...The Future of Healthcare for the APN Rosetta Vaughn Grantham University Foundation of Advance Practice Nursing NUR506 Aimee Kirkendol RN, DNP, FNP-BC May 21, 2014 The Future of Healthcare for the APN According to the IOM report addresses nursing in all practice levels, with the greatest emphasis on advance practice. The report identifies barriers, describes new structures and opportunities, and provides overall specific vision regarding the vital contribution of advanced practice nurses to the health care system. The Department of Veteran’s Affairs (VA), the Geisinger Health system, and Kaiser Permanente are used as examples of care delivery organizations that maximize nursing scope of practice. The transformation of the VA from a hospital-based system into a primary care focused organization is based on the maximization of nurse practitioners (NPs) as primary care providers. As a result, by 2007, VA patients experienced higher quality and significantly lower-cost care compared with similar Medicare populations. Geisinger is noted in the report as an organization that that transitioned from a high-cost, specialty-focused medical facility to an organization of high value. Geisinger’s vision includes “having staff work up to the limit of their license” and to “redistribute caregiving work to increase quality and decrease cost.” Under this model, nurses in call centers shifted to primary care sites and established relationships with patients and families, resulting in...
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...ethics and their applications (Fremgen, 2010, p. 85). Jerry McCall is Dr. Williams’s office assistant. He has received professional training as both a medical assistant and an LPN. He is handling all the phone calls while the receptionist is at lunch. A patient calls and says he must have a prescription refill for Valium and that the provider, a friend, calls in the medication prior to any flights. This type of request happens often and in slightly different scenarios, but the outcome should remain the same to avoid ethical and legal issues. This paper will review the case study to help resolve the problem, the ethics involved, and the medical responsibility to refilling a prescription without provider authorization. Qualified Medical Training Understanding the definitions of a licensed practical nurse, LPN, and a medical assistant, MA is the first step to making a factual conclusion for this case study. Support staff to the provider cannot make decisions about medication refills for patients without a direct order from the provider. This action is outside the scope of practice for an LPN or MA. Licensed Practical Nurse An LPN is a role in support of the nurse or RN, a registered Nurse usually in a skilled nursing setting such as a hospital or long-term care facility. As defined by the National Federation of Licensed Practical Nurses, NFLPN, an LPN “means the performance for compensation of authorized acts of nursing which utilize specialized knowledge and skills and...
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...The Scope of a Nurse Practitioner Tyler O. Pickens Chipola College BSN Program Abstract Advance practice nursing in the United States has evolved in to four main types of advanced practitioners: clinical nurse specialist, nurse practitioner, nurse- mid –wife, and nurse- anesthetist. As healthcare delivery systems continue to change and develop, other roles may emerge to meet future needs. Each advanced role has a distinguishable scope of practice, but knowledge and skills overlap (Blais and Hayes, p. 447). The possibilities of advancing your education in the nursing profession have countless opportunities. If given the opportunity to advance my education in the nursing profession my choice would be to become a Nursing Practitioner....
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...State University College of Nursing Question #1: You are interviewing for an advanced practice nursing position in a multi-physician practice. They have no prior experience with Advanced Practice Nurses or Nurse Practitioners. Please discuss how you might convince them to hire you. Please describe how you would benefit the practice by explaining the role, function, and limitations of a nurse practitioner. Incorporate research demonstrating the significance of the advanced practice nurse to support your position, including cost-related issues. The nurse practitioner role is one that has expanded significantly since its conception. As noted by the APRN Consensus Model, we...
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...LPN to RN Role Transition: Differences and Strategies for Success Taylor Birleffi Indiana State University LPN to RN Role Transition: Differences and Strategies for Success The Licensed Practical Nurse (LPN/LVN) role has involved certain role expectations and behaviors that are similar to the nursing roles of the Registered Nurse (RN). Although many may recognize the similar roles these two nurses have, there are various differences that exist between the two particularly those trained at the Baccalaureate level. These role differences are demonstrated through written regulations, knowledge base and practice roles, and the skills and abilities of both professional roles. Both the LPN and RN have regulations at the state level...
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...internal and external stake-holders are involved with the governance process including the State Board as well as practicing providers. Many states are now adopting the National EMS Scope of Practice which states Emergency Medical Services (EMS) of the future will be community based health management that is fully integrated with the overall health care system. The future model will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and it will be integrated with other health care providers and public health and safety agencies. It will improve community health and result in a more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net. If you read between the lines of the full document, community paramedicine will play a very important and vital role in the future of health care. With that being said, providers currently use and follow state mandated protocols that guide and govern pre-hospital treatment. Slight variation exists in regards to inter-facility, PIFT, and critical care transfers. In comparison with our current scope of practice, CP Expanded role will provide a much broader focus on primary health, public health, disease management, prevention and wellness. This will allow...
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...The readings this week discussed Milstead (2013) six case studies regarding the roles and scopes of APN’s. Case study four reflected upon Medicare and Medical Home Health Services (HHS) with regard to the APN’s scope of practice. NPP’s are all subjected to the same financial restrictions as physicians under the HHS guidelines (Center of Medicare and Medicaid Services, 2015). Chapter seven explained the Medicare policy manual and the regulations related to patient eligibility for home health services and physician certifications. Section 30.5.1.1 described the qualifications of a non-physician practitioner (NPP) for patient face-to-face encounter. The policy revised and implemented in May 2015, stated nurse practitioners, clinical nurse...
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...The Future of Nursing Practice If nurses truly “practice to the full extent of their education and training” (Institute of Medicine, 2010, p. 85), then the sky is the limit for how nurses can lead the way in developing positive changes in many different aspects of the healthcare paradigm. Although there are countless relevant literary reports on how to achieve such changes, The Institute of Medicine’s report on the Future of Nursing (2010) is held in the highest regard for the impact it could have on nursing education, nursing practice, and nursing leadership. About 55% of nurses today are prepared at a Baccalaureate Degree level (American Association of Colleges of Nursing, 2014). A key recommendation of the Future of Nursing report is to increase the number of Baccalaureate Degree prepared nurses to at least 80%. This would impact nursing education significantly, by changing the structure of the delivery of entry level nursing education, or possibly eradicating Associate’s Degree nursing programs altogether. According to Sherman (2012): Many nurses don’t realize that as part of the Bologna agreement, which was signed over a decade ago, professional nursing education in the European Union shifted to the baccalaureate level as the standard for professional licensure. Australia and New Zealand also now have BSN preparation as entry into practice. There are a number of states in the United States where there is active lobbying for legislation to require RNs to obtain a...
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...Institute of Medicine (IOM) set forth to identify how nurses could be better utilized in the health care changes occurring in the United States of America. There is an increased strain on our current health care system due to longer life spans and with more people obtaining health coverage. The number of primary care physicians is unable to increase at a rate to alleviate the need from the general population. Nurses provide a fundamental role to the doctors and the patients they serve. The nursing role has transformed throughout the profession’s lifespan. Nursing care is in a pivotal transformation in the evolving health care system. Nurses are being underutilized while demand for educated providers has increased. “While most nurses are registered nurses (RNs), more than a quarter million nurses are advanced practice registered nurses (APRNs), who have master’s or doctoral degrees and pass national certification exams.” (Institute of Medicine [IOM], 2010a, p. 2). A report from the IOM identified four recommendations to improve the role nurses play in healthcare. These recommendations expanded on nursing education, providing care to full extent of education and training; reshaping relationship between nurses and doctors; and changing policies to improve data collection and the information infrastructure. (Institute of Medicine [IOM]. 2010a). To produce enough educated nurses during World War II, a two-year associates degree of nursing was established. These schools were...
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...Nursing (AACN) is committed to advancing professional nursing roles and highlighting the connection between well-educated nurses and quality health care. As a leading supporter of academic institutions that educate advanced practice registered nurses (APRNs), AACN is keenly aware of the direct link between graduate-prepared nurses and both patient safety and positive outcomes. Within the APRN community, Clinical Nurse Specialists (CNSs) play a unique role in the delivery of high quality nursing care. These clinicians are experts in evidence-based nursing and practice in a range of specialty areas, such as oncology, pediatrics, geriatrics, psychiatric/mental health, adult health, acute/critical care, and community health among others. In addition to direct patient care, CNSs also engage in teaching, mentoring, consulting, research, management and systems improvement. Able to adapt their practice across settings, these clinicians greatly influence outcomes by providing expert consultation to all care providers and by implementing improvements in health care delivery systems. AACN supports the full definition of the Clinical Nurse Specialist outlined in the American Nurses Association’s 2004 publication titled Nursing: Scope & Standards of Practice. (See Attachment A). Further, the growing body of research on CNS outcomes shows a strong correlation between CNS interventions and safe, cost-effective patient care. CNS practice has been directly linked to reducing hospital costs and lengths...
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...Ethics Case Study Ranacia Alford HCS/335 Ruby Wesley Shadow In order to make ethical decisions in the medical office setting, everyone should have a clear understanding of their role in the practice. Knowing the scope of their work allows employees to perform their jobs better and to keep from making mistakes that could reflect badly on the liable provider. In the case study that will be discussed, Jerry, the office assistant, is asked to refill a prescription for Valium, a controlled substance, without the doctor’s presence or authorization based on the word of the patient. Does Jerry’s Medical Training Qualify Him to Issue This Refill Order? Why or Why Not? According to the case study, Jerry’s job title is Office Assistant. He has professional training as a medical assistant and a licensed practical nurse. Technically, Jerry’s medical training does qualify him to refill this order. Unfortunately, his current job title disqualifies since the doctor has neither authorized this prescription nor hired him as a nurse. Since Valium is a controlled substance and the patient stated that the doctor calls it in from time to time, there likely are no refills at the pharmacy, thus Jerry would be calling in a new prescription which is completed outside of the scope of his position. Would It Make A Difference If the Medication Was For Controlling High Blood Pressure That the Patient Critically Needs on a Daily Basis? Why or Why Not? As previously stated, Jerry’s current position does...
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...Reflection Paper One Advanced practice nursing (APN) can be loosely defined as an area of nursing in which nurses are required to practice at an advanced level in a specific area of interest. APN extends the boundaries of nursing’s scope of practice and contributes to nursing knowledge, and the development of the profession (Canadian Nurses Association, 2008). In order to become an APN, the nurse must obtain a master’s or doctoral degree from an accredited university in an area of concentration designated for advanced practice nursing. According to Joel (2009), there are currently four major groups of APNs: certified registered nurse anesthetist, certified nurse midwives, clinical nurse specialists, and nurse practitioners. APN focus on critical thinking, educating the public, diagnosing and treating illnesses, and prescribing medications to name a few. This paper will discuss the future of the nurse practitioner and how I, as a future adult-gerontology primary care nurse practitioner, will advocate for my patient population. Philosophy and Beliefs of Nurse Practitioners Due to the fact that nurse practitioner is a branch of advanced practice nursing, the two professions often share many of the same philosophic beliefs. The overall philosophy of both professions is centered on four key concepts of person, society, health and nursing; whereas, the core philosophy for nurse practitioners is that of individualized care where focus is on patients’ conditions, as well as, the...
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...Profession of Nursing Monica Soto Grand Canyon University October 17, 2013 The IOM’s recommendation on improving the delivery of care begins with the transformation of the nursing profession. The Robert Wood Johnson Foundation (RWJF) along with the Institute of Medicine (IOM) established a two year Initiative on the Future of Nursing (Institute of Medicine [IOM], 2011, p. 2). In an unprecedented partnership to explore challenges central to the future of the nursing profession. The IOM and RWJF stated that accessible, high quality care cannot be achieved without exceptional nursing care and leadership (IOM, 2011, p. 2). This paper will discuss and explore how the IOM report impacts nursing education, nursing practice, and the nurse’s leadership role. The IOM recommends entering the field of Nursing prepared with a baccalaureate degree can provide a consistent foundation. Due to the complexities of managing patient care with chronic illnesses qualified nurses will need to possess the knowledge and training of a higher level of education. The IOM recommends that hospitals have a workforce of at least 80 percent of registered nurses with a minimum of a BSN degree by the year 2020 (IOM, 2011, p. 173). Although, there still exists various modalities to entering the nursing profession without having a BSN. The goal for nurses with a diploma and associate degree are encouraged to further their education by entering a baccalaureate nursing program. The future of...
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...Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health care providers by their approach to patient care, training, and scope of practice. Nurses practice in a wide diversity of practice areas with a different scope of practice and level of prescriber authority in each. Many nurses provide care within the ordering scope of physicians, and this traditional role has come to shape the historic public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing. Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient's family and other team members, that focuses on treating illness to improve quality of life. In the U.S., advanced practice nurses, such as clinical nurse specialists and nurse practitioners, diagnose health problems and prescribe medications and other therapies, depending on individual state regulations. Nurses may help coordinate the patient care performed by other members of an interdisciplinary health care team such as therapists...
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...School of Nursing Concepts of Professional Nursing Practice BSN 306, Section 05 Anne Johnston-Silverberg, MS, FNPc September 14, 2012 The Affordable Care Act: The Role of the Nurse Practitioner The recent implementation of the Affordable Care Act (ACA) has had a significant impact on the American health care delivery systems. The passage of this bill mandates that all Americans must have health care coverage and that insurance companies cannot disqualify applicants due to preexisting conditions (National Council of State Boards of Nursing, 2014). These changes will undoubtedly lead to an increase in the number of people seeking medical care, particularly those with chronic diseases. It is estimated that this influx in the number of patients will result in a primary care provider shortage of 20% by the year 2025 (Poghosyan, Boyd & Knutson, 2014). With many new physicians choosing to pursue specialties due to the promise of a larger salary, hospitals and clinics will need to start looking to other health care providers, such as nurse practitioners, to fill this role. The purpose of this paper is to discuss the role nurse practitioners play with regards to the Affordable Care Act by examining the history and qualifications of nurse practitioners, the current practice of nurse practitioners, the basics of the Affordable Care Act legislation, and potential nursing challenges. History of Nurse Practitioners The role of the modern day nurse practitioner emerged in the late...
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