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 *Protocol signed by the Chief Physician. 1d) Physician Alternate Site correct answer- *No longer in effect. 2.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