South University: NSG 5000 Role of the Advanced Practice Nurse Week 5 project,100% CORRECT

South University: NSG 5000 Role of the Advanced Practice Nurse Week 5 project Role of the Advanced Practice Nurse South University Role of the Advanced Practice Nurse NSG 5000 Role of the Advanced Practice Nurse The advanced practice nurse is a vital part of the future of health care. Advanced practice nurses can fill many roles in nursing and healthcare. APRN’s are researchers, educators, administrators, involved in policy and legislature, and provide direct patient care. Advanced Practice Roles in Nursing An advanced practice nurse is a nurse with a Master of Science degree or higher that provides direct patient care to individuals and families. There are four advance practice nurse roles that are recognized: certified registered nurse anesthetist or CRNA, nurse practitioner or NP, clinical nurse specialist or CNP and certified nurse midwife or CNM. Advanced nursing practice is a general term for the various specialties in nursing (Hamric, Hanson, Tracy, & O’Grady, 2014). This paper will discuss the Master of Science in Nursing with a specialization in Family Nurse Practitioner (MSN-FNP) also referred to as an Advanced Practice Registered Nurse (APRN). A family nurse practitioner performs a variety services such as performing H&P’s; diagnosis, treatment, and management of disease; prescribing medications; educate patients about prevention of disease and health promotion; and performs some procedures. The nurse practitioner is required to have a minimum of a Master of Science degree, pass her state board and depending on the state in which she is licensed provide proof of a certain number of continuing education hours (US National Library of Medicine National Institutes of Health website, 2019) The role of family practitioner as an advanced practice nurse is a clinical role in patient care. The American Association of Nurse Practitioners’ state NPs are an important part of the health care system because they lower the cost of health care, increase patient satisfaction and addresses the primary care shortage (American Association of Nurse Practitioners website, 2019). A mixed method study outcomes of patients who used nurse practitioners was reported by patients as an improvement in care provided; the connections between the practitioners and the practice including teamwork were identified as an increase in quality; the accessibility the patients had to the practice was recorded as having a definite increase; the practices were recognized by several individuals as having become more linked or associated with their locality; and the implementation of acute care services dramatically declined for the patients of the practices (Roots & MacDonald, 2014). This study used case studies and collected data from interviews prior and post the utilization of the nurse practitioner at three rural fee-for-service practices. Family Nurse Practitioner A nurse practitioner is an advanced practice nurse that attends to all facets in caring for patients. This includes diagnosis, treatments and consultations. Family nurse practitioners educate patients about preventative care and prescribed treatments. Family nurse practitioners perform physicals, order tests and serve as a patient's primary healthcare provider. Nurse practitioners may also prescribe medications. Primary care nurse practitioners work in family health clinics or hospitals. They provide general and preventative care, conduct check-ups, treat illnesses, order lab tests and prescribe medication for children and adults (Hospital Authority of Miller County website, 2019). The person interviewed for this paper was Stephanie Phillips, FNP-C. She is a primary care provider at the local clinic. Miller County Medical Center, the facility Stephanie is employed, provides medical care to pediatrics and adults, including women's health. The facility employees two medical doctors, one doctor of osteopathy, and two family nurse practitioners. The three physicians round at the hospital, and two nursing homes in addition to seeing patients in the clinic. The physicians average five to seven patients daily at the clinic. The two nurse practitioners average 25-30 patients per day. The population for the county the clinic serves is 6,125 (69% white, 27% black, 1% other). The population consists of 53% female and 47% male. Of those, only 13% of the citizens are 60 years of age or older (United States Census Bureau website, 2018). Interview The interview was conduction on January 30, 2018 with Stephanie Phillips, FNP-C. Stephanie went to college at the University of Georgia immediately following high school. Initially, Stephanie was not sure of her major. Stephanie’s mother and step-father are both registered nurses. After spending two and a half years at the University of Georgia she transferred to Albany State University where she obtained her Bachelor of Science in nursing. The University of Georgia does not offer a degree in nursing. After graduation she began her nursing career working night shift on the medical-surgical unit at a thirty-two-bed rural hospital. With one year of nursing behind her, Stephanie began her Master of Science in nursing at Columbus State University. She continued to work full-time those the three years while obtaining her FNP. After graduation, she was hired as a family nurse practitioner providing primary care at the local clinic that is owned by the hospital where she was employed. Stephanie continues to work at the same facility where she was initially employed twelve years ago. Stephanie worked on the medical surgical floor for four years and has been an FNP at the local clinic for twelve years. Stephanie also took a national certification exam in adult health. This allows Stephanie to use the credentials FNP-C. Stephanie feels it was beneficial working as a floor nurse and charge nurse on the medical surgical unit prior to becoming a family nurse practitioner. Stephanie states those four years is where she learned “how to be a nurse” and thinks all advanced practice nurses need the experience of hands on patient care prior to entering the master’s program. Floor nursing is where she applied the knowledge she obtained in nursing school. Stephanie is licensed in Georgia. Georgia Board of Nursing requires registered nurses and advanced practice registered nurses to renew their license every two years. The nurse much submit proof of 30 contact hours of continuing education with each license renewal. She is a member of the American Academy of Nurse Practitioners and the Georgia Nurses Association. She feels being a member of a professional organization assists her to in staying up to date on current affairs, political and otherwise, related to nursing in Georgia and nationwide. In addition, it also has the added perk of a discount on her automobile insurance. Stephanie sees 25-30 patients per day of all ages. Most of her patients are adults, and many of those are age fifty and older. These patients are seen for routine exams for hypertension, diabetes, and hypothyroidism. The other common diagnoses are CHF and COPD. Stephanie does not know the economic level of her patients, it is not needed to treat her patients. She would guess given the demographics of the area that most are either average to below average income. She states has not paid attention to race, but she would guess that her patient population is 50-50 white/black (this contradicts the white/black ratio obtained from the US Census for the area). The organization that employs Stephanie does not have any extra restrictions in addition the requirements set forth by the state. Stephanie has prescriptive authority. As an APRN she submitted a nurse protocol agreement to the Georgia Medical Board. She then submitted an application to the DEA showing proof of her submission to the Medical Board and a letter stating the Medical Board reviewed her protocol. This allows Stephanie to write her own prescriptions including controlled substances schedule III-V without a physician co-signature (Georgia Medical Board website, 2019). While working as an FNP-C, Stephanie has had many ethical situations to occur. She states it comes with the territory. One ethical dilemma that stand out in her mind is the withholding a diagnosis from a patient. She had an elderly dementia patient that was diagnosed with lymphoma. The patient’s daughter was her designated medical surrogate. The daughter explained that she did not want to tell her mother about her diagnosis of lymphoma. She stated that due to the dementia, her mother would forget about her diagnosis and every time she is told, it’s as if it’s the first time being told. Her mother would go through the myriad of shock, grief and depression repeatedly. Stephanie stated, initially she felt the patient had the right to be informed of her diagnosis. After the daughter explained her reasoning and assessing the patient, Stephanie agreed with the daughter. In addition, Stephanie was complying with the wishes of the person in charge of the patient’s medical care. When asked, Stephanie stated she truly enjoys being a primary care FNP at the local clinic in the town she was raised. She looks forward to going to work every day and could not imagine doing anything else (S. Phillips, personal communication, January 30, 2019). Interview Questions 1. Please give a brief description of your educational background. Did you start as and LPN and continue your education up to the master’s level or did you start your education as an BSN? 2. What areas of nursing have you worked as you progressed with your degree? 3. What areas of healthcare have you worked as a nurse practitioner? 4. Do you feel you benefitted from working (x) years as an LPN, RN, BSN (whichever applies from previous answer) prior to completing your MSN? 5. Do you have to provide proof of continuing education hours to your state board when renewing your license? If so, how many hours are required? 6. What type of patients do you see daily? Do you see a larger number of a certain age population, economic level or health diagnosis? 7. Do your organization have any restrictions in addition to state restrictions regarding nurse practitioners? 8. Have you ever experienced an ethical dilemma? Can you describe it? Were you pleased with how you handled it? Would you have handled it any differently? (Please provide information so faculty, patients, etc. are not identifiable). 9. Are you a member of a professional organization? Why or why not? 10. Do you enjoy what you do? 11. If you could do anything different with your FNP, what would it be? Qualifications and Scope of Practice A family nurse practitioner in the state of Georgia is an advanced practice registered nurse. She must hold a registered nurse license and earn a national certification through an approved certifying agency. There are several organizations that are approved by the Georgia Board of Nursing. The list of the organizations can be found on their website. Advanced practice registered nurses renew their license every two years and must show proof of a minimum of 30 contact hours of continuing education. Georgia has recently become a member of the enhanced Nurse Licensure Compact, eNLC. To receive a multistate license in the eNLC, a nurse must meet the home state’s qualifications, graduate from a board of nursing-approved nursing education program, pass the NCLEX, have no active discipline on their license, submit to a criminal background check, have no prior state or federal felony convictions and have a valid Social Security number (Georgia Board of Nursing website, 2019). A nurse practitioner must have a written protocol between her and a supervising physician. The protocol specifically defines medical acts that are delegated to the physician and which acts require immediate consultation with the physician. A nurse practitioner in the state of Georgia can write prescriptions for schedule III-V controlled substance with a written protocol reviewed by the Medical Board and submitted to the DEA. Nurse Practitioner are not explicitly recognized in Georgia state policy as primary care providers (Georgia Scope of Practice Policy, 2019). Leadership Attributes This writer believes that her style of leadership is Leadership Trait Theory and the Democratic Leadership of Behavior Theory combination. This writer believes that she possesses many of the distinguishing features depicted by a good leader. She functions easily with others, has efficient oral skills, confronts conflict head on, feels gratified by ruminating resplendence of others’ achievements, congratulates and enjoys the success of others, and exhibits empathy (Weberg, Mangold, Porter-O’Grady, & Mallock, 2019). An example where this writer used the combined leadership styles is when she integrated using a variety of forms when asking for medical records from other facilities prior to accepting a patient to the Swing Bed program. Initially, this writer went to each department and requested information that department manager felt would be the most important in providing the best care. The writer took this information and condensed it to develop transfer forms. The respiratory report form is a simple form This is an easy form for the transferring facility to complete. It has vital information available for the respiratory therapist at a glance including the person’s name, title and contact number who completes the form. To better one’s own self is to have the accumulated knowledge to recognize one’s own shortcomings and purposely act on bettering those shortcomings. Maslow believed that people are “innately motivated toward psychological growth, self-awareness, and personal freedom” (Black, 2014, p. 44). This writer believes that her philosophy of leadership involves encouraging accomplishments, and admirable qualities of others while continuing to encourage advancement. Family Nurse Practitioner Reimbursement Currently Medicare reimbursement for family nurse practitioners is 85% for the same health care that medical doctors receive at 100% reimbursement. According to the Centers for Medicare and Medicaid Services (CMS), nurse practitioners can see patients in any setting, without a physician being present. The physician is not required to see the patient, only available by phone according to each state’s scope of practice guidelines (Centers for Medicare and Medicaid Services website, 2019). “This biased, inequitable payment system sometimes leads to questionable provider billing. Even worse, nurse practitioner outcome data are almost always obscured because their services are hidden under the higher-paid physicians’ provider numbers so a private practice or hospital can collect the maximum payment”(National Association of Pediatric Nurse Practitioners, 2018, para. 3). Organizations such as American Nurses Association and American Academy of Nurse Practitioners are advocates for nursing policy and politics. One way this writer can assist is by being a member of each organization. This writer is already a member of the ANA and plans to become a member of the AANP. Conclusion The advanced practice registered nurse impacts healthcare by improving patient outcomes. The increase in nurse practitioners will make access to rural and medically underserved areas more available to this patient population. Nurse practitioners are still nurses and will always be patient advocates. With continued support from national organizations, advanced practice nurses may be granted the autonomy and reimbursement of physicians for the same services provided. References American Association of Nurse Practitioners website. (2019). Black, B. P. (2014). Professional nursing: Concepts and challenges (7th ed.). St. Louis, Missouri: Elsevier Saunders. Centers for Medicare and Medicaid Services website. (2019). Georgia Board of Nursing website. (2019). Georgia Medical Board website. (2019). Georgia Scope of Practice Policy. (2019). Hamric, A., Hanson, C., Tracy, M. F., & O’Grady, E. (2014). Advanced practice nursing: An integrative approach (5th ed.). St. Louis, MO: Elsevier Saunders. Hospital Authority of Miller County website. (2019). National Association of Pediatric Nurse Practitioners. (2018). Roots, A., & MacDonald, M. (2014, December). Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: A mixed methods study. Human resources for health, 12(69), 1-11. United States Census Bureau website. (2018). US National Library of Medicine National Institutes of Health website. (2019). Weberg, D., Mangold, K., Porter-O’Grady, T., & Mallock, K. (2019). Leadership in nursing practice: Changing the landscape of healthcare (9th ed.). Burlington, MA: Jones & Bartlett Learning.