N5350 ROLES FINAL STUDY GUIDE
1.poWhatpoarepothepo4posettingspoforpoprescriptivepoauthority?
poDescribepotheporequirementspoinpoeachposettingpoforpophysicianposupervision,po#poofpoN
Ps,pochartporeview,poandpoanypootherpospecialporequirementspoinpothatposite.po-poans--
1.poMedicallypoUnderserved
2.poPhysicianpoPrimarypoSite
3.poPhysicianpoAlternatepoSite
4.poFacilitypoBasedpoPracticepoSite.
*poGeneralporequirementspoperpoTBONporulepo222.5:poregularpovisits,pochartporeviewpoasp
odeterminedpobypoAPRNpo&pophysician,poperiodicpofacepotopofacepomeetingpoofpoAPRNpo
&pophysicianpotopodiscusspoptpocarepo&poimprovement.
1a)poMedicallypoUnderservedpo-poans--
*sitepomustpobepoofficial,pophysicianpomustpobeporeachablepobypophonepo&pomustpobepopr
ovidedpowithpodailypostatusporeportpoofpoanypomajorpoproblemspooutsidepoofpothepoprotoco
l.po
*mustpohavepoprotocols.
1b)poPhysicianpoPrimarypoPracticepoSitepo-poans--*poMustpohavepoprotocols.
*SignpodrugpoorderspoonlypoforpoptspowhompothepoMDpohas/
willpoestablishpoaporelationship.
*alternatepoMDpomaypodelegate.
*MDpomaypodelegatepotoponopomorepothanpo7poAPNSpoorpoPAs.
*Physicianpoon-sitepovisitsposhouldpobepo50%poofpothepotimepoaccordingpotopoBME.
1c)poFacilitypoBasedpoPracticepo-poans--
*Mustpobepophysicallypopresentpoinpofacilitypo(hospitalpoorpolongpotermpofacility).
*Physicianpomustpogivepopriorpoconsent.
*Delegationpoonlypoatpo>poonepohospitalpoorpo>po2polongpotermpocarepofacilitiespo-
ponowpoitpoispo7poFTEs.
*Longpotermpocare-onlypo4poAPNspo(APRNs)poorpo4poPAspoorpotheirpoFTEpoequivalentpo-
ponowpoitpoispo7poFTEpo&poapprovedpobypoChiefpoPhysicianpoofpoFacility.
*ProtocolposignedpobypothepoChiefpoPhysician.
1d)poPhysicianpoAlternatepoSitepo-poans--*Nopolongerpoinpoeffect.
2.poThepoFOURpoApprovedpoCategoriespoofpoAPNpoinpoTX?po-poans--
*CRNA,poNP,poCNS,poandpoCNM
,3.poNPporequirementspobypoBONpoforpoapprovalpoofpolicense/
poAPporecognitionpoeachpobiennium.po-poans--*CurrentpovalidpoRNpolicensure.
*400pohourspoofpocurrentpoclinicalpopractice.
*20pohourspoofpoCEs.
*8pohourspoofpocontinuingpoeducationpoinpopharmacotherapeutics.
*Currentpoboardpocertification.
*Separatepoapplicationpoforpodualporoles.
4.poNewpoNPpograduateporequirementspowhenpoapplyingpoforpothepoboard?po-poans--
*Mustpotakepoandpopassponationalpocertificationpoexam.
5.poWhatpoispothepoNP'sposcopepoofpopracticepobasedpoon?po-poans--
*Nursepopracticepoactspodefinepolegalposcopepoofpopracticepoforpolicensedpopractitioners.
*Includespoprivilegespoforpodiagnosis,potreatment,poprescriptivepoauthoritypoandporeimburs
ement.
11.poWhatpoarepoclinicalpoprivilegespoandpohowpoarepotheypoobtained?po-poans--
*autonomypotopoperformpoexpandedporolepofunctionspobasedpoonpothepoindividualspolicen
sure,poeducationalpopreparation,poclinicalpoexperience,poandpocredentials.
*Viapocontractualpoagreementpowithpohospitalspoorpolongpotermpocarepofacilities.
12.poDefinepoMalpracticepo-poans--
*Anypoprofessionalpomisconduct,pounreasonablepolackpoofposkill,poorpoinfidelitypoinpoprofes
sionalpoorpofiduciarypoduties,poorpoillegalpoorpoimmoralpoconduct.
*Negligencepoispothepofailurepoofpoanpoindividualpotopodoposomethingpothatpoaporeasonable
popersonpowouldpodo,pothatporesultspoinpoinjurypotopoanother.
*Thepoallegedpofailurepoonpothepopartpoofpoapoprofessionalpotoporenderposervicespowithpoth
epodegreepoofpocare,podiligence,poandpoprecautionpothatpoanotherpomemberpoofpotheposa
mepoprofessionpoinposimilarpocircumstancespowouldporenderpotopopreventpoinjurypotoposo
mepoonepoelse.
13.poFOURpoElementspoofpoMalpracticepo-poans--
1.poDuty:poprovideposomepolevelpoofpocare,pohadposomepocontact.
2.poDereliction:poreasonable,poordinarypocare,poskillpoandpodiligencepoaspoNP'spoinpogoodp
ostandingpoinposimilarpopractice.
3.poDamage:poMustpohavepoanpoinjurypoorponopomalpracticepoevenpoifpoviolatedpostandard
poofpocare;pocappo"painpoandposuffering"po$250,000potopo$500,po000.
4.poCausationpoofpoInjury:poForpomalpracticepotopohavepooccurred,poapobreachpoofpothepost
andardpoofpocarepomustpohavepocausedpoanpoinjurypotopothepopatient.
15.poNationalpoPractitionerpoDatapoBankpo-poans--
*Receivespoandpodisclosespotheporeportspoonpomedicalpomalpractice.
Whopoispocreditedpotopobepothepofirstpoadvancedpopracticeponurseporole?po-poans--
NursepoAnesthesiapoinpo1800's-
,poperhapspothepooldestpoadvancedponursingpospecialty,poSisterpoMarypoBernardpoatpoSt.po
Vincent'spoHospitalpowaspothepofirstpoanesthetist
Whopoispocreditedpotopobepothepofounderpoofpothepofirstponursepopractitionerporole?po-
poans--LorettapoFord-1965-poColorado
Whopoispo(are)pothepooldestpoprimarypocarepoproviderspoinpothepohistorypoofpoadvancedpop
racticeponurses?po-poans--Midwifespoinpo1700's-
poperhapspothepooldestpoprimarypohealthpocarepoprovider
MarthapoBullard,po1785poispothepooldestponotedpoinpopublication
WhatpoarepotheporolespoofpoAPRNs?poHowpoarepotheypodifferentpofrompoeachpoother?po-
poans--
Topoprovidepohealthpocarepotopoindividuals,pofamily,pogroupspoinpoapovarietypoofpohealthpoc
areposettingspo(homes,pohospitals,poinstitutions,pooffices,poclinics,poetc)
APRNpoincludespoNP,ponursepomidwife,ponursepoanesthetist,poandpoclinicalponursepospeci
alist
Whatpostatespoareporesponsiblepoforpobeingpothepofirstpotopohavepoadvancedpopracticepola
nguagepoinpotheirponursepopracticepoact?po-poans--Idahopo(languageporead-
po"assess,podiagnose,potreat")
WhatpoispoNONPF?poWhatpoispotheirpoinfluencepoforpoAPRNs?po-poans--
NationalpoOrganizationpoofpoNursepoPractitionerpoFaculty
Theypohavepodevelopedpodomainspoandpocompetencies
Organizedporolepocompetenciespo(policy,poethics,poquality,poleadership,poetc)
HowpoispothepoNPporolepodifferentpofrompoPAporole?po-poans--
•PA'spoworkpodirectlypounderpoapoMD,poNP'spocanpofunctionpoindependently
•NP'spofocuspoonpomultiplepopracticepoandponursingpomodels
•PA'spofocuspoonpomedicalpotaskspoutilizingpoapomedicalpoframework
WhatpoarepothepokeypoelementspoofpoOTA,poBrown,poSafrietpoandpoMundingerpo-poans--
•poOTA
NP'spoprovidepoequivalentpocarepotopoMD's.
PatientspowhoporeceivepocarepoformpoanpoNPposhowpodecreasedpopatientposymptoms.
•poBrown
Patientposatisfactionpoandporesolutionpoofpopathologicalpoconditionspowerepogreaterpoforpo
NP'spooverpoMD's
NM'spousepolesspotechnology/poanalgesia
NM'spoachievedpoequivalentponeonatalpooutcomes
•poSafreit
TherepoispoabundantpodatapoonpothepoNPporolepoinpoprovidingpohighpoquality,pocostpoeffect
ivepocare/
TherepoarepomajorporestrictionspoonpothepopracticepoofpoNP'spoandpothesepobarriersposhou
ldpobeporemoved.
, •poMundinger
ComparedpooutcomespoinpopatientspowhopowereporandomlypoassignedpotopoeitherpoNP'spo
orpoMD's.
Resultsposhowedpothatpopatientpooutcomespowerepocomparable.
HowpodoespothepoTexaspoBoardpoofpoNursingpodefinepothepoNPporole?po-poans--
ApoRNpoapprovedpobypothepoboardpotopopracticepoaspoanpoAPNpobasedpoonpocompletingpo
anpoadvancedpoeducationpopracticepoprogrampoacceptablepobypothepoboard.poThepotermp
oincludespoanpoNP,ponursepomidwife,ponursepoanesthetist,poandpoapoCNS.poThepoAPNpoisp
opreparedpotopopracticepoinpoanpoexpandedporolepotopoprovidepohealthpocarepotopoindividu
als,pofamilies,poand/
orpogroupspoinpoapovarietypoofposettingspoincludingpobutponotpolimitedpotopohomes,pohospit
als,poinstitutions,pooffices,poindustry,poschools,pocommunitypoagencies,popublic/
privatepoclinicspoandpoprivatepopractice.poThepoAPNpoactspoindependentlypoand/
orpoinpocollaborationpowithpootherpohealthpocarepoprofessionalspoinpothepodeliverypoofpohea
lthpocareposervices.
Wherepoandpowhenpodidpotheporolepofirstpobegin?po-poans--1965-
poUniversitypoofpoColorado-PNP
Whatpofactorspohaveposupportedpoinitiationpoofpotheporolepoandpoitspodevelopmentpooverpo
time?po-poans--1.Changesposocially/culturally
po•WW2,poVietnampowar-poneededpoanesthetist
po•Communitiesponeededpomidwives,polackpoofpopreparedpoOB's
2.ChangespoinpothepoHealthpocareposystem
po•Nopophysicianspotopoadministerpoanesthesia
po•DecreasepoinpomedicalpointernspoandpoMDs,poandpowaspothereforepoanpoincreasedpone
edpoforpothepoNP
Whatpoarepo3-
5pomajorporesearchpooutcomespo(processpoorpooutcomespofindings)poaboutpoNPpoimpactp
othatpoyoupocanpodocument?po-poans--1.NP'spoprovidepoequivalentpocarepotopoMD's
po•Processpomeasures:poAdequacypoofpopedipoexams,pomedicationpoprescribed,poshortpo
andpolongpotermpocompliance
po•Outcomepomeasures:poimprovedpopatientpofunctioning,poresolutionpoofpoacutepoproble
ms,podecreasedpopainpoorpodiscomfortpoinpochildren
2.NP'spoprovideposuperiorpocarepotopoMD's
po•Processpomeasures:po#poofpodiagnosticpotests,poeffectivenesspoofpointerpersonalpoman
agementposkills
po•Outcomepomeasures:poreducedpopatientposymptoms,pobetterpoHTNpocontrol,poincrease
dpoweightporeduction,popainpodecreasedpoinpoadultpopatients,poimprovedpoactivitypoandpod
ecreasedpoanxietypoinpochronicpopatients
3.Patientspoarepogenerallyposatisfiedpowithpothepoqualitypoofpocarepoprovidedpobypothem,po
particularlypowithpothepointerpersonalpoaspectspoofpocare.
4.NP'spoarepoaposolutionpotopohealthcareposystempoissuesposuchpoaspoAccesspotopoCare,p
oQualitypoofpocarepoandpoCostpoofpoCare
1.poWhatpoarepothepo4posettingspoforpoprescriptivepoauthority?
poDescribepotheporequirementspoinpoeachposettingpoforpophysicianposupervision,po#poofpoN
Ps,pochartporeview,poandpoanypootherpospecialporequirementspoinpothatposite.po-poans--
1.poMedicallypoUnderserved
2.poPhysicianpoPrimarypoSite
3.poPhysicianpoAlternatepoSite
4.poFacilitypoBasedpoPracticepoSite.
*poGeneralporequirementspoperpoTBONporulepo222.5:poregularpovisits,pochartporeviewpoasp
odeterminedpobypoAPRNpo&pophysician,poperiodicpofacepotopofacepomeetingpoofpoAPRNpo
&pophysicianpotopodiscusspoptpocarepo&poimprovement.
1a)poMedicallypoUnderservedpo-poans--
*sitepomustpobepoofficial,pophysicianpomustpobeporeachablepobypophonepo&pomustpobepopr
ovidedpowithpodailypostatusporeportpoofpoanypomajorpoproblemspooutsidepoofpothepoprotoco
l.po
*mustpohavepoprotocols.
1b)poPhysicianpoPrimarypoPracticepoSitepo-poans--*poMustpohavepoprotocols.
*SignpodrugpoorderspoonlypoforpoptspowhompothepoMDpohas/
willpoestablishpoaporelationship.
*alternatepoMDpomaypodelegate.
*MDpomaypodelegatepotoponopomorepothanpo7poAPNSpoorpoPAs.
*Physicianpoon-sitepovisitsposhouldpobepo50%poofpothepotimepoaccordingpotopoBME.
1c)poFacilitypoBasedpoPracticepo-poans--
*Mustpobepophysicallypopresentpoinpofacilitypo(hospitalpoorpolongpotermpofacility).
*Physicianpomustpogivepopriorpoconsent.
*Delegationpoonlypoatpo>poonepohospitalpoorpo>po2polongpotermpocarepofacilitiespo-
ponowpoitpoispo7poFTEs.
*Longpotermpocare-onlypo4poAPNspo(APRNs)poorpo4poPAspoorpotheirpoFTEpoequivalentpo-
ponowpoitpoispo7poFTEpo&poapprovedpobypoChiefpoPhysicianpoofpoFacility.
*ProtocolposignedpobypothepoChiefpoPhysician.
1d)poPhysicianpoAlternatepoSitepo-poans--*Nopolongerpoinpoeffect.
2.poThepoFOURpoApprovedpoCategoriespoofpoAPNpoinpoTX?po-poans--
*CRNA,poNP,poCNS,poandpoCNM
,3.poNPporequirementspobypoBONpoforpoapprovalpoofpolicense/
poAPporecognitionpoeachpobiennium.po-poans--*CurrentpovalidpoRNpolicensure.
*400pohourspoofpocurrentpoclinicalpopractice.
*20pohourspoofpoCEs.
*8pohourspoofpocontinuingpoeducationpoinpopharmacotherapeutics.
*Currentpoboardpocertification.
*Separatepoapplicationpoforpodualporoles.
4.poNewpoNPpograduateporequirementspowhenpoapplyingpoforpothepoboard?po-poans--
*Mustpotakepoandpopassponationalpocertificationpoexam.
5.poWhatpoispothepoNP'sposcopepoofpopracticepobasedpoon?po-poans--
*Nursepopracticepoactspodefinepolegalposcopepoofpopracticepoforpolicensedpopractitioners.
*Includespoprivilegespoforpodiagnosis,potreatment,poprescriptivepoauthoritypoandporeimburs
ement.
11.poWhatpoarepoclinicalpoprivilegespoandpohowpoarepotheypoobtained?po-poans--
*autonomypotopoperformpoexpandedporolepofunctionspobasedpoonpothepoindividualspolicen
sure,poeducationalpopreparation,poclinicalpoexperience,poandpocredentials.
*Viapocontractualpoagreementpowithpohospitalspoorpolongpotermpocarepofacilities.
12.poDefinepoMalpracticepo-poans--
*Anypoprofessionalpomisconduct,pounreasonablepolackpoofposkill,poorpoinfidelitypoinpoprofes
sionalpoorpofiduciarypoduties,poorpoillegalpoorpoimmoralpoconduct.
*Negligencepoispothepofailurepoofpoanpoindividualpotopodoposomethingpothatpoaporeasonable
popersonpowouldpodo,pothatporesultspoinpoinjurypotopoanother.
*Thepoallegedpofailurepoonpothepopartpoofpoapoprofessionalpotoporenderposervicespowithpoth
epodegreepoofpocare,podiligence,poandpoprecautionpothatpoanotherpomemberpoofpotheposa
mepoprofessionpoinposimilarpocircumstancespowouldporenderpotopopreventpoinjurypotoposo
mepoonepoelse.
13.poFOURpoElementspoofpoMalpracticepo-poans--
1.poDuty:poprovideposomepolevelpoofpocare,pohadposomepocontact.
2.poDereliction:poreasonable,poordinarypocare,poskillpoandpodiligencepoaspoNP'spoinpogoodp
ostandingpoinposimilarpopractice.
3.poDamage:poMustpohavepoanpoinjurypoorponopomalpracticepoevenpoifpoviolatedpostandard
poofpocare;pocappo"painpoandposuffering"po$250,000potopo$500,po000.
4.poCausationpoofpoInjury:poForpomalpracticepotopohavepooccurred,poapobreachpoofpothepost
andardpoofpocarepomustpohavepocausedpoanpoinjurypotopothepopatient.
15.poNationalpoPractitionerpoDatapoBankpo-poans--
*Receivespoandpodisclosespotheporeportspoonpomedicalpomalpractice.
Whopoispocreditedpotopobepothepofirstpoadvancedpopracticeponurseporole?po-poans--
NursepoAnesthesiapoinpo1800's-
,poperhapspothepooldestpoadvancedponursingpospecialty,poSisterpoMarypoBernardpoatpoSt.po
Vincent'spoHospitalpowaspothepofirstpoanesthetist
Whopoispocreditedpotopobepothepofounderpoofpothepofirstponursepopractitionerporole?po-
poans--LorettapoFord-1965-poColorado
Whopoispo(are)pothepooldestpoprimarypocarepoproviderspoinpothepohistorypoofpoadvancedpop
racticeponurses?po-poans--Midwifespoinpo1700's-
poperhapspothepooldestpoprimarypohealthpocarepoprovider
MarthapoBullard,po1785poispothepooldestponotedpoinpopublication
WhatpoarepotheporolespoofpoAPRNs?poHowpoarepotheypodifferentpofrompoeachpoother?po-
poans--
Topoprovidepohealthpocarepotopoindividuals,pofamily,pogroupspoinpoapovarietypoofpohealthpoc
areposettingspo(homes,pohospitals,poinstitutions,pooffices,poclinics,poetc)
APRNpoincludespoNP,ponursepomidwife,ponursepoanesthetist,poandpoclinicalponursepospeci
alist
Whatpostatespoareporesponsiblepoforpobeingpothepofirstpotopohavepoadvancedpopracticepola
nguagepoinpotheirponursepopracticepoact?po-poans--Idahopo(languageporead-
po"assess,podiagnose,potreat")
WhatpoispoNONPF?poWhatpoispotheirpoinfluencepoforpoAPRNs?po-poans--
NationalpoOrganizationpoofpoNursepoPractitionerpoFaculty
Theypohavepodevelopedpodomainspoandpocompetencies
Organizedporolepocompetenciespo(policy,poethics,poquality,poleadership,poetc)
HowpoispothepoNPporolepodifferentpofrompoPAporole?po-poans--
•PA'spoworkpodirectlypounderpoapoMD,poNP'spocanpofunctionpoindependently
•NP'spofocuspoonpomultiplepopracticepoandponursingpomodels
•PA'spofocuspoonpomedicalpotaskspoutilizingpoapomedicalpoframework
WhatpoarepothepokeypoelementspoofpoOTA,poBrown,poSafrietpoandpoMundingerpo-poans--
•poOTA
NP'spoprovidepoequivalentpocarepotopoMD's.
PatientspowhoporeceivepocarepoformpoanpoNPposhowpodecreasedpopatientposymptoms.
•poBrown
Patientposatisfactionpoandporesolutionpoofpopathologicalpoconditionspowerepogreaterpoforpo
NP'spooverpoMD's
NM'spousepolesspotechnology/poanalgesia
NM'spoachievedpoequivalentponeonatalpooutcomes
•poSafreit
TherepoispoabundantpodatapoonpothepoNPporolepoinpoprovidingpohighpoquality,pocostpoeffect
ivepocare/
TherepoarepomajorporestrictionspoonpothepopracticepoofpoNP'spoandpothesepobarriersposhou
ldpobeporemoved.
, •poMundinger
ComparedpooutcomespoinpopatientspowhopowereporandomlypoassignedpotopoeitherpoNP'spo
orpoMD's.
Resultsposhowedpothatpopatientpooutcomespowerepocomparable.
HowpodoespothepoTexaspoBoardpoofpoNursingpodefinepothepoNPporole?po-poans--
ApoRNpoapprovedpobypothepoboardpotopopracticepoaspoanpoAPNpobasedpoonpocompletingpo
anpoadvancedpoeducationpopracticepoprogrampoacceptablepobypothepoboard.poThepotermp
oincludespoanpoNP,ponursepomidwife,ponursepoanesthetist,poandpoapoCNS.poThepoAPNpoisp
opreparedpotopopracticepoinpoanpoexpandedporolepotopoprovidepohealthpocarepotopoindividu
als,pofamilies,poand/
orpogroupspoinpoapovarietypoofposettingspoincludingpobutponotpolimitedpotopohomes,pohospit
als,poinstitutions,pooffices,poindustry,poschools,pocommunitypoagencies,popublic/
privatepoclinicspoandpoprivatepopractice.poThepoAPNpoactspoindependentlypoand/
orpoinpocollaborationpowithpootherpohealthpocarepoprofessionalspoinpothepodeliverypoofpohea
lthpocareposervices.
Wherepoandpowhenpodidpotheporolepofirstpobegin?po-poans--1965-
poUniversitypoofpoColorado-PNP
Whatpofactorspohaveposupportedpoinitiationpoofpotheporolepoandpoitspodevelopmentpooverpo
time?po-poans--1.Changesposocially/culturally
po•WW2,poVietnampowar-poneededpoanesthetist
po•Communitiesponeededpomidwives,polackpoofpopreparedpoOB's
2.ChangespoinpothepoHealthpocareposystem
po•Nopophysicianspotopoadministerpoanesthesia
po•DecreasepoinpomedicalpointernspoandpoMDs,poandpowaspothereforepoanpoincreasedpone
edpoforpothepoNP
Whatpoarepo3-
5pomajorporesearchpooutcomespo(processpoorpooutcomespofindings)poaboutpoNPpoimpactp
othatpoyoupocanpodocument?po-poans--1.NP'spoprovidepoequivalentpocarepotopoMD's
po•Processpomeasures:poAdequacypoofpopedipoexams,pomedicationpoprescribed,poshortpo
andpolongpotermpocompliance
po•Outcomepomeasures:poimprovedpopatientpofunctioning,poresolutionpoofpoacutepoproble
ms,podecreasedpopainpoorpodiscomfortpoinpochildren
2.NP'spoprovideposuperiorpocarepotopoMD's
po•Processpomeasures:po#poofpodiagnosticpotests,poeffectivenesspoofpointerpersonalpoman
agementposkills
po•Outcomepomeasures:poreducedpopatientposymptoms,pobetterpoHTNpocontrol,poincrease
dpoweightporeduction,popainpodecreasedpoinpoadultpopatients,poimprovedpoactivitypoandpod
ecreasedpoanxietypoinpochronicpopatients
3.Patientspoarepogenerallyposatisfiedpowithpothepoqualitypoofpocarepoprovidedpobypothem,po
particularlypowithpothepointerpersonalpoaspectspoofpocare.
4.NP'spoarepoaposolutionpotopohealthcareposystempoissuesposuchpoaspoAccesspotopoCare,p
oQualitypoofpocarepoandpoCostpoofpoCare
