N
CERTIFICATION TEST WITH Q&A
100% GUARANTEED{UPDATED
VERSION}
cope of Practice
S
Based on legal allowances in each state, individual state nurse practice acts providing
guidelines for nursing practice
Key elements of the NP role include
integration of care across the acute illness continuum with collaboration and
coordination of care; research based clinical practices, clinical leadership, family
assessment, and discharge planning
Standards of Advanced Practice are delineated by...
American Nurses Association which measure quality of practice, service, or education
State Practice Acts
Authorize Boards of Nursing in each state to establish statutory authority for licensure of
RNs
State Practice Acts - authority includes:
use of title, authorization for scope of practice including prescriptive authority, and
disciplinary grounds
States vary in practice requirements, such as
certification
Prescriptive authority
Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain..
registration numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass...
required education, licensure and certification to practice as an NP
Credentials establish...
minimal levels of acceptable performance
Credentialing is necessary to:
ensure that safe healthcare is provided by qualified individuals; comply with federal and
state laws r/t APN
Credentials also...
, cknowledges the scope of practice of NP, mandates accountability, enforces
a
professional standards for practice
Licensure
establishes that a person is qualified to perform in a particular professional role
Licensure is granted as defined by rules and regulations set forth by
a governmental regulatory body (ie. state board of nursing)
Certification
Person has met certain standards that signify mastery of specialized knowledge
Certification is granted by nongovernmental agencies such as
ANCC, AANP
Admitting privileges to hospitals (non physican) were granted
1983 by JC
Credentialing and privileging
process which an NP is granted permission to practice in an inpt setting
Credentialing with hospital privileges is granted by a
Hospital Credentialing Committee
Pt Medical Abandoment
When caregiver-pt relationship is terminated w/o making reasonable arrangements w an
appropriate person so that care can be continued
Determination of pt abandonment depends on factors such as:
Whether NP accepted pt assignment, whether NP provided reasonable notice before
termination, whether reasonable arrangements could have been made
Following do not constitute pt abandonment
NP refuses to accept responsibility for pt assignment when NP has given reasonable
notice to proper authority that NP lacks competence to carry out assignment; NP
refuses assignment of a double shift or addtl hrs beyond posted work schedule when
proper notification has been given..latter phrase can be controversial
Risk Mgmt
Systematic effort to reduce risk begins w formal written risk mgmt plan that includes:
organizations goals, delineation of program's scope, components, methods; delegating
responsibility for implementation and enforcement; demonstrating commitment by the
board; confidentiality and immunity from retaliation for those who report sensitive info
Most common method of documentation for risk mgmt
incident reports
Policies regarding incident reports should address:
ppl authorized to complete report; ppl responsible for review of a report, immediate
actions needed to minimize the effects of the event; ppl responsible for follow up; plan
for monitoring aftermath; security/storage of completed report
Risk mgmt - Satisfaction surveys
,Important for identifying problems before they develop into incidents or claims; for pts
and employees
Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and
managing complaints by clearly identifying:
ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for
monitoring follow up
Action taking initiatives:
Prevention, correction (corrective steps must be monitored and audited),
documentation, education, departmental coordination
Medical Futility
Interventions that are unlikely to produce significant benefit for pt - "Does the
intervention have any reasonable prospect of helping this pt?"
Two kind of medical futility:
Quantitative futility: likelihood that intervention will benefit pt is extremely poor
Qualitative futility: quality of benefit an intervention will produce is extremely poor
Informed consent - competence (decisional capability)
state that pt is able to make personal decisions about their care
competence implies that ability to:
understand, reason, differentiate good and bad, and communicate
informed consent
pt has received adequate instruction or info regarding aspects of care to make prudent,
personal choice regarding such tx
Informed consent includes:
discussing benefits and risk
consent is assumed if...
pt's condition is life threatening
Danforth Amendment 1991
pts are informed at time of admission to federally funded institution (such as hospital,
nursing home, hospice, HMO, etc) that they have the right to refuse care as long as the
pt has decisional capability (competence)
Ethics
study of moral conduct and behavior protecting the rights of an individual
1st priority is the
most salvagable pts. Most critically injured cared for last.
Key ethical principles are:
nonmaleficence, utilitarianism, beneficence, justice, fidelity, veracity, autonomy
Nonmaleficence
duty to do no harm
Utilitarianism
the right act is the one that produces the greatest good for the greatest number
, eneficence
B
duty to prevent harm and promote good
Justice
duty to be fair
Fidelity
duty to be faithful
Veracity
duty to be truthful (tends to be in conflict with fidelity)
Autonomy
duty to respect an individual's thoughts and actions (tend to be in conflict with
beneficence)
Dismissing/discharging a pt or closing practice
NP cannot withdraw from caring for a pt without notification
Examples of reasons for discharging a pt from practice:
abuse, refusal to pay, persistent non-adherence to care
Steps for discharging a pt from practice:
send a certified letter with return receipt (copy for chart), provide general healthcare
coverage for 1st 15-30 days post termination deadline, obtain release of info to provide
copies of all needed records for next care provider
Obligations in closing practice d/t relocation, retirement
give pt adequate time to find another provider, keep all files for min 5 years, provide
timely notification and names of other providers and resources for future care
Role of NP developed in the early...
1960s as a result of physician shortages in the area of peds
First NP program was peds, begun in...
1964 by Dr. Loretta Ford and Dr. Henry Silver at CU Health Sciences mainly focusing on
ambulatory and outpt care
Historical service of NPs in primary care resulted in part from the...
availability of federal funding for preventive and primary care NP education
Movement of NPs expanded to the...
inpt setting as a result of managed care, hospital restructuring, and decreases in
medical residency programs
4 distinct roles for NPs:
clinician, consultant/collaborator, educator, researcher
Crisis/Acute Grief Communication
Acknowledge feelings
Offer self
Crisis Intervention
Boundaries
Security if necessary, NOT police