Briefly define advance nursing practice and the roles in advanced practice nursing pertaining to clinical practice primary care education administration
Overview/Description of Final Paper: The final written assignment will synthesize what you have discovered about the different advanced practice roles and scope of practice found in the master of nursing curriculum: APRNs, nurse educator, nurse informaticist, and nurse administrator/executive. You will review all roles and then examine the specialty for which you were admitted, focusing on the scope of practice, core competencies, certification requirements, and legal aspects of practice for that specific role. You will also identify the practice environment and population you will be working with, as well as peers and colleagues. In addition, you will discuss your future leadership role and participation in professional organizations.
Your paper is to be based on current literature, standards of practice, core competencies, and certification bodies for your chosen role. The paper should be 8-10 pages excluding the title and reference pages, and APA format is required.
- 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.
- 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.
- Selected Advanced Practice Role:
- Identify the AP you interviewed and summarize the interview, which should/may include (if not in the interview, please address):
- Examine regulatory and legal requirements for the state in which you plan to practice/work.
- Describe the professional organizations available for membership based on your selected role.
- Identify required competencies (domains), including certification requirements for your selected role.
- Describe the organization and setting, population, and colleagues with whom you plan to work.
- Leadership Attributes of the Advanced Practice Role:
- Determine your leadership style
- Define Transformational Leadership and as it relates to your identified leadership attributes that you possess or need to develop
- Apply the leadership style you will embrace in AP to one of the domains
- 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.
- 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 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.
- Nurse Informaticists: What law(s) was enacted to regulate health information? Please address questions below and state your position on this regulation.
- Nurse Educator: What agency regulates nursing education? Explain in detail.
For the above category chosen, address the following:
- Describe the current policy or trends and determine if it needs to change; if opposed to change state why
- Provide the process required to make the change with key players and parties of interest; support opposition
- 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.
- Conclusion-Summarize your role paper by highlighting key points made in your paper.
Advanced Practice Roles in Nursing
Advanced nursing practitioners are highly trained and experienced registered nurses who have the capacity to manage complete clinical healthcare of their patients, without focus on any primary condition. Advanced nurse practitioners have advanced capacity across the four principles or pillars of practice namely facilitation of learning, clinical practice, evidence-based research and development, and leadership.
In relation to clinical practice, advanced nurse practitioners conduct physical examination, develop differential diagnosis, order and interpret lab tests, maintain patient records, and evaluate the performance of patient in regard to particular medication (Woo, Lee, & Tam, 2017).
Advanced nursing practitioners such as family nurse practitioners offer direct primary care services to individuals of all ages. They have the capacity to diagnose illnesses and injuries, and treat acute and common healthcare conditions. They also offer preventive care.
The intensive training which advanced nursing practitioners have undergone through partly focuses on various techniques a healthcare provider can employ to foster good nurse-patient relationship. The knowledge acquired through education enables ANPs to offer supportive care to patients by providing advice and disease management plan.
Just like any other organization, healthcare institutions also require a leader to provide direction, control resources, and ensure the organization operates within the established legal framework. Nurse administrator is one of the ANPs who have knowledge and experience in leadership and administration. Part of the roles of the nurse administrator include planning or arranging work schedules for each employee, and delegating tasks and responsibilities to nursing staff. They plan and supervise training of staff (Woo, Lee, & Tam, 2017). They also formulate organizational budget and ensures that there is budgetary compliance.
Nurse informaticists play a significant role towards the provision of high quality care to patients. They manage patient data and technical systems. With the available health information, nurse informaticists are able to analyze trends, and keep track on consistent mistakes and errors. With this information coupled with their problem-solving skills, nurse informaticists provide a vital support in regard to formulation of plans aimed at enhancing the quality of care provided by other professionals within the domain of advanced nursing practice.
Distinction between ANP and APN
|Typical duties||· Evaluate, diagnose, and treat chronic and acute diseases.
· Take patient’s health history
· Provide referrals for the specialized care
|· Typical duties vary according to specialization of the nurse.
· For example, nurse midwives concentrate on healthcare of women, whereas nurse anesthetics operate mostly in surgical environments.
|Education||· The minimum education qualification is the Master of Science in Nursing.
· A doctoral of nursing practice may be needed later.
|· The minimum qualification for APN specialized examinations is master’s degree.|
|Certification and Licensing||· ANPs are required to register with their state’s Board of Nursing.
· Certification for ANPs in different specialties can be done through American Nurses Credentialing Center (ANCC) and American Academy of Nurse Practitioners (ANP)
|· Certification for the nurse anesthetists can be accessed from the National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA) (Wooden, Krogh, Waters, & Plaus, 2017)
· For clinical nurse specialists and nurse practitioners, certification can be accessed from American Nurses Credentialing Center (ANCC)
|Population focus or specialization||· Pediatric primary care
· Family health
· Pediatric acute care
· Psychiatric-mental health
|· The four key APN specializations include certified nurse midwife, certified Registered nurse anesthetist, nurse practitioner, and clinical nurse specialist.|
My Role as a Family Nurse Practitioner
I aspire to be a family nurse practitioner (FNP). FNPs are part of the advance nurse practitioners who can work either independently or in collaboration with other professionals in the healthcare to provide family-focused health care. Due to the wide nature of the term “family”, family nurse practitioners offer various health care services which rotate around family unit. These services include disease prevention, counseling, and health promotion.
My personal philosophy is primarily based on empathetic, compassionate, competent, and comprehensive patient care to best of my knowledge and ability. This personal philosophy draws its roots from beliefs and values instilled in me in during my childhood. These beliefs and values are accompanied by compassion, respect, trustworthiness. This is what attracted me towards this career, and still, guiding me as I keep on providing care to the patients, families, and society.
As a FNP, I believe that education is fundamental for the purpose of keeping an eye on my philosophy. Continued training regarding the issues connected to patient care is of great importance. I subscribe to the school of thought which holds that extensive research results to a wealth of information, which in turn, may improve my skills and place me in better position to offer prime quality care.
I truly believe that sexual orientation, ethnic background, and cultural beliefs of families and individual ought to be respected. I am strongly confident that I will continue offering care as a FNP without demonstrating any kind of discrimination. My objective is to be a promoter, an educator, a leader, and an advocator of various rights of patients and those of other professionals. I believe that nursing is not just a career. It is a golden opportunity for individuals who’re passionate about applying their skills and knowledge to assist those who’re not in a position to assist themselves.
Selected Advanced Practice Role
Legal and Regulatory Requirements for Washington State
For a FNP to operate in Washington, he or she must have graduated from a recognized nurse practitioner institution. The applicant should have an active Registered Nurse license in Washington. As a way of verification, the applicant is required to submit official transcripts with the degree date indicated as received directly from the applicant’s degree institution. A statement about health and mental status of the applicant and any record of convictions, disciplinary cases, or loss of privileges should also be submitted. Other requirements include HIV/AIDS training certificate and national certification examination certificate.
According to Section 4 of WAC 246-840-300, a FNP will obtain guidance, consultation, and supervision as necessary prior to implementation of unfamiliar or new practices or techniques. A family nurse practitioner is expected to perform his or her duties within their scope of experience, knowledge, and practice (Gadbois, Miller, Tyler, & Intrator, 2014). In Washington, the FNP may carry out the following;
- Assess patients and come up with diagnoses through physical examination, patient history, and other approaches of examination.
- Manage, admit, and discharge the patients to and from healthcare facilities
- Prescribe medical equipment and therapies
- Prescribe drugs upon being granted permission (Gadbois, Miller, Tyler, & Intrator, 2014)
- Refer the patients to other services, facilities, and healthcare practitioners
- Carry out procedures or offer care services which within their scope of practice in accordance with certified commission
Available Professional Organizations for FNPs
Professional organizations for FNPs and other professions basically focus on raising the standards of nurses, promote and advance the rights of healthcare providers in their places of work, and to persuade Congress and other regulatory institutions on matters affecting both the public and nursing professionals. Some of the professional bodies which FNPs can enroll as members include;
- American College of Nurse Practitioners (ACNP)
- National Gerontological Nursing Association
- International Society of Psychiatric-Mental Health Nurses (ISPN)
- American Society for Pain Management Nursing (ASPMN)
- American Nurses Association (ANA)
Certification Requirements for the Role of FNP
For one to qualify for a family nurse practitioner program, he or she should first complete a degree in RN and be certified as RN in the United States or its territory (Barnes, 2015). After completing a BSN degree, one is required to enroll for Master of Science in Nursing through a certification program certified by either Accreditation Commission for Education in Nursing (ACEN) or National League for Nursing Accrediting Commission (NLNAC). One is also required to pass NCLEX-RN test to qualify for certification as RN. Having a work experience of 1 or 2 years is an added advantage. The applicant should also complete at least 500 clinical hours related to the role of FNP and population.
Organization and Setting, Colleagues, and Population
- Organization and Setting
Some of the common practice settings for family nurse practitioners include;
- Ambulatory clinics: Also referred to as outpatient care centers. These centers provide outpatient services such as observation, treatment, dialysis, consultation, rehabilitation, and intervention services.
- Private practice: Private practice health care facilities provide primary care services such as antenatal, diagnosis, treatment of acute and chronic conditions.
- Community clinics: Also referred to as community health centers. These are chains of clinics which are staffed by various health nursing professionals like FNP/general nurse practitioners. They offer health care services to residents of a given region.
- Long-term care facilities: They provide restorative, rehabilitative, and skilled nursing care to residents or patients in need of help with daily living activities.
Some of the nursing professional whom am I plan to work with include;
Adult-gerontology Acute Care (AGACNP)
Adult-gerontology acute care helps to evaluate and manage patients with acute illnesses within inpatient environments and across hospital-clinic settings such as intensive care unit, emergency department, specialty clinics, and specialty labs among others.
Adult-gerontology Primary Care (AGPCNP)
This type of health professionals focus their practice on primary care and put more weight towards disease prevention and health promotion
Psychiatric-mental health professionals work with groups, individuals, communities, and families to examine their mental requirements.
In relation to population, am likely to serve individuals from all ages such as adults, young adults, teenagers, and children among others.
Leadership Attributes of Advanced Practice Role
My leadership style is transformational leadership. Transformation leadership is form of leadership technique where the leader works with members of the team to formulate vision, identify required change, and implement change in through team members (Saravo, Netzel, & Kiesewetter, 2017). Some of the attributes I posses which I believe are important as far as the concept of transformational leadership is concerned include ability to inspire and motivate others, adaptability, self-management, ability to control my ego, ability to make tough decisions, and ability to welcome new ideas. I also possess power to influence individuals through communication and ability to take greater risks.
One of the domains under my specialization as a FNP is leadership. With transformational leadership model, I will be able to encourage and motivate, and instill positive ethical standards among my subordinates. Transformational leadership will also enable me to form an organizational culture where employees embrace the idea of working together as a team for the common good. Health care institutions are among the organizations where interprofessional collaboration is the recipe for high quality care. The idea of combining efforts and sharing information regarding particular illnesses helps significantly when it comes to provision of value-based care.
Health Policy and Advanced Practice Role
“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.”
Personally I don’t agree with Medicare’s and Medicaid’s reimbursement plan whereby NPs receive 85% while MDs get 100% for the same health care provided. Nurse practitioners and physicians share a number of job functions such as treating, diagnosing, and management of chronic and acute conditions. Also, either a physician or a NP can conduct diagnostic tests, interpret lab results, and prescribe drugs (in majority of states). Even as they share these job functions, NPs are reimbursed less compared to the physician. The idea of discounting reimbursements implies that there is difference in terms of quality of care, which is not true. Quality care is supposed to be reimbursed at the same rate.
Current Policy on Reimbursement
Under the current payment plan, state Medicaid programs, third-party payers, and Medicare reimbursements, NPs are only reimbursed approximately 85% whereas physicians get 100% for exact services (Poghosyan, Norful, & Martsolf, 2017). According to me, this outright bias, and NPs should be reimbursed for equal amount as that of physicians for similar services. Therefore, this calls for change of reimbursement policy.
Process of Policy Change
There must be a strong reason to warrant policy change by the government. For this case, the issue of reimbursement is a major problem because it promotes inequality in terms of payments. NPs and MDs share a number of job functions. It is very unfair to reimburse NPS 85% while MDs get 100% for the exact job. There is need for equality.
Formulation and Adoption
At this step several solutions to the issue of reimbursement will be formulated. This stage will involve various stakeholders such the Congress, nursing organizations, courts. At the same, opposition is also likely to arise especially from affected agencies such as Medicaid and Medicare. To build a strong case which will warrant policy change, there will be need to team up with other policy advocacy agencies. Besides providing strategies for pushing for the change, these bodies also have lobbying capacities. They will help to persuade various members of the Congress to support the change. With enough support from the key players, the change will be effected.
Once the policy has been changed, it will be now the responsibility of the reimbursement agencies to implement the new changes, whereby the MDs and NPs will be receiving equal reimbursement for similar tasks.
My Role in Influencing Policy Change
As a FNP, apart from providing nursing care, I am also required to advocate for the rights of patients and those of other nursing professionals. I can lead efforts to influence policy change by;
- Writing position statements, newspaper editorials, white papers, and other educative correspondences which inform the lawmakers and the public about the needs for change or maintaining the current policies
- Looking for the opportunities to advance, develop, enhance, or transform health care regulations within a micro or macro environment.
- Fostering relationships with multiple interested parties advance the agenda of the policy
- Seeking appointments to various county health departments and local administration boards to advocate for need for change.
The roles of advanced nurse practitioners include provision patient education to assist in decision-making, maintenance and use of health information, and assessment of performance of patients as part of clinical practice. They also carry out administrative functions such as formulation of budget, delegations of duties, management of resources within the healthcare facility. As a FNP, part of my role will include diagnoses and prevention of acute and chronic illnesses. I will also provide counseling and promote health care by encouraging and educating individuals and families on how to stay healthy. While working in Washington, some of my roles will include prescribing medical equipment and therapies and drugs upon being granted permission, referring the patients to other services, facilities, and healthcare practitioners. Some of the organizational settings or healthcare facilities where I will possibly work as a FNP include community clinics, long-term care clinics, and ambulatory clinics. Examples of the colleagues am likely to work with include Adult-gerontology Acute Care and Adult-gerontology Primary Care.
Barnes, H. (2015). Exploring the Factors That Influence Nurse Practitioner Role Transition. The Journal for Nurse Practitioners, 11(2), 178–183. https://doi.org/10.1016/j.nurpra.2014.11.004
Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2014). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Medical Care Research and Review, 72(2), 200–219. https://doi.org/10.1177/1077558714563763
Poghosyan, L., Norful, A. A., & Martsolf, G. R. (2017b). Primary Care Nurse Practitioner Practice Characteristics. Journal of Ambulatory Care Management, 40(1), 77–86. https://doi.org/10.1097/jac.0000000000000156
Saravo, B., Netzel, J., & Kiesewetter, J. (2017). The need for strong clinical leaders – Transformational and transactional leadership as a framework for resident leadership training. PLOS ONE, 12(8), e0183019. https://doi.org/10.1371/journal.pone.0183019
Woo, B. F. Y., Lee, J. X. Y., & Tam, W. W. S. (2017). The Impact of the Advanced Practice Nursing Role on Quality of Care, Clinical Outcomes, Patient Satisfaction, and Cost in the Emergency and Critical Care Settings: A Systematic Review. Human Resources for Health, 15(1). https://doi.org/10.1186/s12960-017-0237-9
Wooden, S., Krogh, M. A., Waters, E., & Plaus, K. (2017). Developing the Continued Professional Certification Program for Nurse Anesthetists. Journal of Nursing Regulation, 8(1), 31–37. https://doi.org/10.1016/s2155-8256(17)30072-8