Personal Practice Theoretical Framework
In our fast-paced world of health care the demand for Advance Practice Nurses (APNs) has never been stronger. According to current trends in nursing and healthcare, there are many driving forces that increase demand for skilled graduate nurses. In particular, with aging, population growth, the projected physician shortage, and the new health care models, APNs will continue to be in high demand, and will be truly needed (Naylor & Kurtzman, 2010).
Given the need for more nurses to serve as Advanced Practice Registered Nurses (APRN), I decided to be assertive with my own progress to achieve an advance degree. Last year, I got inspired to pursue a graduate degree in nursing in order to become a Nurse Practitioner (NP). My specialty interest is in Adult-Gerontology Primary-Care. I believe that this specialty will allow me to further define my career path, and give me the flexibility to work in multiple areas of medicine.
Introduction to the Primary Care Nurse Practitioner Role
The role of the primary nurse practitioner (NP) has emerged in the US in the late 1960s. The development of the primary NP role in the US is widely perceived as a response to increased medical specialization and the accessibility to medical care ensured by Medicare and Medicaid programs. The increase in physicians’ specialization shrank the number of primary care physicians mainly in the rural and medically underserved areas. Meanwhile, access to medical care by low-income people increased the demand for primary care services. To meet this demand, nurses stepped in to breach the gap (Pohl & Tsui-Sui, 2014).
The events today in the medical workforce are a repeat of yesterdays. Once again health care faces...
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...atients.
As primary NPs care for undeserved, ethnically diverse, and an aging population, they may encounter ethical issues as well. For instance, some ethical challenges arise when patients refuse an appropriate treatment and make inappropriate requests. Other ethical demands involve, informed consent, pressure to see high patient loads, conflicts between colleagues, allocation of resources, etc (Ulrich, Zhou, Hanlon, Danis, & Grady, 2014).
Given this facts, the primary NP role has its ethical demands. To better address the ethical challenges they will face as primary care providers, NPs have to learn ethical reasoning. Ethical reasoning will help NPs to make just decisions, act appropriately, and conduct themselves in professional relationships. Ultimately ethical reasoning will direct the primary NP’s ethical behavior (Ulrich, Zhou, Hanlon, Danis, & Grady, 2014).
Nurse practitioners (NPs), one type of advanced practice nurses, are licensed by the states where they practice and certified by private boards. Nurse practitioners hold advanced degrees in clinical practice and function in a wide variety of settings and across the life span. They provide a broad array of healthcare services ranging from managing treatment plans, to prescribing medications, to implementing health promotion services. As of 2014, 205,000 NPs were licensed in the United States with 86% of those prepared to deliver care to patients in primary care settings (NP Facts, 2015). The progression of the Nurse Practitioner movement that occurred in the 1960 and 1970s emerged as a creative and
In 2011, Barbara Safriet published an article “Federal options for maximizing the value of Advanced Practice Nurses in providing quality, cost-effective health care” from a legal perspective. The article focused on the benefits of utilizing Advance Practice Nurses to the full extent of their abilities as well as the current barriers that APNs encounter in their practice. The aim of this paper is to discuss two regulatory provisions to full deployment of APNs in current health care system, as well as three principle causes of current barriers to removal of the restrictive provisions for the APN. Furthermore, I will discuss the critical knowledge presented in the article and how it relates the APN practice. This article was incorporated into a two-year initiative was launched Institute of Medicine (IOM) and by the Robert Wood Johnson Foundation (RWJF) in 2008 which addressed the urgency to assess and transform the nursing profession.
The Affordable Care Act (ACA) was passed in 2010 with the goal of expanding healthcare coverage to all Americans by reforming insurance policies and practices (Tillett, 2011). The ACA upsurges the demand for an increase in primary care providers in order to supply quality care to the much larger population that will have coverage and therefore acquiring healthcare. The Institute of Medicine (IOM) through its report The Future of Nursing: Leading Change, Advancing Health has generated a solution to the shortage of primary care providers by promoting a transformation of the nursing profession to fill the gap.
The national shortage of Registered Nurses (RNs) has helped generate formidable interest in the nursing profession among people entering the workforce and those pursuing a career change. According to a report issued by the U.S. Department of Health and Human Service in 2002, the national population is continuing to grow and age and medical services continue to advance, so the need for nurses will continue to increase. They report from 2000 to 2020 the predicted shortage of nurses is expected to grow to 29 percent, compared to a 6 percent shortage in 2000. With the projected supply, demand, and shortage of registered nurses and nursing salaries ever-increasing, the nursing profession can offer countless opportunities. But first one must determine which educational path to pursue, Bachelor of Science in Nursing (BSN) or Associate Degree in nursing (ADN). Most will initially be educated at the associate degree level, even though the American Organization of Nursing Executives (AONE) has recommended a baccalaureate level as a minimal for entry-level nurses. With the expanding number of RN to BSN programs available there is always the option to further one’s education at a later date. The benefits for acquiring a BSN over an ADN include a better knowledge for evidence-based practice, an increased advantage for promotion, and the necessary gateway for higher education.
Access to quality healthcare is a growing concern in the United States especially in light of healthcare reform coverage expansions made possible by the Patient Protection and Affordable Care Act of 2010. It is estimated that 94% of all Americans will acquire healthcare coverage under the law, an increase of nearly 30 million people (King, 2011). This dramatic influx of patients into the healthcare system has projected to cause an immediate increase in added pressure on an already challenged healthcare workforce (King, 2011). Notably, at a time when healthcare demands are growing, graduate rates from medical schools remain unchanged while advanced practice registered nurse (APRN) graduate rates are rising (Cipher, Hooker, Guerra, 2006). The increased availability of APRNs, along with enhanced delivery of healthcare skills, gives the role a unique advantage in the current state of healthcare. These specialized advanced practice nurses provide services often at a patient’s first (and in some cases, primary) point of contact into the healthcare system (Brassard, 2013). Due to this, many states have started to take action to mitigate the increased healthcare system burden by enhancing the APRN’s scope of practice by broadening prescriptive authority. This has been shown to be one of the fundamental ethical avenues of increasing not only access to healthcare, but also efficiency and quality of care (Ross, 2012).
In the medical profession, doctors and nurses run into ethical dilemmas every day whether it be a mother who wants to abort her baby or a patient who has decided they want to stop cancer treatment. It is important for the nurse to know where they stand with their own moral code, but to make sure they are not being biased when educating the patient. Nurses are patient advocates, it is in the job description, so although the nurse may not agree with the patient on their decisions, the nurse to needs to advocate for the patient regardless.
During this same time, Medicaid and Medicare programs were growing rapidly and increasing the number of individuals covered, such as to low income individuals, the disabled, and the elderly. The abrupt expansion of coverage caused the demand of primary care services to skyrocket. With physicians no longer able to meet the growing demand, nurses stepped to provide medical care, and soon believed that were qualified to broaden their role and scope of abilities. In 1965, a nurse and physician, Loretta Ford and Henry Silver, recognized the need for a training program, and developed the first curriculum for nurse practitioners. Since then, the role of nurse practitioner has rapidly increased in response to the expanding and growing need for accessible and affordable care and is currently ranked as one of the fastest growing professions in healthcare.
Most APNs or NPs posses a master’s degree; however the American Association of Colleges of Nursing (AACN) member institutions voted to change the current level of preparation for advanced nursing practice from a masters degree to a doctorate level by 2015”. “An individual who wished to apply for a license must meet the following requirements; a complete application, pass the NCLEX, provide any felony or misdemeanor conviction information, any drug related behavior, functional ability deficit and license fee to Virginia State Board of Nursing”. Most RNs gain their clinical experience by working a staff nurse before entering into a graduate program for their nurse practitioners, but once they gain a significant of experience as a nurse t...
It is no secret that the current healthcare reform is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify ways to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal.” (Bailey, Jones & Way, 2006, p. 381).
About 32 million people will represent the newly insured, affecting the health care system and nurses are the fundamental in health system. Health care reform is positive for nurses. The health care bill provides money for advance practice and general nurse education. The law also creates a grant program for innovative safety net programs, such as nurse-managed health clinics. Due to the shortage of family Physicians, nurse practitioner programs are going strong. The health care reform is a good opportunity for nurses; the law will permit different approaches to deliver primary care and with the decreasing number of physicians going in to primary care, Nurses represent the best way to provide primary care to the millions of new insured people. (Satowski, 2010)
This paper will evaluate the local, national and international drivers that have influenced the development of advanced nursing practice. The discussion will include the political, economic, social, and technological influences that have contributed to the transformation from the traditional nursing role to the numerous exciting advanced level career opportunities achievable in nursing today. Dynamics that have shaped my own current advanced nursing role will be discussed and to conclude some thoughts on the future of advanced nursing practice.
What led me to nursing in the beginning was having a passion for people. I love the holistic approach and level of care that nurses bring to the literal bedside table. I knew throughout nursing school that I wanted to advance my education further than bedside nursing. I debated on whether to pursue a master’s degree in nursing and just become a nurse practitioner, but ultimately, I knew I wanted to advance my education even further to help make and promote changes in healthcare. By choosing to become a doctorally prepared nurse practitioner, I hope to change the stigma that is attached with being “just a nurse” and show that nurses play a vital role in redesigning
There has been a drastic cut in both the Medicare and Medicaid reimbursement rates. According to Robert (2012), “cuts of more than $360 billion to Medicare and Medicaid will be made over the next 10 years. The focus of nursing needs to emphasize more on wellness care and prevention rather than acute care” (McNeal, G., 2012). Nursing practice will need to shift more towards community and population focused nursing. Baccalaureate prepared nurses are provided with a curriculum that includes both community health and leadership skills that are not included in the associate program. By encouraging associate’s degree nurses to obtain a bachelor’s degree in nursing, an increase in the awareness of the needs of the community and population may be seen. The IOM report has outlined the anticipated obstacles that healthcare will face if changes are not made. By allowing nurses to provide care within their full scope of practice, quality care may be provided at an affordable cost to the population. The use of advanced practice nurses in primary care may provide quality, access, and cost efficient healthcare to high-risk populations and possibly decrease hospital admission rates, thus lowering the overall cost of healthcare. If nurses partner with doctors and other healthcare providers, it may improve healthcare by providing seamless transitions (Institute of Medicine,
In conclusion, there are numerous legal and ethical issues apparent in the nursing practice. Nurses should study and be as informed as they can with ethics and legality within their field in order to ensure no mistakes occur. Ethical issues vary based on patient’s views, religion, and environment. Nurses are influenced by these same views, but most of the time they are not the same as the patients. As a nurse we must learn to put the care of our patients and their beliefs, rights, and wishes before our own personal
To briefly summarize, the report identifies nurses as an important factor in enabling access to high quality, affordable health care. This was supported by the development of four fundamental recommendations. The first suggests that nurses be allowed to practice within the scope of their degree. This becomes evident in the differences in state laws that pertain to nurse’s who have acquired advanced degrees, such as the nurse practitioner.... ...