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Ethical and legal issues in nursing advanced practice
Legal and ethical issues advanced nurse practitioners
Ethics and the nurse practitioner
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Confusion in Professional Titling
While development and expansion of advanced nurse practice is greeted with enthusiasm it does not necessarily fall short of ethical and policy issues surrounding the actual practice. Questions has been raised whether it is in order to refer advanced nurse practitioners prepared at doctorate level ( DNPs) as “doctors” particularly in healthcare setting. Schierhorn (2010) point out the sentiments made by Dr. Yasso, the vice president and chair of the American Osteopathic Association (AOA) Bureau of State Government Affairs that DNPs deliver necessary care to patients and help reduce effects of worsening physician shortage. However, many physicians and other interested parties has questioned the validity and justification of referring DNPs as “doctors” in an environment that only physicians has traditionally referred by that title. Dr. Yasso contends “If nurses want to be doctors, they should go to medical school to prevent confusion among patients”. Nevertheless, Literature show no evidence that such initial confusion on the part of patients causes harm as long as patients are receiving high-quality care (Schierhorn, 2010).
Issue of Autonomy
Traditionally nurses have taken a subordinate role in making decisions regarding patient care. With increasing emergence of advanced nurse practice, ethical issues that relate to independence of practice arise. After years of legislative debate some states are trying to fill the primary care physician shortage with nurses who have advanced degrees in family medicine. There are currently 18 states in America that have allowed DNPs to practice without physician oversight (Vestal, 2013). While many state and federal legislations bear concerns about patient’s s...
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Fairman, J. A. (2011). Broadening the Scope of Nursing Practice. The New England journal of Medicine, 193-196.
Mundinger, M. O. (2008). American Board of Comprehensive Care Certification (ABCC): Too Close to Medicine. Clinical Scholars Review : JDNP, Volume 1( 2), 67-68.
Palermo, J. (2014, January 13). Physicians and Nurses At Odds Over NP Autonomy. Space Coast Daily . Retrieved from http://spacecoastdaily.com/2014/01/physicians-and-nurses-at-odds-over-np-autonomy/
Schierhorn, C. (2010, March 19). As NPs push for expanded practice rights, physicians push back. TheDO. Retrieved May 13, 2014, from http://thedo.osteopathic.org/?p=11501&page=2
Vestal, C. (2013, Jul 19). Nurse Practitioners Slowly Gain Autonomy. Kaiser Health News. Retrieved May 12, 2014, from http://www.kaiserhealthnews.org/stories/2013/july/19/stateline-nurse-practitioners-scope-of-practice.aspx
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,
Role clarity and title confusion pose barriers to the amalgamation of advanced practice nursing roles. Colleagues and the public are unaware of the precise roles of the APN. Much of what the public knows about medicine is associated with a doctor, and the “doctor knows best” (Safriet, 2011). The public i...
The first provision of the American Nurses Association’s (ANA) “Code of Ethics” states, “ The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems.” The second provision states, “The nurse’s primary commitment is the patient, whether the patient is an individual, family, group, or community” (Fowler, 2010). As nurses we need to respect the autonomy and allow for the patient to express their choices and concerns. We also need to provide them with support by giving them knowledge and understanding so they
This discussion board is about the nurse’s scope of practice. The purpose of this posting is to discuss the definition and standards of the nurse’s scope of practice as defined by the American Nurses Association (ANA) and by the Ohio Board of Nursing with an example of how to use the standards of practice. Per the ANA, when determining the nurse’s scope of practice there is no one specific explanation that can be provided due to the fact that registered nurses can have a general practice or a practice that is very specialized. The limits that are placed on a RN’s scope of practice will depend on a registered nurse’s education, type of nursing, years as a nurse, and the patients receiving care. At the basic level, every nurse’s practice
In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
Gordon makes a great argument about doctor and nurse relationship. She states that in fact “many doctors still consider nurses to be their handmaidens,” although they are supposed to work together as a te...
The white paper entitled, The Doctor of Nursing Practice: Current Issues and Clarifying Recommendations was written and published by the American Association of Colleges of Nursing (AACN). The AACN Board of Directors formed a task force to review and clarify the evolution of the doctorate in nursing practice as outlined in the Essentials of Doctoral Education for Advanced Nursing Practice (DNP Essentials). This paper highlights the recommendations to describe and clarify the characteristics of the Doctor of Nursing Practice (DNP) graduate scholarship, the DNP project, efficient use of resources, program length, curriculum considerations, practice experiences, and guidelines for collaborative partnerships. In 2004, the AACN issued a Position Statement on the Practice Doctorate in Nursing that changed the trajectory of nursing education by recommending that advanced nursing practice education be moved to a doctoral level. DNP practice scholarships are validated when the principles of nursing scholarship are combined with the eight DNP Essentials to prepare a graduate capable of improving health and care outcomes.
Zerwekh, J., Claborn, J. (2006). Nursing today: Transitions and trends (pp. 343-346). St. Louis, Missouri:
Mundinger, M., (1994). Advanced-Practice nursing—good medicine for physicians? New England Journal of Medicine, 33(3), 211-214. Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJM199401203300314
The healthcare system can be difficult for clients to navigate and they are often unsure how to access information which puts them at the mercy of others and can lead to feelings of helplessness (Erlen, 2006). Nurses can provide resources to educate patients when they becomes dependent on a health care provider and no longer feel in control of their own body which can lead to fear, hopelessness, helplessness and loss of control (Cousley et al., 2014). The change in roles individuals face can further increase their stress and feelings of powerlessness (Scanlon & Lee, 2006). According to the CNA code of ethics, nurses are responsible for protecting patients from objective risks that place them in an increased level of vulnerability (Carel, 2009). They can do this by providing the resources necessary for patients to educate themselves and be better able to cope with the health challenges they
The acceptance of the DNP has not come without some hesitation. There were many leaders in nursing who had some beliefs that the practice doctorate would somehow take away the spotlight from the research being done in the field of nursing (Zaccagnini & White, 2017). Many physicians also view the DNP as trying
Davis, A. J. (1997). Ethical dilemmas and nursing practice (4th ed.). Stamford, Conn.: Appleton & Lange.
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
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
Burton, A. (2000) Reflection: nursing’s practice and education panacea? Journal of Advanced Nursing; 31: 5, 1009–1017.