Final Project
The nurse workforce has been growing substantially for the past two decades necessitated by the demand for quality care, an ever increasing population, increased complexity of illnesses as well as a new found passion by the current generation to seek career growth in nursing and healthcare. However, the role of education and nursing curriculum in facilitating the increasing number of nurses trained in various ways and for different roles cannot be assumed. The nursing curriculum has been redefined to accommodate many roles which traverse across direct care roles and indirect care roles (Lowe et al., 2012). On the other hand, authorities and stakeholders in the healthcare sector have significantly improved the work conditions for nurses and today nursing colleges can ably compete for the top cream of the society from an academic and scholarly perspective. Previously, the licensed Registered Nurse was regarded as the senior nursing role and qualification and even today, the number of licensed RNs remains high at close to 3 million and unrivalled for the time being (Lowe et al., 2012). However, as the healthcare sector sought to respond to the needs of the population and to allow nurses to practice and grow in their career to administrative and management roles, the advanced nursing practitioner (APN) roles were invented.
The APN is basically a nurse who has completed the Masters Degree in Nursing. This implies that an APN has already acquired the qualifications of a RN. Today, the APNs form up to 8% of the nurse workforce and this percentage is continually increasing even as the opportunities for continued education have been expanded within the sector (Lowe et al., 2012). However, there is no risk as to whether the number of RNs could significantly decline going forward as nurses continually seek higher education and pursue APN roles. Since nursing colleges have indicated increased enrollment of students willing to take up the BSN roles and thus achieve RN status. The APN is however an umbrella description of the many roles that emanate from the completion of a MSN. These roles include Nurse Practitioners, nurse educator, nurse informaticist, and nurse administrator all which are generally described within the APN roles (Lowe et al., 2012).
Nurse Practitioners (NPs): NPs are required to have a Masters in Nursing and a in future there is a requirement for Doctor of Nursing. Their typical duties include taking the health history of the patient, assessment, diagnosis as well as the treatment of chronic, acute and advance illnesses while acting as the primary care provider. The NPs are also allowed to initiate referrals and they can practice in a host of practice settings including private practice, ambulatory clinics, long term care and community clinics. The NPs can order, perform as well as interpret the diagnostic tests but in some cases, depending on the state they may be required to act under the supervision of the physician. NPs are required to register with the Board of Nursing within the state where they practice (Lowe et al., 2012).
Nurse educator: The nurse educator is typically a registered with advanced education preferably n masters in nursing within any specialty or baccalaureate degree but with proven clinical training in some healthcare specialty and substantial experience. They could work in many settings ranging and they may hold various titles such as Administrative Nurse Faculty, Staff Development Officer, Clinical Nurse Educator or Continuing Education Specialist. Some of the major roles for nurse educators include developing courses and study programs, design and redesigning of curricula, evaluating the learning process, teaching learners, engagement in research and scholarly work, peer review functions, leading and organizing professional organizations as well as writing grant proposals for research among many other roles that link education, research and clinical practice (American Association of Colleges of Nursing, 2015).
Nurse Informaticist: This role is concerned about the movement of data cross the healthcare facility as well as its maintenance for future use. Is encompasses the utilization of technology to promote good communication to the nurses, patients, consumers, healthcare providers as well as administration and management. It helps or promotes better decision making by enabling access to data and information. Some of the specific tasks for nurse informaticists include policy writing, systems optimization and maintenance, planning and choosing systems, providing support, education and training to system users as well as project management (American Association of Colleges of Nursing, 2015). The minimum requirement for nurse informaticists is the BSN degree and thus qualification a registered nurse. Specialization in some filed such as health informatics, quality management or healthcare management through a masters’ program is regarded a necessary qualification. Nurse informaticists are also required to achieve certification from the American Nurses Credentialing Center (ANCC) as well as the Health Information and Management Systems Society (HIMSS) (American Association of Colleges of Nursing, 2015).
Nurse Administrator: A nurse administrator performs roles that do not offer any platform for direct interaction or contact with the patients and are confined to the office setting. Their typical daily duties could include developing work policies, administrating performance reviews, creating work schedules, setting up legal and ethical standards, employee training as well as attending and representing in administrative meetings. They could however work within different settings ranging from nursing homes, hospitals, home health care facility, and urgent care facilities or even within a private doctor’s facility. A nurse administrator’s minimum requirement includes a baccalaureate nursing degree that leads to the qualification as a RN. The standard requirement however is the Master’s in Nursing with a specialty in management and administration (American Association of Colleges of Nursing, 2015).
Selected Advanced Practice Role
The role of the Family Nurse Practitioner is essentially derived from the name; the FNP specialize as specialty or primary healthcare providers who serve under the supervision of the nurse. They work with the family across the care continuum. Rather than viewing each member of the family as the client, the FNP considers the family as the client and thus all actions; that is, diagnosis, examination, prescription and care planning are defined within the context of the family in one way or another. The FNP usually has a history with their patients that extend to the year or months depending on the time they have been in service. It is this feature that gives the FNP a significant influence in the patient’s care planning since they have substantial data and information in regard dot the patient and they use that information and data to educate the patients about their health problems and further develop tailored measures that fall within the social, economic and cultural needs of the patient.
In Florida, the roles of the FNP and the scope of practice are defined within the roles and scope of the Advanced Registered Nurse Practitioners (ARNPs). The terms are set out by the Florida Board of Nursing which certifies and licenses all FNPs within the state. The Florida statutes describe the APRN as a registered nurse who has achieved post-basic specialized training and education and who has been approved and certified by the Board of Nursing to serve in roles that encompass advanced nursing actions (Florida Board of Nursing, 2007). The ARNPs once licensed by the Board can perform diagnosis and treatment for alterations in the health status of the patient while also being allowed to diagnose, treat, prescribe as well as operate. Unless states otherwise, the Board of Nursing in Florida requires that the APRN performs most of the roles under the supervision of a physician as long as they all fall within the defined scope of practice (Florida Board of Nursing, 2007).
However, this supervision is defined in writing and depending on the general rule is that the physician can supervise APRNs in other stations beyond their primary station but not in more than four other different stations. This in essence implies that even as the supervision of the physician exists, the physical presence of the physician is not a necessity as long as there exists a system for consultation between the physician and the APRN. The State Board of Nursing defines that the patient has to be informed whether the physician will be present or absent and make a decision in that regard on whether they would wish the care process to continue in the absence of the physician (Florida Board of Nursing, 2007).
While at this, the physicians who have a specialty are only allowed to supervise in not more than two stations including their primary care facility and these should be within a distance of 75 miles between them when supervising the APRNs (Florida Board of Nursing, 2007). Further, the Florida Board of Nursing bars APRNs from prescribing controlled substances and that includes even within the supervision of the physician, In that case, the state laws also set out that APRNs are not allowed to use any physician’s pre-signed prescription forms or in any way use the physician’s DEA number for purposes of prescription. These laws apply for all FNPs working within Florida and there are no exceptions for FNPs in adhering or subscribing to these regulations (Florida Board of Nursing, 2007).
Professional organizations are a key component of any sector and within the nursing sector; professional nursing organizations play a key role in the development and progress of the sector. Apparently, these professional bodies have significant authority in matters of certification, licensing and accreditation since they work collaboratively with the Board of Nursing to ensure uniformity and fairness. Within Florida and in my role as a FNP I would consider two professional organizations; the Florida Association of Nurse Practitioners (FLANP) and the Florida Nurse Practitioner Network also referred to as the ENP Network. FLANP is a professional organization that brings together all NPs and ARNPs within the state of Florida to help network and connect members so that they can share valuable experiences as well as increase their voice. FLANP acts on one side as a resource organization that offers NPs within Florida an avenue for professional and educational development by promoting their participation in policy making, research, education and redesign of practice (FLANP, 2015).
At a time when states have been accused of promoting legislation that limits the ability of NPs and ARNPs to function optimally as defined by heir certifications and educational preparation, the FLANP has become a major advocate and the voice of reason for nurses in the negotiation of policies that affect this group. The FLANP regularly organizes conferences and workshops for nurses as well as special training and education modules that are driven by health dynamics (FLANP, 2015). These courses and modules are usually certified and recognized by the Florida Board of Nursing and can be used at times as determinants of an individuals’ viability to continue in practice. In most cases such modules are expensive when accomplished individually and thus the organization helps eliminate such bureaucracies that may crop up in seeking such modules (FLANP, 2015).
The ENP Network on the other hand is a professional organization that brings in willing NP professionals to enable them to remain up to date with all events that affect their practice as well as facilitate job searching among NPs. It works collaboratively with care facilities, state authorities and other key stakeholders seeking to work through measures that can increase the impact of NPs in the community. For NPs who are new in the market, it is a suitable body that affords one to easily seek jobs and choose from a variety of employees (ENP Network, 2016).
As I prepare to get into practice, I have a personal philosophy that will guide me. In my personal philosophy I regard the patient as the epicenter of the care process and the nurse as the interface on which the patient can seek help. I thus consider that nurses have to work towards the betterment of the patient putting into consideration the very fact that patients operate in an environment that is dynamic and controlled by social, economical and cultural aspects. If at all nurses have to afford patients a recovery and restoration ability, the nursing process has to be worked out by a multidisciplinary team. This includes the patient, the nurse, the physician as well as all other members who can facilitate help handle the social, spiritual, cultural and psychological needs of the patient. I therefore look forward to working with nurses and professionals who are willing to work closely with the patient and afford them holistic care. In this perspective, I would look forward to a situation where I get to work in an environment where team work is regarded as a work culture and where communication, cooperation and collaboration are the elements that define that culture. In Florida I have a feeling that the workplace environments all offer such a platform and this would significantly help my personal and professional growth all which are the secondary outcomes I seek to achieve beyond positive patient outcomes as the primary outcomes.
Leadership Attributes of the Advanced Practice Role
The role of the FNP and more so that of the ANP revolves around increased focus on the patient. The fact that ANP requirements are based on specialization implies that the objective is to ensure that the patient is afforded quality care within the very detailed specifics of their health problems. The insistence on holistic and patient-centered care remains key elements even within the definition of the roles of the FNP/ANP to the patient. It is important to recognize that patient-centered care and holistic care are possible within an environment that promotes team work, collaboration and constant communication between the members of the care team. Thus, FNPs/ANPs in their leadership roles at the clinical level have to create an environment that promotes team work. FNP/ANPs are trained and prepared to work as problem solvers and in this case, the democratic leadership style would suitable work well for the FNP/ANP. In democratic leadership, the key feature is participation. Everyone is regarded an equal member of the team with something unique to offer and the decision-making process is based on consultation and negotiation as well as seeking a common ground that accommodates all views (Huber, 2013).
While the decision making process is shared across the team, the leader retains all the responsibilities in regard to the decision that is made as well as how that decision impacts the outcomes. This implies that there exists a strong bond of trust between the leader and the team members and the leader entrusts the members to make appropriate decisions at all times (Huber, 2013). In this case, the members are fully aware of their job and the respective tasks they are expected to accomplish and thus the leader only presents the problem to the group and lets them work through it to the end. Another attribute that is associated with democratic leadership is communication and feedback. In resolving problems, the FNP/ANP engage in a multidisciplinary teams and the leader has to keep the flow of information at top notch so that there are no cases of inconsistent and members of the team are well are of the results and outcomes from each member. Simply, the feedback and communication across the group forms the foundations on which the solution is developed (Huber, 2013).
The role of the leader is to ensure that communication and feedback is effective, consistent and reachable at all times. As an FNP/ANP I feel that I possess these attributes; effective communication, collaboration as well as ability to control and share feedback. However, this type of leadership style calls for patience as it involves dealing with several people even when solving smaller issues. Since each member knows that they have a role, such smaller problems could be complicated due to the high level negotiations that at time lead to conflict within the group. I would fail terribly in such cases where I have to manage such conflicts and seek fast solutions and this is a sure recipe for the disintegration of the groups and poor outcomes. However, I believe that patience at times develops as someone consistently works with people and learns their weaknesses and strengths. Once I identify these strengths and weaknesses I would actually be in a position to understand each person and thus plan my work in such a way that their strengths work to my advantage and the weaknesses do not manifest significantly (Huber, 2013).
Health Policy and the Advanced Practice Role
The costs of care have been on a dramatic rise and even with the Affordable Care Act seeking to increase access for care to all populations in spite of their financial capabilities, this dream is turning into a nightmare. The current healthcare is so open and empowers the healthcare providers and the insurance companies to take control of the costs trends even when there exists policies that limit the free market. One of the contentious issues that have led to the current state is the current fee-for-service system where the healthcare providers receive payments for each service they perform. This has meant that healthcare providers increase the volume of services even when they are not medically necessary so as to increase the quantity and volumes of total services and subsequently the reimbursements (Robert Wood Johnson Foundation, 2015).
Apparently, this has happened due to the uncontrolled nature in which insurance companies operate where the level of accountability is minimal and with loopholes for colluding with healthcare providers for payment of services that were not even medically necessary. There is a need to change from the fee-for-service to the pay-per-performance (value-based purchasing) where the reimbursements are made for the complete package of services offered to the patient at each visit (Robert Wood Johnson Foundation, 2015). This would eliminate the cases of payment for services that are not medically necessary as it would help increase accountability and follow-up. In essence, there would be internal regulation by healthcare providers and eliminate the channels for healthcare providers and insurance companies colluding to receive payments for services that were actually not important.
The change process especially because it touches on the pertinent issue of costs and finances will have to involve key stakeholders the healthcare sector as well as the state and federal authorities who are concerned with and law making. On one hand, the need to involve the professional nursing organizations such as the American Nurses Association and the regional professional nursing organizations such as the Florida Association of Nurse Practitioners (FLANP) would help bring into context the basic information and data that justifies the need for change. Nurses are the patient advocates and professional nursing organizations have an obligation to protect and represent the patient as their client.
Further, the integration of nurse administrator and managers to help provide a financial and budgetary perspective on the issue would be necessary. Legislators within the state as well as legislators at the federal level have to be involved because ultimately there will be a need for an individual or group that will directly lobby for support of the intended policy change at the legislative level (Jha et al., 2012). However, it is important to recognize that individual nurses will play a key role in the process of policy change and as a nurse I know and recognize that my role is within advocacy. I would thus act as a change agent and I would be a teacher to other nurses to help them recognize the impact of this intended policy change to the patient and population in general as well as to the healthcare sector.
The change in policy would mean that healthcare facilities are reimbursed for the each single complete package of care that they afford patients as opposed to where reimbursement is based on each independent service that is afforded. In this case, the commercialization of the patient a would be minimized and the nurses and the care team s would place more focus on quality outcomes as opposed to commercial benefits that they accrue from each patient (Jha et al., 2012). The direct care providers; that is nurses and physicians would be eliminated from the role of determining the financial gains of the organization since all reimbursements would be based on outcomes and not number and magnitude of services offered. There would be increased need for patient volumes with positive outcomes as this is essentially what would determine the volume of reimbursements. Care quality would increase and more importantly, care facilities would seek to optimize the available resources to serve higher patient volumes (Robert Wood Johnson Foundation, 2015).
References
American Association of Colleges of Nursing. (2015). Expanded Roles for Advanced Practice Nurses. Retrieved from http://www.aacn.nche.edu/media-relations/fact-sheets/apn-roles
ENP Network. (2016). The Professional Network for Nurse Practitioners | ENP Network. Retrieved from https://www.enpnetwork.com/
FLANP. (2015). Platform and Policies - Florida Association of Nurse Practitioners. Retrieved from http://www.flanp.org/?page=platformpolicies
Florida Board of Nursing. (2007). Nurse Practice Act: Chapter 464 Florida Statutes. Retrieved from http://phsc.edu/sites/default/files/program/files/Nurse-Practice-Act.pdf
Huber, D. (2013). Leadership and nursing care management. Elsevier Health Sciences.
Jha, A. K., Joynt, K. E., Orav, E. J., & Epstein, A. M. (2012). The long-term effect of premier pay for performance on patient outcomes. New England Journal of Medicine, 366(17), 1606-1615.
Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of advanced nursing, 68(3), 677-685.
Robert Wood Johnson Foundation. (2015). Determining and Controlling the Cost of Health Care. Retrieved from http://www.rwjf.org/en/library/research/2015/10/determining-and-controlling-the-cost-of-health-care.html
