Discussion 10.1: Scope of Practice and Patient Safety

Discussion 10.1: Scope of Practice and Patient Safety

The following post is a reflection on the American Medical Association’s (AMA) video interview with Michaela Sternstein, JD regarding scope of practice and patient safety. Michaela is the vice president of the AMA’s State Advocacy Resource Center. The interview detailed Michaela’s work in defining scope of practice between physician and non-physician providers. I agree with Michaela’s perspective that clear scope of practice guidelines allow physicians, non-physicians, and the entire healthcare team to work more efficiently together. Michaela mentions the importance for patients to understand the different members that make up their healthcare team. Healthcare encompasses a wide range of professions with varying skill sets. It can be confusing to patients to understand who is responsible for what part of their care. For example, I had a patient referred to our dermatologist by their oncologist for a skin rash. The dermatologist I work with specializes in oncodermatology. The patient was upset when the physician was not also a trained oncologist, even though their oncologist was the one that referred them. The COVID-19 pandemic put a new emphasis on healthcare workers in the media. El-Awaisi et al. (2020) used social media to determine the public perception of members in the healthcare team. Results found majority (57.9%) of social media users were discouraged with public perceptions focusing on doctors and nurses when other professions, like physician assistants, greatly contribute to patient care (El-Awaisi et al., 2020). Public education and awareness to the different titles and roles in healthcare is the first step to patients becoming familiar with their healthcare team. I disagreed with Michaela’s notion that physician assistants are wasting their time and resources lobbying for a name change. Titles are less important to colleagues in healthcare who already understand the role. However, titles can lead patients to make assumptions regarding a role without any background knowledge on the position. For example, physician assistant (PA) and medical assistant are two similar titles. Physician assistants are non-physician providers with a master’s degree that can diagnose and treat patients. On the other hand, medical assistants have a high school diploma/GED with a 1–2-year program to become certified clinical support staff. Staff in these roles have two different levels of education and responsibility in patient care. The names can be deceiving to people outside of healthcare. The American Academy of Physician Assistants (2021) officially changed their title from physician assistant to physician associate to reflect their role more accurately in healthcare as a non-physician provider. The title change will be an extensive process to implement, but it will be worth it for the PA community to feel comfortable with their title and role.

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Discussion 10.1: Scope of Practice and Patient Safety

References

American Academy of Physician Assistants. (2021). Title change. AAPA. https://www.aapa.org/title-change/

El-Awaisi, A., O’Carroll, V., Koraysh, S., Koummich, S., & Huber, M. (2020). Perceptions of who is in the healthcare team? A content analysis of social media posts during COVID-19 pandemic. Journal of Interprofessional Care, 34(5), 622–632. https://doi.org/10.1080/13561820.2020.1819779

Stucky, C. H., Brown, W. J., & Stucky, M. G. (2020). COVID 19: An unprecedented opportunity for nurse practitioners to reform healthcare and advocate for permanent full practice authority. Nursing Forum, 56(1), 222–227. https://doi.org/10.1111/nuf.12515

Discussion 10.1: Scope of Practice and Patient Safety

Hi Skylar

It is apparent that scope of practice in the framework of healthcare practices has for long been a relatively controversial topic that has generated divergent opinions among distinct medical stakeholders. Based on the insights of the interview, I concur with your indications that laying out a lucid scope of practice guidelines for both physicians and non-physicians is integral towards fostering improved quality patient care. According to Cawley and Hooker (2018), clear scope of practice framework constitutes the fundamental basis for the development of collaborative care teams, which is critical in the realization of quality care deliverables among distinct healthcare providers. However, while it is true that patients require comprehensive awareness regarding distinct roles in healthcare, don’t you think that Michaela may also be right to insinuate that physician assistants may be wasting time lobbying for a title change? Although title transformation may indeed lead to the realization of the prevailing roles of physician assistants in contemporary care practices, it may also negatively alter the patients’ comprehension of the evolving responsibilities of non-physician assistants, thus putting the safety of patients in jeopardy (Al-Agba & Bernard, 2020).

References

Al-Agba, N., & Bernard, R. (2020). Patients at risk: The rise of the nurse practitioner and physician assistant in healthcare. Universal-Publishers.

Cawley, J. F., & Hooker, R. S. (2018). Determinants of the physician assistant/associate concept in global health systems. Int J Healthcare,k,4(1), 50-60. https://doi.org/10.5430/ijh.v4n1p50

Hello Skylar,

I agree with you that scope of practice between physician and non-physician providers creates a conducive environment for physician and non-physician providers to work together. The harmony and coexistence between these two groups of workers benefit both organizations and patients (Leem et al., 2019).  The scope of practice specifies the assignments rendered to both physicians and non-physician providers to reduce chances of conflict of interests or any form of disagreement between parties. The American Medical Association’s (AMA) understands the importance of coordination between physician and non-physician providers (Choi et al., 2019). Therefore, the organization leadership has created scope of practice to safeguard work environment for both groups of physicians. The outbreak of COVID-19 pandemic necessitated additional nurses to attend to the increasing new cases of infections. As a result, physician and non-physician providers were important in handling patients of the pandemic both within and outside healthcare facilities.

References

Choi, S., Jang, S. G., & Lee, W. (2019). The scope of practice for registered nurses in 64 South Korean laws. Journal of Korean Academy of Nursing49(6), 760-770. DOI: https://doi.org/10.4040/jkan.2019.49.6.760

Links to an external site.

Leem, C. S., Choi, S. J., Lim, K. C., Yi, Y. H., Jeong, J. S., Shin, Y., … & Kim, E. M. (2019). Common scope of practice for advanced practice nurses in Korea derived from expert agreement. Journal of Korean Critical Care Nursing12(3), 35-49. DOI: https://doi.org/10.34250/jkccn.2019.12.3.35

Links to an external site.

Hello Evans

You provided a concise reflection of the video. Indeed, a clear scope of practice guidelines allows physicians, non-physicians, and the entire healthcare team to work more efficiently together. I also agree that it is important for patients to understand the different members that make up their healthcare team. Do you agree with the speaker’s view that the scope of practice should not be expanded to allow nurses to practice independently? Perhaps you could expound your view on this observation because the speaker presents that physicians undergo lengthy and vigorous training that prepares them to become leaders. In my view, I agree with the speaker. My discussion established that nurse practitioners are important members of the Physician-led healthcare team but they are not trained to practice independently. Nurses are not required to go through years of medical residency training and get only 500 to 720 hours of clinical training compared to the 10,000 to 16,000 hours that physicians receive (Peacock & Hernandez, 2020). It would be unjust and morally wrong to place nurses and physicians at the same level despite physicians going through more lengthy and cumbersome training (Peacock & Hernandez, 2020). Again, what is your thought on the speaker’s point that expanding the scope of practice will not increase access to health care? I also support the view because States like Oregon which allow for independent practice have not witnessed any significant shift of nurses to rural areas (Feyereisen & Puro, 2020). On the contrary, evidence demonstrates that states that need physician-led health care teams have witnessed a significant increase in the number of nurse practitioners as opposed to states that allow independent practice (Tsuyuki et al., 2018). You had an excellent discussion. 

References 

Feyereisen, S., & Puro, N. (2020). Seventeen states enacted executive orders expanding advanced practice nurses’ scopes of practice during the first 21 days of the COVID-19 pandemic. Rural and Remote Health20(4). DOI:10.22605/RRH6068

Peacock, M., & Hernandez, S. (2020). A concept analysis of nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners32(2), 113-119. doi: 10.1097/JXX.0000000000000374

Tsuyuki, R. T., Houle, S. K., & Okada, H. (2018). Time to give up on expanded scope of practice. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada151(5), 286-286. https://doi.org/10.1177/1715163518793844

Grading Rubric Guidelines

Performance Category 10 9 8 4 0
Scholarliness

Demonstrates achievement of scholarly inquiry for professional and academic decisions.

  • Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
  • Evaluates literature resources to develop a comprehensive analysis or synthesis.
  • Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
  • Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
  • Evaluates information from source(s) to develop a coherent analysis or synthesis.
  • Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
  • Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
  • Demonstrates little or no understanding of the topic.
  • Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
  • Information is taken from source(s) without any interpretation/evaluation.
  • The posting uses information that is not valid, relevant, or reliable
  • No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
  • Information is not valid, relevant, or reliable
Performance Category  10 9 8 4 0
Application of Course Knowledge –

Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations

  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
  • Applies concepts to personal experience in the professional setting and or relevant application to real life.
  • Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
  • Applies concepts to personal experience in their professional setting and or relevant application to real life
  • Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
  • Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
  • Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
  • Posts are superficial and do not reflect an understanding of the lesson content
  • Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
  • Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
  • No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category  5 4 3 2 0
Interactive Dialogue

Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.

(5 points possible per graded thread)

  • Exceeds minimum post requirements
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
  • Replies to a post posed by faculty and to a peer
  • Summarizes what was learned from the lesson, readings, and other student posts for the week.
  • Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
  • Replies to a question posed by a peer

Summarizes what was learned from the lesson, readings, and other student posts for the week.

  • Meets expectations of 2 posts on 2 different days.
  • The main post is not made by the Wednesday deadline
  • Does not reply to a question posed by a peer or faculty
  • Has only one post for the week
  • Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
  • Does not post to the thread
  • No connections are made to the topic
  Minus 1 Point Minus 2 Point Minus 3 Point Minus 4 Point Minus 5 Point
Grammar, Syntax, APA

Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.

Points deducted for improper grammar, syntax and APA style of writing.

The source of information is the APA Manual 6th Edition

  • 2-3 errors in APA format.
  • Written responses have 2-3 grammatical, spelling, and punctuation errors.
  • Writing style is generally clear, focused, and facilitates communication.
  • 4-5 errors in APA format.
  • Writing responses have 4-5 grammatical, spelling and punctuation errors.
  • Writing style is somewhat focused.
  • 6-7 errors in APA format.
  • Writing responses have 6-7 grammatical, spelling and punctuation errors.
  • Writing style is slightly focused making discussion difficult to understand.
  • 8-10 errors in APA format.
  • Writing responses have 8-10 grammatical, spelling and punctuation errors.
  • Writing style is not focused, making discussion difficult to understand.
  • Post contains greater than 10 errors in APA format.
  • Written responses have more than 10 grammatical, spelling and punctuation errors.
  • Writing style does not facilitate communication.
  • The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
  0 points lost       -5 points lost
Total Participation Requirements

per discussion thread

The student answers the threaded discussion question or topic on one day and posts a second response on another day.       The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement

per discussion thread

The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.       The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.