N5350 Roles Final Study Guide

1. What are the 4 settings for prescriptive authority? Describe the requirements in each setting for physician supervision, # of NPs, chart review, and any other special requirements in that site. correct answer- 1. Medically Underserved 2. Physician Primary Site 3. Physician Alternate Site 4. Facility Based Practice Site. * General requirements per TBON rule 222.5: regular visits, chart review as determined by APRN & physician, periodic face to face meeting of APRN & physician to discuss pt care & improvement. 1a) Medically Underserved correct answer- *site must be official, physician must be reachable by phone & must be provided with daily status report of any major problems outside of the protocol. *must have protocols. 1b) Physician Primary Practice Site correct answer- * Must have protocols. *Sign drug orders only for pts whom the MD has/will establish a relationship. *alternate MD may delegate. *MD may delegate to no more than 7 APNS or PAs. *Physician on-site visits should be 50% of the time according to BME. 1c) Facility Based Practice correct answer- *Must be physically present in facility (hospital or long term facility). *Physician must give prior consent. *Delegation only at one hospital or 2 long term care facilities - now it is 7 FTEs. *Long term care-only 4 APNs (APRNs) or 4 PAs or their FTE equivalent - now it is 7 FTE & approved by Chief Physician of Facility. *Protocol signed by the Chief Physician. 1d) Physician Alternate Site correct answer- *No longer in effect. 2. The FOUR Approved Categories of APN in TX? correct answer- *CRNA, NP, CNS, and CNM 3. NP requirements by BON for approval of license/ AP recognition each biennium. correct answer- *Current valid RN licensure. *400 hours of current clinical practice. *20 hours of CEs. *8 hours of continuing education in pharmacotherapeutics. *Current board certification. *Separate application for dual roles. 4. New NP graduate requirements when applying for the board? correct answer- *Must take and pass national certification exam. 5. What is the NP's scope of practice based on? correct answer- *Nurse practice acts define legal scope of practice for licensed practitioners. *Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement. 11. What are clinical privileges and how are they obtained? correct answer- *autonomy to perform expanded role functions based on the individuals licensure, educational preparation, clinical experience, and credentials. *Via contractual agreement with hospitals or long term care facilities. 12. Define Malpractice correct answer- *Any professional misconduct, unreasonable lack of skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct. *Negligence is the failure of an individual to do something that a reasonable person would do, that results in injury to another. *The alleged failure on the part of a professional to render services with the degree of care, diligence, and precaution that another member of the same profession in similar circumstances would render to prevent injury to some one else. 13. FOUR Elements of Malpractice correct answer- 1. Duty: provide some level of care, had some contact. 2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in similar practice. 3. Damage: Must have an injury or no malpractice even if violated standard of care; cap "pain and suffering" $250,000 to $500, 000. 4. Causation of Injury: For malpractice to have occurred, a breach of the standard of care must have caused an injury to the patient. 15. National Practitioner Data Bank correct answer- *Receives and discloses the reports on medical malpractice. Who is credited to be the first advanced practice nurse role? correct answer- Nurse Anesthesia in 1800's- perhaps the oldest advanced nursing specialty, Sister Mary Bernard at St. Vincent's Hospital was the first anesthetist Who is credited to be the founder of the first nurse practitioner role? correct answer- Loretta Ford-1965- Colorado Who is (are) the oldest primary care providers in the history of advanced practice nurses? correct answer- Midwifes in 1700's- perhaps the oldest primary health care provider Martha Bullard, 1785 is the oldest noted in publication What are the roles of APRNs? How are they different from each other? correct answer- To provide health care to individuals, family, groups in a variety of health care settings (homes, hospitals, institutions, offices, clinics, etc) APRN includes NP, nurse midwife, nurse anesthetist, and clinical nurse specialist What states are responsible for being the first to have advanced practice language in their nurse practice act? correct answer- Idaho (language read- "assess, diagnose, treat") What is NONPF? What is their influence for APRNs? correct answer- National Organization of Nurse Practitioner Faculty They have developed domains and competencies Organized role competencies (policy, ethics, quality, leadership, etc) How is the NP role different from PA role? correct answer- •PA's work directly under a MD, NP's can function independently •NP's focus on multiple practice and nursing models •PA's focus on medical tasks utilizing a medical framework What are the key elements of OTA, Brown, Safriet and Mundinger correct answer- • OTA NP's provide equivalent care to MD's. Patients who receive care form an NP show decreased patient symptoms. • Brown Patient satisfaction and resolution of pathological conditions were greater for NP's over MD's NM's use less technology/ analgesia NM's achieved equivalent neonatal outcomes • Safreit There is abundant data on the NP role in providing high quality, cost effective care/ There are major restrictions on the practice of NP's and these barriers should be removed. • Mundinger Compared outcomes in patients who were randomly assigned to either NP's or MD's. Results showed that patient outcomes were comparable. How does the Texas Board of Nursing define the NP role? correct answer- A RN approved by the board to practice as an APN based on completing an advanced education practice program acceptable by the board. The term includes an NP, nurse midwife, nurse anesthetist, and a CNS. The APN is prepared to practice in an expanded role to provide health care to individuals, families, and/or groups in a variety of settings including but not limited to homes, hospitals, institutions, offices, industry, schools, community agencies, public/private clinics and private practice. The APN acts independently and/or in collaboration with other health care professionals in the delivery of health care services. Where and when did the role first begin? correct answer- 1965- University of Colorado-PNP What factors have supported initiation of the role and its development over time? correct answer- 1.Changes socially/culturally •WW2, Vietnam war- needed anesthetist •Communities needed midwives, lack of prepared OB's 2.Changes in the Health care system •No physicians to administer anesthesia •Decrease in medical interns and MDs, and was therefore an increased need for the NP What are 3-5 major research outcomes (process or outcomes findings) about NP impact that you can document? correct answer- 1.NP's provide equivalent care to MD's •Process measures: Adequacy of pedi exams, medication prescribed, short and long term compliance •Outcome measures: improved patient functioning, resolution of acute problems, decreased pain or discomfort in children 2.NP's provide superior care to MD's •Process measures: # of diagnostic tests, effectiveness of interpersonal management skills •Outcome measures: reduced patient symptoms, better HTN control, increased weight reduction, pain decreased in adult patients, improved activity and decreased anxiety in chronic patients 3.Patients are generally satisfied with the quality of care provided by them, particularly with the interpersonal aspects of care. 4.NP's are a solution to healthcare system issues such as Access to Care, Quality of care and Cost of Care What are 3 major questions about the NP role and its impact that research should address? correct answer- 1.Does eligibility reimbursement for nurses cause loss of quality of care or incentive to help more people? 2.Would requiring a DNP for APN cause less nurses to become APN and therefore cause a greater shortage for the growing population. 3.Does have limitations on prescriptive authority cause a delay in care and pain management? What are 3 major healthcare system issues that can be impacted by the NP role? Describe how these can be impacted. correct answer- 1.Assess to care 2.Quality of care 3.Cost of care *According to Safreit, in order for NP's to be part of the solution, barriers to practice that exist must be removed. •Scope of Practice: no protocols, full authority to practice with no supervision •Unlimited prescriptive authority •Full reimbursement •Autonomy as a provider: hospital privileges What are 3 issues that can impact the NP role either positively or negatively? Describe how the issues can impact the role and what you think needs to be done to promote a positive outcome. correct answer- 1.DNP: positive side is lengths of programs are lengthy anyways with no change in credentialing awarded. You would not have to do or much extra, and you would have a DNP. Negative side is this might push nurses from continuing their education and the need for care providers should take precedent over professionalized agenda. 2.Prescriptive authority: increasing prescriptive authority could impact the role positively in that patients will not have a delay of care. Pain could be better managed. 3.Eligibility for reimbursement: offers larger groups of people in communities primary care but can also cause competition as NP's and MD's attempt to serve the same population. Also, umbrella corporations tend to give the NP a min number of patients to see and then offer incentive pay to see more. Loss of quality of care? Identify and be able to discuss the 3 phases of transition by Barton, 2007. correct answer- 1.The Identity Loss Phase •Early in the APN program. Come in as expert and now you are a novice nurse again. Try to separate from prior career. 2.Transitional Role Evolution •Uncertainty of the APN role continues. Feel a sense of role limbo and may feel invisible. Peers are important. Resocialization occurs acquiring individuality and new role identity. 3.Incorporation Phase •Occurs at the end of the program usually in the final practicum course. Change in relationship between RN peers. End of phase is passing of the APN certification exam What are the considerations towards transition from the RN to the APN role? correct answer- •Develop a Theoretical Nurse Practice Framework: emphasizes EBP, research, to stay on top of APN profession •Know the APN scope of practice •Choose appropriate preceptors that will encourage feelings of self worth •Get a mentor •Reflect each day •Maintain a clinical Elog (values, attitudes, practice) •Maintain a clinical portfolio •Network with peers and experienced NP's •Have a Positive Attitude •Maximize clinical experiences •Treat failures as learning experiences •Keep up with legal issues What are 5 major responsibilities of the RN role that you will bring to the NP role? correct answer- •Document •Educate •Observe and assess patients •Review treatment/care plan •Consult with MD's and other professionals Be able to identify/discuss top issues for the APN. correct answer- •You can become so specialized that you lose broad knowledge that is needed. •Some specialty roles are recognized in some places but not others. Ex: forensic NP in California but not in TX •There are so many credentials that it is confusing •Being recognized as a PCP as an NNP •Putting the MD name on a prescription bottle, pharmacies accepting NP scripts •Hospital privileges •Medicare and Medicaid reimbursements •Third parties can deny reimbursements to NP for care •Have to get an NPI number (everyone has to have it, don't really get why its an issue) •Autonomous APN Practice- no supervision by MD. Would have prescriptive authority •Has to be in protocols to delegate to anyone other than MA, NA •Needed md signature to order supplies •Social problem of discounting Discuss the evolution of the APN. correct answer- i.Includes Specialization: a concentration in a selected area of clinical nursing. •Includes specialties (pedi, women's health) and subspecialties (diabetes) ii.Involves expansion •Stage 1: Specialty begins- in a practice setting •Stage 2: Specialty organizes- institution training develops, specialty organization forms (NANN) •Stage 3: demands mount, knowledge base grows, scope of practice grows, regulations established to make sure public is safe, articles appear Is there a difference between the APRN, APN, and the Nurse Practitioner? If yes, elaborate? If no, elaborate. correct answer- •The NP is a type of APN. •APRN and APN are similar terms for the same thing. What are the 4 APRN Roles? correct answer- •Clinical nurse specialist (CNS), nurse anesthetist (CRNA), nurse midwife (CNM), and nurse practitioner (CNP) What are the recognized NP roles by the Consensus Model? correct answer- •Family, Adult-gerontology, neonatal, pediatrics, women's health/gender, and psychiatric-mental health Medicare and Medicaid reimburse the NP at what percentage of the physician's reimbursement? correct answer- •Medicare: 85% of the 80% the MD gets for reimbursement •Medicaid: 92% of the 80% of the MD unless its Texas healthy steps and then its 100% of what the MD gets Organizations and Resources: What is CNAP/ NONPF? NAPNAP" NANN? AANP? ANCC? Tri Council? AACN? TNP? correct answer- •CNAP: Coalition for Nurses in Advanced Practice •NONPF: The National Organization of Nurse Practitioner Faculties- promotes quality nurse practitioner education at the national level •NAPNAP: National Association of Pediatric Nurse Practitioners: organization for PNP's •NANN: National Association of Neonatal Nurses • AANP: American Association of Nurse Practitioners •ANCC: American Nurses Credentialing Center •Tri Council: organized to advance policy at national level •AACN: American Association of Critical-Care Nurses •TNP: Texas Nurse Practitioner Which of these organizations in question 7 is responsible for certification of APRNs? What are the renewal requirements of the certification by the recognized organization(s) in questions 7? correct answer- •ANCC- American Nurses Credentialing Center, renewed every 5 years. 150 Contact hours. Min of 1000 practice hours. Testing if you do not have practice hours. Can a Blog be accessed by the public? True or False? Explain. correct answer- •Yes, it can be disseminated to others Are confidentiality and privacy the same? Explain. correct answer- •NO they are different. •Confidentiality has to do with sharing only the information with the patients informed consent or that is required if not disclosing the information could result in patient harm. Or sharing with other health care members for the purpose of providing care. •Privacy: has to do with the patient's expectation and right to be treated with dignity and respect. "need to know" What are the steps to avoid for inappropriate us of social media by the NP? correct answer- •Ethical and legal obligation to maintain privacy and confidentiality at all times. •Prohibited from transmitting electronic media any patient-related image •Do not identify patients by name or give info that can identify them •Do not refer to patients in a disparaging manner •Take photos or videos on personal devices •Maintain professional boundaries with patients in the online environment •Consult employer policies and comply with them •Promptly report any identified breach •Do not make disparaging remarks about employers or co-workers •Do not post content or speak on behalf of the employer unless authorized to do so What are the 6 tips to avoid as listed by ANA? correct answer- 1.Standards of professionalism are the same online as in any other circumstance 2.Do not share of post info or photos gained through the nurse-patient relationship 3.Maintain professional boundaries in the use of electronic media. Online contact blurs the boundaries 4.Do not make disparaging remarks about patients, employers, or coworkers 5.Do not take photos or videos of patients on personal devices 6.Promptly report a breach of confidentiality or privacy What are 3 key elements of any healthcare system and how do these interact with each other? correct answer- -Cost -Access -Quality -change in any one of the parameters above changes the remaining two Describe primary care and discuss how your specialty role relates to the primary care system. correct answer- -Primary Care: (Buppert pg 7-8) •the provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs •when a consumer makes contact with a healthcare provider who assumes responsibility and accountability for the continuity of healthcare regardless of the presence or absence of a disease •the healthcare which the clients receive at the first point of contact with the healthcare system that is continuous and comprehensive, included health promotion, prevention of the disease and disability, health maintenance, rehabilitation, identification of health problems, management of health problems, and referral •The NNP provides very specialized care to a specific group of patients in the NICU in collaboration with the neonatologist. How can (and how has) the NP role been affecting healthcare in the US? correct answer- (Buppert pg 7) The NP can address a need for more primary providers in underserved areas of the nation, as well as address changes in health care from the Affordable Care Act. As more health plans designate certain generalist physicians as PCPs for groups of patients, it is important for NPs to be included in the definition of PCP. It is also important for NPs to be included as providers who can be a "medical home" for a patient. What identified issues drive health care changes? correct answer- Employers wanting lower premium costs, improved QOC, and enhanced employee benefit packages. Increases in cost of health care services (cost rising twice as fast as wages). Not enough primary care physicians. Fear about government intervention/control. Lack of universal access to care. Growing complexity of health care system. Growing number of uninsured (12.4 million women and 8 million children). Health Care Triangle (Costs, Access, Quality) Health Care System Basics (Cost, Access, Quality) - a change in one parameter changes the remaining two What are the various organizational designs of managed care delivery systems? correct answer- A.HMO (Health Maintenance Organizations) - Primary feature is the sharing of financial risk between insurer and care provider. Comprehensive care for fixed costs. Cost control is limitations of patient seeking services and services being referred. 3 types 1st - Staff Model: health care providers are salaried employees of health plan, more control over services allowed 2nd - IPAs (Independent Practice Associations): contracts are made with health care providers in private practice settings to offer health care services to HMO members, less control over how services are used 3rd - Network: a combination of staff and IPA B.PPO (Preferred Provider Organization) - discounted fee agreements, seeking outside of list will result in higher costs C.POS (Point of Service) - patients can select their choice of provider at the time the service is needed rather than upon entry into plan D.UR (Utilization Review Companies) - assist in monitoring how and what health care services are being used, authorize services requested, validates claims submitted, monitoring of and reporting on the medical necessity of services provided E.EPO (Exclusive Provider Organizations) - contracts with 1 hospital to service the HMO members with a specific set of health care providers, if don't use contracted group pay total cost out of pocket F.Managed Insurance - traditional insurance companies that implement some sort of the managed care principles ex BCBS, Aetna, Cigna, Kaiser, Humana What are the attributes of the PCP according to Joel? correct answer- Primary Clinical Practitioner: -comprehensive assessment -diagnosis of health and disease -treatment and management -referral to other professionals -counseling -leadership and management -health promotion and disease prevention What does Joel identify as the principles guiding the Medical Home Model? correct answer- MHM is an ongoing relationship with the health care provider to provide first contact, continuous, and comprehensive care. Should include: active patient participation, enhanced access, open scheduling and expanded hours, new patient communication and potentials via email/phone, emphasis on preventive services for all age groups. Identify seven external forces affecting health care delivery? correct answer- A. Social Values - ethnic diversity, cultural diversity, social cohesion B. Global Influences - immigration, trade and travel, terrorism, epidemics C. Economic conditions - general economy, competition D. Technology development - biotechnology, information systems E. Population characteristics - demographic trends and issues, health needs, social morbidity (AIDS, drugs, homicides, auto accidents) F. Physical environment - toxic waste, air pollutants, chemicals, sanitation, ecological balance, global warming G. Political climate - president and congress, interest groups, laws and regulations Social Media What are the 4 settings for prescriptive authority? correct answer- 1. Medically Underserved (site must be official-federal or state) 2. Physician Primary Site 3. Physician Alternate Site 4. Facility Based Practice Site (licensed hospital/LTC) Describe the requirements in each setting for physician supervision, # of NPs, chart review, and any other special requirements in that site. correct answer- *Medically Underserved- Physician SupervisionReachable by phone provided daily status report of major problems, onsite 10% of hours of operationChart Review10%-Special RequirementsMust have protocols *Physician Primary Site-Physician Supervision-Must have protocols, physician on site 50% of the time--# of NPs-7 APNs/PAs per MD *Physician Alternate Site-Physician Supervision-Physician reachable, on site 10% of the time, within 75 miles of primary practice *Facility Based Practice Site-Physician Supervision-MD present at facility, MD gives prior consent--# of NPs-7 FTEs-Special Requirements-Protocol signed by MD What are the 4 approved categories of advanced practice nurses in Texas? correct answer- CRNA, NP, CNS, and CNM What things does the Board of Nursing require the NP to have before approving for RN license/advanced practice recognition each biennium? correct answer- -Current valid RN licensure. -400 hours of current clinical practice. -20 hours of CEs. -8 hours of continuing education in pharmacotherapeutics. -Current board certification. -Separate application for dual roles. What are the requirements for the new NP graduate when applying to the Board? What does initial approval look like? correct answer- -Texas BON grants authorization, APRN licensure (not advanced practice titles) -Must take and pass national certification exam. What is the NP's scope of practice based on? correct answer- -Educational preparation, continued advance practice experience, Accepted scope of professional practice of specialty organizations -Nurse practice acts define legal scope of practice for licensed practitioners. -Includes privileges for diagnosis, treatment, prescriptive authority and reimbursement. How would an NP change his/her scope of practice? What would be required? correct answer- -Proof of graduation from APN program and/or national certification. Need post-master's certificate and MSN How is the term "protocol" defined in Texas? correct answer- -Texas: protocols as written authorization to initiate medical aspects of care (allow APN to exercise professional judgment and are not required to outline specific steps APN must take) What are the key elements of a protocol or practice agreement? correct answer- -Broad enough to allow APN to exercise judgment ("but not limited to...") -Accessible to verify authority to provide medical aspects of care -Maintained, review and re-sign annually Are NPs in Texas allowed to prescribe controlled substances? If so, what is required to be able to do this? What are limitations, if present, on this kind of prescribing? correct answer- -Must obtain valid Rx authority number (must practice in qualifying site, MD/DO must delegate authority per delegation protocols, MD/DO must register name and license of APN with BME, APN registration of Prescriptive authority form) -Must apply for DEA number: -Forms provided by board -Limitations: -Prescribe per protocols and scope -controlled substances: schedules III, IV, and V -Issued for only 90 day period -Must consult with MD/DO for refills -Not authorized for child less than 2 y/o without consulting MD/DO -Document consult -DEA # of MD/DO must be on the prescriptive authority -APN's DEA and DPS must be on prescription Can you delegate medication administration to an unlicensed person? If not, how would you manage this in a primary care setting? correct answer- -Cannot delegate to MA, LVN, CNA, but MD can delegate to NP to delegate to MA, LVN, or CNA What are clinical privileges and how are they obtained? correct answer- -Clinical privileges the autonomy to perform expanded role functions based on the -individual's licensure, educational preparation, clinical experience, and credentials. -Via contractual agreement with hospitals or long term care facilities. Obtaining: -acceptance of APN by medical and hospital staff -clear definition and approval of the scope of practice of APNs -development of entry & credentialing process -revision of hospital and nursing policies to reflect expanded nurse roles How is malpractice defined? correct answer- -Any professional misconduct, unreasonable lack of skill, or infidelity in professional or fiduciary duties, or illegal or immoral conduct. What are the 4 key elements of malpractice that must be proven for malpractice to have occurred? Give a clinical example of each one. correct answer- 1. Duty: provide some level of care, had some contact. (even bad advice on the phone/neighbor). If you give professional advice or treatment in ANY setting, a duty may be established. 2. Dereliction: reasonable, ordinary care, skill and diligence as NP's in good standing in similar practice. Evidence-based practice 3. Damage: Must have an injury or no malpractice even if violated standard of care; cap "pain and suffering" $250,000 to $500,000. 4. Causation of Injury: For malpractice to have occurred, a breach of the standard of care must have caused an injury to the patient. What is the difference between a claims-made and an occurrence based malpractice policy? correct answer- Claims-made coverage: only those claims filed during the policy coverage period, regardless of when they occurred (buy tail insurance as needed- coverage extension- large lump sum) Occurrence-based coverage: covers events of alleged malpractice which occurred during the policy period, regardless of the date of discovery or when the claim was filed (all NPs should obtain their own occurrence insurance per Dr. Adams- keep your policy letter showing you were covered back then) What is the National Practitioner Data Bank? correct answer- Tracks actions against health care practitioenrs, all hospitals query data bank q2years, not available to public thought. Receives and discloses the reports on medical malpractice. What are at least 5 things you can do to prevent malpractice claims? correct answer- -Care in establishing pt-provider relationship -Know the standard of care & practice within it -Follow practice guidelines &/or protocols -If in doubt, take conservative approach -Rule out worst diagnosis early on -Know your limits (training & experience) -Follow-up with pt & document the plan to do so -Effective interpersonal relationships -Careful, complete documentation in chart What are 3 things you should do and/or not do if you are notified of a malpractice claim? correct answer- Call your liability insurance company Do not talk about the suit with anyone Retain your attorney (provided by insurance company) Never change a record (your insurance company can drop coverage) A deposition can be as important as trial (and can prevent a trial) Think carefully before agreeing to settlement (goes on record with NPDB) What are key characteristics of an effective collaborative relationship? correct answer- Trust- ensures a high-quality working relationship, develops over time Knowledge- knowledge and trust remove the need for supervision Shared responsibility - joint decision making for quality patient care and outcomes, as well as accountable practice Mutual respect- for the expertise of all members of the team should be the norm Communication- not heirarchial but rather two way to ensure the sharing of patient information and knowledge, questioning the approach to care of either partner cannot be delivered in a manner that is construed as criticism, but as method to enhance knowledge and improved patient care Cooperation/Coordination- promote the use of the skills of all team members, prevent duplication, and enhance the productivity of the practice Optimism- promotes success when the involved parties believe that collaboration is the more effective means of promoting high quality of care What specific things can you do to promote effective collaboration? correct answer- Create a collegial team, accept growth and development as a joint responsibility, use protocols and guidelines wisely, watch your language, socialize students to communication skills needed for collaborative interactions.Agreement on common purpose, effective communication, must have frequent and direct communication for a positive collaborative practice, value and acknowledge each providers contribution, implement role negotiation and conflict resolution on a daily basis to preserve relationship. What are three key characteristics from Joel of the definition or essentials of collaboration? correct answer- Essential Components: Separate and unique practice spheres - autonomous, trusting relationship; confidence in partner's skill Common goals - bidirectional referrals and consultation Shared power control Mutual concerns - consensus-driven decision making; equitable reporting lines and evaluators; mutually defined goals of the practice; open, informal communication; parity between providers (physical space, caseload, and support staff); positive support by collegues, support staff, and consumers What are three key competencies identified by Joel for to achieve collaborative practice? correct answer- Assertiveness, communication skills, conflict management, cooperation, coordination, clinical skills, mutual respect, decision making skills, positive attitude, trust, willingness to dialogue How do decision-making and communication interact with each other to affect collaboration? correct answer- Poor communication patterns also affect working relationships and seriously hinder any attempts at collaboration, often resulting in separate professional decision-making that can create confusion and safety issues. Physician abuse - result of poor communication and lack of trust, creating a defensive, noncollaborative practice environment in which the number of errors rises and patient safety and positive outcomes are threatened. Line of reporting accountability What are major steps having to do with communication that are helpful to achieve and/or improve Collaboration? correct answer- Create a collegial team, accept growth and development as a joint responsibility, use protocols and guidelines wisely, watch your language, socialize students to communication skills needed for collaborative interactions. Agreement on common purpose, effective communication, must have frequent and direct communication for a positive collaborative practice, value and acknowledge each providers contribution, implement role negotiation and conflict resolution on a daily basis to preserve relationship. What is a specific strategy you will use in your first NP position to overcome barriers to collaboration identified by Clarin (2007)? (First list the barriers she identified.) correct answer- Joel states: educational isolation, professional elitism, organizational hierarchy, unrecognized diversity, role and language confusion, inadequate communication patterns, professional dissonance. Clarin states: lack of knowledge on NP scope of practice, lack of knowledge about NP role, poor physician attitude, lack of respect, poor communication, patient and family reluctance to NP care. Participate in interdisciplinary rounds to visibly show the pt/family the NP's involvement with the medical management of care. What approximate percentage of revenue generated is used for office overhead? correct answer- Rule of Thumb is 50%. Larger practices with lower overhead (cost to open practices doors, salaries, rent, utilities, phones, etc), due to economies of scale might be 25-35% What key data do you need to be able to track your revenue generation? Use specific terms to answer. correct answer- Revenue - income generated Volume - the number of services provided Price - income received for each service provided Ex: -20pts/day, 100pts/week, 4800pts/year over 48 weeks -Average $85 reimbursement per patient (each practice will be different, includes labs, and only collected billings, and based on federal payers (Medicare), state payers (Medicaid), third party payers (insurance companies), or self pay -4800 x $85.00 = $408,000 revenue generation What kind of financial data will you ask the office manager to receive? correct answer- Buppert pg 350-351) - Name - Address - Telephone Number - Social Security Number - DOB - Method of payment: insurance, cash, credit card - Insurance company name, address, and telephone number - Copy of insurance card - Emergency contact name, address, and telephone number What are all the sources of revenue that you will need to track in your practice? correct answer- (Joel pg 204) In addition to patient services, organizations may generate other operating revenue such as: parking garage or cafeteria, or indirect research revenue, the overhead received from research sponsors for providing facilities and administrative support for research projects. What kind of billing can an NP submit for hospitalized patients on which she/he is rounding? What is required for billing? How is the physician involved in this billing? correct answer- Medicare: In-hospital care, the NPs services can not be billed separately to Medicare id the NPs salary is reported as part of the annual cost report (NP employed by hospital); if the hospital is not receiving reimbursement for the NPs salary as a component of the annual cost report or the NP is part of a physician group or is a subcontractor to the hospital, the NP services can be billed as a component of Medicare Part B physician services; an NP can not take over care of the patient on his/her own because federal law requires that a patient is under the care of a physician Name 3 factors used to calculate the RVUs score. correct answer- Practice Expense: the practice's overhead expenses Work: physician's time, intensity, and technical skill required for the service, mental effort and judgment Malpractice Expense What is the intended purpose of RVUs? correct answer- To determine the physician fee schedule based on variety of factors including geographic location. Services are reimbursed on the basis of resources related to the procedure rather than historical trends. Physician services are paid on a fixed fee schedule. What data are needed to calculate an NP's productivity? correct answer- Level of visit code. Number of patients seen. Other revenue from labs, etc. Patient age and ICD-9 code profiles. Patient satisfaction. Number of patients seen daily, weekly, monthly, annually. Level and type of service provided. Accurate tracking of patients and receipts. What is the percentage of overhead expenses in a medical practice range from the lowest to the highest? correct answer- 25-50% of the productivity income What is considered a typical payment rate to a physician collaborator by an NP with an Independent practice? correct answer- The NP pays the physician 10% of net revenue for consultation fee. What is the difference between the resume and the curriculum vitae (CV correct answer- The CV is an overview of your professional life, everything you have done professionally. A resume is a general and concise introduction of your experiences and skills as they relate to a particular career or position that you are aiming to acquire. When should the resume be used? correct answer- A resume is used to apply to most non-academic jobs When should the CV be used? correct answer- CVs are mostly used when applying for faculty positions, for grants or fellowships or for research positions in industry, academia or government. Whenever your research productivity and teaching experience would be valued. How often should both be revised/updated? correct answer- Every 6 months When and how could each be required to submit in the course of the career of the APN? correct answer- Resume- for each time you apply for a job or advancement within current position. CV- Any time you apply for a faculty positions, grants or fellowships or for research positions, academia or government. What are the steps of the marketing process? correct answer- •Assessment of personal and professional goals, Planning, Implementation (updated resumes, prepared for interviews), Evaluation What are the 4 "Ps" of marketing? Discuss the characteristics of each of the "Ps". Discuss the characteristics of the 5th "P". correct answer- 1.Product - The service the APN offers. "YOU!" Consider the benefit of the product (Convenience, uniqueness, quality, economy, scope of service.) 2.Place - The location and environment for the APN practice 3.Price - The monetary value exchanged for the services of the APN--Profit - sum of money left over after revenue is generated and bills are paid. Fixed Costs. Variable costs. Total Costs 4.Promotion - The marketing of the services offered and available by the APN to the target population/group/community 5.Public relations-The "5th P"-Establish a plan for public relations. Consider hiring a public relations agent Discuss marketing and the 10 key questions to be considered related to marketing. correct answer- •What are we in and what is the purpose for the organization's existence? •Who is the client? •What is the client's need? •Which markets should the organization be addressing? •What are the strengths of the organization? •What are the weaknesses of the organization that need to be attended to? •Who are the competitors? •Which groups (sections/targets do we want to serve in the community? •What are our marketing strategies to communicate to these groups? •What strategies should we develop related to pricing, promotion, access, and the types of services offered? Identify and describe the current marketable skills as related to traditional roles of the NP. correct answer- A.Clinician B.Consultant C.Educator D.Researcher E.Administrator Describe/discuss ownership or structure of a business. Sole Proprietorship - correct answer- a.Owned and operated by one person b.Simple organization c.Easy to form / inexpensive d.Owner resumes all responsibility and risk e.Advantages i.Owner makes all decisions ii.Losses can be deducted from person income iii.No potential liability for purchases, mistakes or bad judgments from partners iv.No double taxation f.Disadvantages i.Owner responsible for all expenses ii.Ups and down are managed alone Describe/discuss ownership or structure of a business. Partnership- correct answer- a.The association of two or more people to carry on a business and make a profit b.Are relatively easy to form c.Liabilities for debts and expenses are shared d.Capital is easier to obtain e.Decisions to be made: i.If a partner dies, is sued, wants out; how losses and profits are divided, how are decisions made, ii.Who is the administrator -shared? f.Advantages: i.Risk is shared ii.Success and failure are shared iii.Losses can be deducted from individual partner's taxable income iv.There is back-up for individual partners in a practice g.Disadvantages i.Debt