NUR 5350 ROLES FINAL QUESTIONS WITH VERIFIED
ANSWERS
1. What are the 4 settings for prescriptive authority? Describe the requirements in each
setting for physician supervision, # of NPs, chart review, and any other special
requirements in that site. - Answers - 1. Medically Underserved
2. Physician Primary Site
3. Physician Alternate Site
4. Facility Based Practice Site.
* General requirements per TBON rule 222.5: regular visits, chart review as determined
by APRN & physician, periodic face to face meeting of APRN & physician to discuss pt
care & improvement.
1a) Medically Underserved - Answers - *site must be official, physician must be
reachable by phone & must be provided with daily status report of any major problems
outside of the protocol.
*must have protocols.
1b) Physician Primary Practice Site - Answers - * Must have protocols.
*Sign drug orders only for pts whom the MD has/will establish a relationship.
*alternate MD may delegate.
*MD may delegate to no more than 7 APNS or PAs.
*Physician on-site visits should be 50% of the time according to BME.
1c) Facility Based Practice - Answers - *Must be physically present in facility (hospital or
long term facility).
*Physician must give prior consent.
*Delegation only at > one hospital or > 2 long term care facilities - now it is 7 FTEs.
*Long term care-only 4 APNs (APRNs) or 4 PAs or their FTE equivalent - now it is 7
FTE & approved by Chief Physician of Facility.
*Protocol signed by the Chief Physician.
1d) Physician Alternate Site - Answers - *No longer in effect.
2. The FOUR Approved Categories of APN in TX? - Answers - *CRNA, NP, CNS, and
CNM
3. NP requirements by BON for approval of license/ AP recognition each biennium. -
Answers - *Current valid RN licensure.
*400 hours of current clinical practice.
*20 hours of CEs.
*8 hours of continuing education in pharmacotherapeutics.
*Current board certification.
,*Separate application for dual roles.
4. New NP graduate requirements when applying for the board? - Answers - *Must take
and pass national certification exam.
5. What is the NP's scope of practice based on? - Answers - *Nurse practice acts define
legal scope of practice for licensed practitioners.
*Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement.
11. What are clinical privileges and how are they obtained? - Answers - *autonomy to
perform expanded role functions based on the individuals licensure, educational
preparation, clinical experience, and credentials.
*Via contractual agreement with hospitals or long term care facilities.
12. Define Malpractice - Answers - *Any professional misconduct, unreasonable lack of
skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct.
*Negligence is the failure of an individual to do something that a reasonable person
would do, that results in injury to another.
*The alleged failure on the part of a professional to render services with the degree of
care, diligence, and precaution that another member of the same profession in similar
circumstances would render to prevent injury to some one else.
13. FOUR Elements of Malpractice - Answers - 1. Duty: provide some level of care, had
some contact.
2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in
similar practice.
3. Damage: Must have an injury or no malpractice even if violated standard of care; cap
"pain and suffering" $250,000 to $500, 000.
4. Causation of Injury: For malpractice to have occurred, a breach of the standard of
care must have caused an injury to the patient.
15. National Practitioner Data Bank - Answers - *Receives and discloses the reports on
medical malpractice.
Who is credited to be the first advanced practice nurse role? - Answers - Nurse
Anesthesia in 1800's- perhaps the oldest advanced nursing specialty, Sister Mary
Bernard at St. Vincent's Hospital was the first anesthetist
Who is credited to be the founder of the first nurse practitioner role? - Answers - Loretta
Ford-1965- Colorado
Who is (are) the oldest primary care providers in the history of advanced practice
nurses? - Answers - Midwifes in 1700's- perhaps the oldest primary health care provider
Martha Bullard, 1785 is the oldest noted in publication
, What are the roles of APRNs? How are they different from each other? - Answers - To
provide health care to individuals, family, groups in a variety of health care settings
(homes, hospitals, institutions, offices, clinics, etc)
APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist
What states are responsible for being the first to have advanced practice language in
their nurse practice act? - Answers - Idaho (language read- "assess, diagnose, treat")
What is NONPF? What is their influence for APRNs? - Answers - National Organization
of Nurse Practitioner Faculty
They have developed domains and competencies
Organized role competencies (policy, ethics, quality, leadership, etc)
How is the NP role different from PA role? - Answers - •PA's work directly under a MD,
NP's can function independently
•NP's focus on multiple practice and nursing models
•PA's focus on medical tasks utilizing a medical framework
What are the key elements of OTA, Brown, Safriet and Mundinger - Answers - • OTA
NP's provide equivalent care to MD's.
Patients who receive care form an NP show decreased patient symptoms.
• Brown
Patient satisfaction and resolution of pathological conditions were greater for NP's over
MD's
NM's use less technology/ analgesia
NM's achieved equivalent neonatal outcomes
• Safreit
There is abundant data on the NP role in providing high quality, cost effective care/
There are major restrictions on the practice of NP's and these barriers should be
removed.
• Mundinger
Compared outcomes in patients who were randomly assigned to either NP's or MD's.
Results showed that patient outcomes were comparable.
How does the Texas Board of Nursing define the NP role? - Answers - A RN approved
by the board to practice as an APN based on completing an advanced education
practice program acceptable by the board. The term includes an NP, nurse midwife,
nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded role to
provide health care to individuals, families, and/or groups in a variety of settings
including but not limited to homes, hospitals, institutions, offices, industry, schools,
community agencies, public/private clinics and private practice. The APN acts
independently and/or in collaboration with other health care professionals in the delivery
of health care services.
Where and when did the role first begin? - Answers - 1965- University of Colorado-PNP
ANSWERS
1. What are the 4 settings for prescriptive authority? Describe the requirements in each
setting for physician supervision, # of NPs, chart review, and any other special
requirements in that site. - Answers - 1. Medically Underserved
2. Physician Primary Site
3. Physician Alternate Site
4. Facility Based Practice Site.
* General requirements per TBON rule 222.5: regular visits, chart review as determined
by APRN & physician, periodic face to face meeting of APRN & physician to discuss pt
care & improvement.
1a) Medically Underserved - Answers - *site must be official, physician must be
reachable by phone & must be provided with daily status report of any major problems
outside of the protocol.
*must have protocols.
1b) Physician Primary Practice Site - Answers - * Must have protocols.
*Sign drug orders only for pts whom the MD has/will establish a relationship.
*alternate MD may delegate.
*MD may delegate to no more than 7 APNS or PAs.
*Physician on-site visits should be 50% of the time according to BME.
1c) Facility Based Practice - Answers - *Must be physically present in facility (hospital or
long term facility).
*Physician must give prior consent.
*Delegation only at > one hospital or > 2 long term care facilities - now it is 7 FTEs.
*Long term care-only 4 APNs (APRNs) or 4 PAs or their FTE equivalent - now it is 7
FTE & approved by Chief Physician of Facility.
*Protocol signed by the Chief Physician.
1d) Physician Alternate Site - Answers - *No longer in effect.
2. The FOUR Approved Categories of APN in TX? - Answers - *CRNA, NP, CNS, and
CNM
3. NP requirements by BON for approval of license/ AP recognition each biennium. -
Answers - *Current valid RN licensure.
*400 hours of current clinical practice.
*20 hours of CEs.
*8 hours of continuing education in pharmacotherapeutics.
*Current board certification.
,*Separate application for dual roles.
4. New NP graduate requirements when applying for the board? - Answers - *Must take
and pass national certification exam.
5. What is the NP's scope of practice based on? - Answers - *Nurse practice acts define
legal scope of practice for licensed practitioners.
*Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement.
11. What are clinical privileges and how are they obtained? - Answers - *autonomy to
perform expanded role functions based on the individuals licensure, educational
preparation, clinical experience, and credentials.
*Via contractual agreement with hospitals or long term care facilities.
12. Define Malpractice - Answers - *Any professional misconduct, unreasonable lack of
skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct.
*Negligence is the failure of an individual to do something that a reasonable person
would do, that results in injury to another.
*The alleged failure on the part of a professional to render services with the degree of
care, diligence, and precaution that another member of the same profession in similar
circumstances would render to prevent injury to some one else.
13. FOUR Elements of Malpractice - Answers - 1. Duty: provide some level of care, had
some contact.
2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in
similar practice.
3. Damage: Must have an injury or no malpractice even if violated standard of care; cap
"pain and suffering" $250,000 to $500, 000.
4. Causation of Injury: For malpractice to have occurred, a breach of the standard of
care must have caused an injury to the patient.
15. National Practitioner Data Bank - Answers - *Receives and discloses the reports on
medical malpractice.
Who is credited to be the first advanced practice nurse role? - Answers - Nurse
Anesthesia in 1800's- perhaps the oldest advanced nursing specialty, Sister Mary
Bernard at St. Vincent's Hospital was the first anesthetist
Who is credited to be the founder of the first nurse practitioner role? - Answers - Loretta
Ford-1965- Colorado
Who is (are) the oldest primary care providers in the history of advanced practice
nurses? - Answers - Midwifes in 1700's- perhaps the oldest primary health care provider
Martha Bullard, 1785 is the oldest noted in publication
, What are the roles of APRNs? How are they different from each other? - Answers - To
provide health care to individuals, family, groups in a variety of health care settings
(homes, hospitals, institutions, offices, clinics, etc)
APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist
What states are responsible for being the first to have advanced practice language in
their nurse practice act? - Answers - Idaho (language read- "assess, diagnose, treat")
What is NONPF? What is their influence for APRNs? - Answers - National Organization
of Nurse Practitioner Faculty
They have developed domains and competencies
Organized role competencies (policy, ethics, quality, leadership, etc)
How is the NP role different from PA role? - Answers - •PA's work directly under a MD,
NP's can function independently
•NP's focus on multiple practice and nursing models
•PA's focus on medical tasks utilizing a medical framework
What are the key elements of OTA, Brown, Safriet and Mundinger - Answers - • OTA
NP's provide equivalent care to MD's.
Patients who receive care form an NP show decreased patient symptoms.
• Brown
Patient satisfaction and resolution of pathological conditions were greater for NP's over
MD's
NM's use less technology/ analgesia
NM's achieved equivalent neonatal outcomes
• Safreit
There is abundant data on the NP role in providing high quality, cost effective care/
There are major restrictions on the practice of NP's and these barriers should be
removed.
• Mundinger
Compared outcomes in patients who were randomly assigned to either NP's or MD's.
Results showed that patient outcomes were comparable.
How does the Texas Board of Nursing define the NP role? - Answers - A RN approved
by the board to practice as an APN based on completing an advanced education
practice program acceptable by the board. The term includes an NP, nurse midwife,
nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded role to
provide health care to individuals, families, and/or groups in a variety of settings
including but not limited to homes, hospitals, institutions, offices, industry, schools,
community agencies, public/private clinics and private practice. The APN acts
independently and/or in collaboration with other health care professionals in the delivery
of health care services.
Where and when did the role first begin? - Answers - 1965- University of Colorado-PNP
