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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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).
The role of nurse practitioner in the Canadian healthcare system is relatively new compared to the traditional roles of doctors and registered nurses, and as with any new role, there are people who oppose the changes and others who appreciate them. Some members of the public and the healthcare system believe that the addition of the nurse practitioner (NP) role is an unnecessary change and liability to the system because it blurs the line between a doctor and a nurse; this is because nurse practitioners are registered nurses with additional training (usually a masters degree) that allows them to expand their scope of practice into some areas which can be treated by doctors. Other people feel that nurse practitioners can help provide additional primary care services, while bridging communication between nurses and doctors. There are always legitimate challenges to be overcome when changing a system as complicated as healthcare,
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.
There is a shortage of all health care professions throughout the United States. One shortage in particular that society should be very concerned about is the shortage of Registered Nurses. Registered Nurses make up the single largest healthcare profession in the United States. A registered nurse is a vital healthcare professional that has earned a two or four year degree and has the upper-most responsibility in providing direct patient care and staff management in a hospital or other treatment facilities (Registered Nurse (RN) Degree and Career Overview., 2009). This shortage issue is imperative because RN's affect everyone sometime in their lifetime. Nurses serve groups, families and individuals to foster health and prevent disease.
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 reformation 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 a way 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). The key to a successful healthcare reformation is interdisciplinary collaboration between Family Nurse Practitioners (FNPs) and physicians. The purpose of this paper is to review the established role of the FNP, appreciate the anticipated paradigm shift in healthcare between FNPs and primary care physicians, and recognize the potential associated benefits and complications that may ensue.
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)
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
...sa, H. Cashin, A. Buckley, T. Donoghue, J. (2014). Advancing advanced practice — clarifying the conceptual confusion. Nurse Education Today 34 (2014) pp. 356–361
With my academic, professional and volunteer experience, I have reached a point in my career where I am fully equipped to enter the advanced curriculum of the Doctor of Nursing practice, Family Nurse Practitioner program. Working in the nursing profession for the past three years has shown me that there is an increasing need for research to improve health care delivery and access to vulnerable populations. It is rewarding to be a nurse; however there are limitations in my current scope of practice that prevents me to go beyond my job requirements. Through advanced education, my aim is to provide quality patient-family
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.... ...