NP-NR 508 -Pharm Midterm Outline + chart

Midterm Outline Chapter 1: The Role of the Advanced Practice Nurse as Prescriber Roles and responsibilities of APRN prescribers: APRNs exist in a range of practices and include certified RN anesthetists, certified nurse midwives, and others whose title includes the words nurse practitioner or advanced practice registered nurse. The responsibility for the final decision on which drug to use and how to use it is in the hands of the APRN prescriber. The degree of autonomy in this role and the breadth of drugs that can be prescribed vary from state to state based on the nurse practice act of that state. Every year, the January issue of the Nurse Practitioner journal and an issue of the American Journal for Nurse Practitioners present a legislative update providing a summary of each state's practice acts as they relate to titling, roles, and prescriptive authority. As of January 2015, the following were true of NP regulation of practice and prescribing authority: • All states have title protection for NPs. • Only Oregon has mandated third-party reimbursement parity for NP services. • In all but five states, the control of practice and licensure is within the sole authority of the state's board of nursing. These five states have joint control in the board of nursing and the board of medicine. • Scope of practice is determined by the individual NP's license under the nurse practice act of the licensing jurisdiction. Some have a graduated scope based on experience level. New prescribers need to understand that their employment sites may restrict this legal scope of practice but cannot extend it. • In 17 states and the District of Columbia, NPs have independent scope of practice and prescriptive authority without a requirement or attestation for physician collaboration, consultation, delegation, or supervision. • Six states have full autonomous practice and prescriptive authority following a period of postlicensure/postcertification supervision or collaboration. The 2010 Institute of Medicine's publication Future of Nursing: Leading Change, Advancing Health called for removing scope of practice barriers and allowing NPs to practice to the full extent of their education and training. Many states are responding to this call, with the expectation that the above list will be significantly modified in years to come. Clinical judgement in Prescribing: Prescribing a drug results from clinical judgment based on a thorough assessment of the patient and the patient's environment, the determination of medical and nursing diagnoses, a review of potential alternative therapies, and specific knowledge about the drug chosen and the disease process it is designed to treat. In general, the best therapy is the least invasive, least expensive, and least likely to cause adverse reactions. Frequently, the best choice is to have lifestyle, nonpharmacological, and pharmacological therapies working together. When the choice of treatment options is a drug, several questions arise. Collaboration with other providers: No one member of the health-care team can provide highquality care without collaborating with other team members. They most often collaborate w