on the complexity of each case and the time spent on diagnosing and managing the case.
· FNP/AGNP: What states have NP Full Practice Authority and which states have limitations or restrictions? How does this apply to your state? Please address questions below and state your position on this regulation.
Nurse practice regulations and laws are distinctive to each state. Stanik-Hutt, Newhouse & White et al. (2013) reveal that while some states have the authority to undertake full practice, others have put some limitations in place. The states with full practice are 23; these include: Alaska, Hawaii, Iowa, Arizona, Nebraska, Colorado, Maine, Connecticut, Vermont, Idaho, Oregon, Maryland, Minnesota, Rhode Island, Montana, New Hampshire, New Mexico, Nevada, North Dakota, Oklahoma, South Dakota, Washington and Wyoming. States that have reduced practice authority include: Kansas, New York, South Dakota, Virginia, Utah, Alabama, Michigan, Mississippi, Arkansas, Illinois, Indiana, Delaware, Kentucky, West Virginia, Wisconsin, Massachusetts, Pennsylvania, Ohio and New Jersey. The states with restrictions on practice include: California, Oklahoma, Florida, Georgia, Missouri, North Carolina, South Carolina, Tennessee and Texas.
Practice in Florida, where I intend to work, is restricted. The implication of this is that my capacity to prescribe medication is supervised by either a physician or surgeon. Moreover, I must abide by the dictates of the FL Nurse Practice Act and ensure that I obtain a malpractice exemption or insurance.
· Nurse Executive: What is value-based care and how will it impact decisions made at the executive level relative to nursing and AP nursing? Please address and state your position on the regulation.
Pappas (2013) describes the value-based model of nursing care as that which places preeminence on the relationships and associations between individual nurses and patients/clients, as well as the healthcare services offered. Value based care as notable impacts on both decisions making and nursing. According to Gielen, Dekker & Francke et al. (2014) the most important include: enhanced health in target population, reduction of costs and improvements in the general experience of patients receiving care. As intimated by Pappas & Welton (2015), my position on this issue is that value-based care is best determined using metrics that evaluate the economic and clinical effects of nursing.
· Nurse Informaticists: What law(s) was enacted to regulate health information? Please address questions below and state your position on this regulation.
AHIMA Practice Brief (2014) reveals that health information is regulated through the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule which (effected in April 2003). Other important regulations include the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 which tasked the Federal Department of Health and Human Services (HHS) with ensuring the security, quality and safety of health IT. The Privacy Cat of 1974 and the Confidentiality of Alcohol and Drug Abuse Patient Records Rule also play an instrumental role in ensuring that patients’ medical information and records are protected.
· Nurse Educator: What agency regulates nursing education? Explain in detail.
According to the American Nephrology Nurses Association (ANNA) (2018) the agencies that regulate nursing education are: state nursing boards and the National Council of States Boards of Nursing (NCSBN). The agencies base their regulation on the dictates of the Nurse Practice Act. Bousso, Poles & Cruz (2014) assert that nursing education and practice is regulated in all American states. Firstly, all nursing schools must receive approval and authorization in the states that they are located. Secondly, nursing schools should be voluntarily accredited by an association that is non-governmental because all graduates must sit for a uniform licensing examination and a computer adaptive test (American Nephrology Nurses Association, 2018).
For the above category chosen, address the following:
· The category chose from the two offered above is nurse informaticist.
· Describe the current policy or trends and determine if it needs to change; if opposed to change state why
Peltonen (2016) asserts that the most notable policies and trends in nurse informatics include those related to big data research, support for clinical decisions, education, patient safety, mobile health and standardized technologies.
· Provide the process required to make the change with key players and parties of interest; support opposition
The policy and trends regarding this role and its regulation have evolved in the last few years due to the action of the HITECH Omnibus Rule which, since 2013, has extended the requirements for information protection or disclosure-and related issues-to business associates (AHIMA Practice Brief, 2014). In order to make changes, therefore, the key players and parties of interest include governmental agencies regulating nursing, professional bodies of nursing and relevant politicians (Kung & Lugo, 2014). Any opposition encountered will be redressed through the use of open communication and feedback channels and the use of both intrinsic and extrinsic rewards.
· Explain how you could lead the effort to make or influence the change in policy or keep the policy the same and the impact in healthcare quality.
The areas of policy I would influence are financing and the integration of telehealth with nursing informatics. This is because reimbursement is fundamental in expanding telehealth. Rather than focus solely on information systems, information nurses must also consider such integration. I would lead the change effort by communicating my vision and desired goal to all relevant parties and involving all direct stakeholders in the process.
· Conclusion
This paper has examined and discussed different issues pertaining to the role of advanced nursing practice. The key points made in this paper include the importance of practicing authority, the role played by government and non-governmental regulatory bodies and the dependence of quality healthcare delivery of nurses’ expertise, competence and commitment to improving healthcare. The different policies and trends in select advanced nursing roles have also been examined.
References
AHIMA Practice Brief (2014). Laws and Regulations Governing the Disclosure of Health
Information. Retrieved from: http://bok.ahima.org/doc?oid=300245#.W4u5aCQzaRl (01 September, date last accessed)
American Association of Nurse Practitioners (2014). Nurse Practitioner State Practice
Environment 2014. Available online at: http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf (21 August 2014, date last accessed).
American Nephrology Nurses Association (2018). Nursing Regulations and State Boards
of Nursing. Retrieved from: https://www.annanurse.org/advocacy/resources-and-tools/state/nursing-regulations (01 September, 2017, date last accessed)
Blackwell, C. W. & Neff, D. F. (2015). Certification and education as determinants of nurse
practitioner scope of practice: An investigation of the rules and regulations defining NP scope of practice in the United States. Journal of the American Association of Nurse Practitioners, 27(10).
Brewer, C. S., Kovner, C. T., Djukic, M., Fatehi, F., Greene, W., Chacko, T.P. & Yang, Y.
(2016). Impact of transformational leadership on nurse work outcomes. Journal of Advanced Nursing, 72: 2879–2893.
Bousso, R. S., Poles, K. & Cruz, D. D. A. L. M. (2014). Nursing Concepts and Theories.
SciELO Analytics, 48(1): 141-145.
Buppert, C. (2017). Nurse Practitioner’s Business Practice and Legal Guide. Jones and Bartlett
Publishers, 125-151.
Cotter, V. T., Renz, S. M., Bradway, C. W. & Taylor, M. A. (2013). Adult-Gerontology Primary
Care Nurse Practitioner Competencies. Conference: The National Organization of Nurse Practitioner Faculties 39th Annual Meeting.
Florida Board of Nursing (2016). Updated Standards for Protocols: Physicians and ARNPs.
Retrieved from: https://floridasnursing.gov/standards-for-protocols-physicians-and-arnps/ (01 September, 2018, date last accessed).
Florida Association of Nurse Practitioners (2018). Advocacy. Retrieved from:
https://www.flanp.org/ (01 September 2018, date last accessed).
Gehring, K., Schwappach, D. L. & Battaglia, M. et al. (2013). Safety climate and its association
with office type and team involvement in primary care. International Journal of Quality Health Care, 25: 394-402.
Gielen, S. C., Dekker, J. & Francke, A. L. et al. (2014). The effectives of nurse prescribing: a
systematic review. International Journal of Nursing Studies, 51: 1048.
Goolsby, M. J. & Dubois, J. (2017). Professional organization Membership: Advancing the nurse practitioner role. Journal of the American Association of Nurse Practitioners, 29(1): 434-440.
Jackson Health System (2018). Jackson South Medical Center. Retrieved from: http://www.jacksonhealth.org/jackson-south.asp#gref (01 September, 2018, date last accessed).
Kung, Y. M. & Lugo, N. R. (2014). Political advocacy and practice barriers: A survey of Florida
APRNs. Journal of the American Association of Nurse Practitioners, 27(3).
Masters, K. (2015). Role development in professional nursing practice. Boston: Jones & Bartlett Publishers.
Martinez-Gonzalez, N. A., Djalali, S. & Tandjung, R. et al. (2014). Substitution of physicians by
nurses in primary care: a systematic review and meta-analysis. BMC Health Services Res, 14: 214.
Nursing Council of New Zealand (2014). Competencies for the nurse practitioner scope of the
practice. Retrieved from: file:///C:/Users/us/Downloads/NP%20competencies%20December%202012.pdf
Pappas, S. & Welton, J. M. (2015). Nursing: Essential to Healthcare Value. Nurse Leader, 13(3):
26-29.
Papas, S. H. (2013). Value, a Nursing Outcome. Nursing Administrative Quarterly, 37: 122-128.
Peltonen, L. M. et al (2016). Current Trends in Nursing Informatics: Results of an International
Survey. Studies in Health Technology and Informatics, 225: 938-939.
Phillips, S. J. (2018). Improving access to healthcare one state at a time: 30th annual APRN
legislative update. Nurse Practitioner, 43(1): 27-55.
Saleh, S., Alameddine, M & Mourad, Y. et al. (2015). Quality of care in primary health care
settings in the Eastern Mediterranean region: A systematic review of the literature. International Journal of Quality Health Care, 27: 79-88.
Stanik-Hutt, J., Newhouse, R. P. & White, K. M. et al. (2013). The quality and effectiveness of
care provided by nurse practitioners. Journal of Nurse Practitioners, 9(492): 492-500.
Swan, M., Ferguson, S., Chang, A., Larson, E. & Smaldone, A. (2015). Quality of primary care
by advanced practice nurses: A systematic Review. International Journal for Quality in Health Care, 27(5): 396-404.
Torres-Contreras, C. C. (2013). Situational Leadership in Nursing in a Health Institution in
Bucaramanga, Columbia. Enfermeria Clinica, 23(4): 140-147.
Yee, T., Boukus, E., Cross, D., & Samuel, D. (2013). Primary care workforce shortages: Nurse
practitioner scope of practice laws and payment policies. National Institute for Health Care Reform: Advancing Health Policy Research (13).
