NR510 Week 7 Discussion Part 2: Interprofessional Collaboration

NR510 Week 7 Discussion Part 2: Interprofessional Collaboration A fellow NP at the table responded: An increasing number of practices are scrapping the traditional one-on-one doctor- patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising physician still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases. Discussion Question: What are your thoughts on interprofessional collaboration? Provide evidence to support your response. Topic responses • • More Sort By:    Molly McIntyre Part 2 8/14/2016 8:47:47 PM According to Sangster-Gormley, Griffith, Schreiber, Borycki, Feddema, and Thompson (2015) the goal of interprofessional collaboration is to create an environment of trust, open communication, and respect to share knowledge and experience to problem solve and make decisions. If done successfully, the result can be an efficient practice providing safe patient care with seamless patient transitions (Sangster-Gormley et al., 2015). When nurse practitioners (NP) are added to the interprofessional team, they produce effective, safe patient care and add efficiency to the practice as a whole. Depending on the NP's experience, the physician can expect the experienced NP to function independently and manage their own part of the practice while the less experienced NP will need mentoring and support in the NP-physician relationship; this relationship should be discussed prior to beginning working together (Sangster-Gormley et al., 2015). A major barrier or facilitator to interprofessional collaboration is the physician-NP relationship and depends on whether a supportive relationship with clearly defined roles is established or not (Sangster-Gormley et al., 2015). I hope to one day be working in a practice that fully embraces a supportive, healthy interprofessional collaboration. Reference Sangster-Gormley. E., Griffith, J., Schreiber, R., Borycki, E., Feddema, A., Thompson, J. (2015). Interprofessional collaboration: Co-workers perceptions of adding nurse practitioners in primary care teams. Quality in Primary Care, 23(3), 122-126. Retrieved from Show Less Instructor Duncanreply to Molly McIntyre RE: Part 2 Hi Molly, 8/17/2016 11:36:59 PM Interprofessional communication directly influences the organizational culture, and vice versa. Therefore, it is important you lead by example when you enter a new practice so that your leadership behaviors and communication will shine and improve the practice. Dr. Duncan Show Less Mijanou Marretta-Lewis Discussion Part Two 8/15/2016 9:45:50 AM Some physicians believe their opposing counterparts think this is more of a territory issue that threatens their economy and professional superiority. Some opposition also believes that there is a lack of clinical expertise that degrades the quality of care being given by the nurse practitioner. There are those in the American Academy of Family Practitioners that believe against widening the scope-of practice for the nurse practitioner while the American College of Physicians (ACP) suggests taking a wait and see policy (Page, 2014). From research NPs have worked well with physicians even when they have an independent practice as nurses are more inclined to working using a team approach (Page, 2014). It would enhance the practice to work with the NP for better patient care then fight against the inevitable change. Many physicians believe that the supervision of the NP is not only resented but remains pointless, as physicians that are off site do not monitor in real time anyway (Horrocks, Anderson & Salisbury 2002). The complication arises when there is a lack of delineation with the scope of practice by the states for the NP. In Ohio the Standard of Agreement with the supervision of the physician is a written agreement but there remain no consistent understanding of skill sets or limitations in regards to the NPs practice. The NP who has a complicated case has in the past referred that patient to a specialist not because the NP lacks the training as a family practitioner but because the patient needs a specialized practitioner for their condition. In many cases due to the Affordability Act, the need for primary care providers has increased to such a level that physicians are no longer able to supply the demand for care (Peterson, Phillips, Puffer, Bazemore & Petterson, 2013). It was discovered in a survey conducted by the American Board of Family Medicine, of the 5818 physician pooled across the United States, nearly 60% stated they routinely worked with NPs especially those in the rural are. This 60% were a younger group of physicians under the age of 50 and stated they enjoyed working with NPs to help meet the needs of health care by alleviating difficult patient access to health care. This same group acknowledged the shortage of primary care physician in the rural setting and felt the skills of the NPs met the needs of the under-served population (Peterson et a., 2014). With a major push to expand the scope-of-practice and break the barriers of regulatory restrictions this will allow the NP the ability to practice with more autonomy and allow for better access and quality outcomes for patients especially in the rural and underserved population (Odell, Kippenbrock, Buron, 2013). Coordinating care with a multidisciplinary team will enhance the outcome and allow for more education of disease prevention and meet the needs of our more diverse populations who are challenged navigating the healthcare system. Mijanou References Page, L. (2014) Physicians, NPs and Pas: Where’s this all going? Retrieved from Horrocks S, Anderson E, Salisbury C.(2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal. 324(7341):819-823. doi:10.1136/bmj.324.7341.819 Peterson LE, Phillips RL, Puffer JC, Bazemore A, Petterson S.(2013) Most family physicians work routinely with nurse practitioners, physician assistants, or certified nurse midwives. Journal of Am Board Fam Med.26 (3):.3122/jabfm.2013.03.120312 Peterson, L. E., Blackburn, B., Petterson, S., Puffer, J. C., Bazemore, A., & Phillips, R. L. (2014). Which family physicians work routinely with nurse practitioners, physician assistants or certified nurse midwives. The Journal of Rural Health, 30(3), .1111/jrh.12053 Odell,E.,Kippenbrock,T., Buron.W., Narcisse, M.R. (2013). Gaps in primary care of rural and underserved populations: The impact of nurse practitioners in four Mississippi Delta states. Journal of the American Association of Nurse Practitioners 25(12): 659-666. doi:10.111/ Show Less Kirsten Englishreply to Mijanou Marretta-Lewis RE: Discussion Part Two 8/21/2016 6:56:19 PM Hello Mijanou, I really enjoyed reading your post, they are always so thorough and informative! There is significant evidence that suggests successful inter-professional collaboration leadShow More Jose DelAcruz Discussion Part Two 8/16/2016 7:00:45 AM Hello Dr Duncan and Classmates, Nurse Practitioners (NPs) play a significant role in meeting the rising demand for primary caregivers, especially in the underserved regions. NPs unShow More Mijanou Marretta-Lewisreply to Jose DelAcruz RE: Discussion Part Two Jose’, 8/17/2016 11:11:00 AM Both of us live in states that have some restrictions on the scope of practice of the nurse practitioner (NP). Hain and Fleck (2014) have emphasized the need for continued collaboration of both physicians and NPs in the best interest of the patients and their quality of health. What would be interesting to hear is form those who have independent practice with full authority. Those in the 21 states that have independent practice appear to answer only to their start board only. These NPs appear to have the education and skills to know when a patient comes in that are in a critical state, they refer them to the appropriate specialist. The need to collaborate and network with willing physicians when practicing in any state would be advantageous for the NP as well as the patient population. The current need for primary care specialist in the NP profession in the state of Ohio is growing, jobs are being offered to those of us who are students with commitments prior to our graduation. Preceptors are asking if we would be willing to work for them prior to signing up as preceptors as this appears to hinge on whether they will consider taking us on a student NPs. This nurse wonders what you are experiencing in your state as you pursue looking for sites to precept in. Currently my primary care NP who has been in practice since 1988, is very disillusioned with the group she is working for. She told this nurse to shop for a boss who will support and encourage me and find out how that physician is supportive of the NP in practice. It has been an eye opening experience, this course to find out about the Standard of Care contracts the amount of money physicians are paid to oversee a practice even when they are not present. The situation of the Ohio NP has become a controversial and complicated battlefield in regulation and legislation. Being a member of the Ohio Association of Advanced Practices Nurses has been an eye opening experience. This summer Bill HG 216 was approved but has not passed as law in Ohio. This law introduced is an attempt to modernize laws allowing advanced practice nurses (APNs) to practice to the full extent of the education, training and certification. This legislation will help to address the shortage of primary care providers in Ohio. Ohio’s laws are currently outdated and interfere with the APRNs ability to provide the needed primary health care, especially to the vulnerable populations in medically under-served populations. HB.216 is not considered an expansion of the scope-of-practice; it just removes the barriers that are unnecessary for the APRN to practice. Those barriers cause a delay in treatment and contribute to inefficient health care. HB 216 includes: • Removal of mandated, written practice arrangements with a physician • Removal of physician supervision required for certified registered nurse anesthetists. • Removal of confusing and unnecessary, multi-page (35 plus pages) drug formulary (Ohio Association of Advanced Practice Nurses, 2016). As the number of primary care physicians decline in Ohio out healthcare system is at a critical level to provide quality needed care and changes are overdue. This imbalance puts Ohioans at risk health wise for high-quality care and NPs are able and willing to fill that gap and become a part of the solution. This legislation will modernize current practices and expand the number of primary care providers in Ohio. Currently 40 percent of states and the District of Columbia allow APRNs to practice without mandated collaborating or supervising physicians, including prescriptive authority. Research has shown APRNs give quality of care and remain safe and effective. For Ohio, it is a beginning. Mijanou References