NR 510 Week 1 Discussion 2

Sample Answer for NR 510 Week 1 Discussion 2 Included After Question

Jessica, a baccalaureate prepared registered nurse, has been practicing for 8 years. Throughout her nursing career, she has worked in pediatric, surgical, and emergency departments. She worked as a floor nurse, a charge nurse, and she was recently offered a position in Nursing Administration. A stipulation for becoming a nurse administrator is that Jessica must attain a Master of Science in Nursing degree within 2 years of accepting the position. The offer prompted Jessica to contemplate her career. She is interested in returning to college, and wants to have greater impact on patient care but isn’t sure she will find that in an Administrative role, nor is she sure is ready for the responsibility of becoming a Nurse Practitioner. Jessica has decided to explore the advance practice roles available in nursing in order to determine the best MSN track for her. Jessica must choose one role (CNP, CRNA, CNS, CNM) and apply to a program, but she is unsure about the different roles and their individual scopes of practice. One colleague states, “You know, Jessica, working as an NP is great because you can diagnose and write prescriptions, and the accountability will fall on the physician you are working with.”

Discussion questions:

Is Jessica’s colleague right? Why or why not?
Explore the four APN roles, and compare and contrast the pros and cons of each role against each other in order to determine the best choice for Jessica. Consider issues such as work environment, level of accountability, patient population, salary, and scope of practice. Include each role of the APN on the list, and be certain to provide appropriate rationales and citations.

A Sample Answer For the Assignment: NR 510 Week 1 Discussion 2

Title: NR 510 Week 1 Discussion 2

Jessica’s colleague is not correct. No matter if your state allows for full practice, reduced practice, or restricted practice, NPs just as RNs are accountable for providing care according to their scope of practice. Mennella and Heering (2017) state “accountability is the primary outcome of all levels of professional nurse autonomy” (p. 1). According to Park, Athey, Pericak, Pulcini, and Greene (2018), 21 states and the District of Columbia allow NPs to practice independently and have full practice authority. In NJ NPs have reduced practice authority and must have physician’s sign off on certain care decisions. I worked in LTC in NJ, we had an NP that came in weekly and did wound rounds. She was able to make care recommendations, but we had to call the primary physician to write the order for the needed treatment. NR 510 Week 1 Discussion 2

CNP (Certified Nurse Practitioner)

Provide primary health care services to pediatrics, families, and geriatrics. These NPs can diagnose and treat illness and injuries. They can prescribe medications and diagnostic tests. Depending on the state that the NP is employed they may have to work with a physician on certain aspects of patient care. (www.nursejournal.org)

CRNA (Certified Registered Nurse Anesthetist)

Administer anesthesia care to patients. These duties include administering anesthesia during medical and dental procedures, follow-up care, pain management and inserting PICC lines. This is a highly skilled position and requires licensing from the American Association of Nurse Anesthetists. (www.anaa.com)

CNS (Clinical Nurse Specialist)

Work in many areas of health care including acute care, home health, and community health settings. There knowledge and skills are used to apply theory and research to practice improving patient outcomes. In my hospital the CNS works with stroke and palliative care patients. They manage care of these patients and have the ability to prescribe care based on organizational protocols. (www.graduatenursingedu.org)

CNM (Certified Nurse Midwife)

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NR 510 Week 1 Discussion 2

These NPs specialize in women’s reproductive health and childbirth. They provide preventative and health maintenance, family planning, and all aspects of childbirth. They provide holistic care to the women in their care. This NP position can be stressful, emotional, and include long hours. (www.registerednursing.org).

APN Role     Median Salary
CNP                 $98,000 
CRNA             $154,000 
CNS                 $80,000 
CNM                $91,000

A nurse pracitioner master’s degree program may not be practical for Jessica to complete if she is only given 2 years to complete the degree. Also, if she accepts the administrative position she may find it difficult to complete the intensive practicum required by most programs. However, if she chooses to enroll in a program, she would probably be most suited for a clinical nurse specialist program. In this position she can still have direct patient interaction and can make a positive impact on patient care and outcomes.

Resources:

Certified registered nurse anesthetist fact sheet. (2017, October 10). Retrieved from https://www.aana.com/patients/certified-registered-nurse-anesthetists-fact-sheet.

Certified nurse midwife. (2017). Retrieved from https://www.registerednursing.org/nurse-midwife/.

Clinical nurse specialist (CNS). (2018). Retrieved from https://www.graduatenursingedu.org/clinical-nurse-specialist/.

How to become a CNP certified nurse practitioner. (2017). Retrieved from https://nursejournal.org/nurse-practitioner/how-to-become-a-certified-nurse-practitioner/.

Mennella, H. & Heering, H. (2017). Professional autonomy and advanced nursing practice. Cinahl Information Systems.

Nurse practitioner career guide. (2018). Retrieved from https://nurse.org/resources/nurse-practitioner/.

Park, J., Athey, G., Pericak, A., Pulcini, J., & Greene, J. (2018). To what extent are state scope of practice laws related to nurse practitioners’ day-to-day practice autonomy. Medical Care Research and Review, 75(1), 66-87.

I will admit that I have not looked a great deal at the liabilities of the various APN roles extensively, but I do have acquaintances in all of the 4 major areas we are discussing.  It is my opinion that the CRNA would face the most potential jeopardy simply based on the nature of their position and the ramifications of a mistake to the patient outcomes.  That said that, the role of APN is one which requires extreme care and carries the potential to do great harm to patients.  This harm can extend to not only what the NP does, but also to what they do not do.  In the emergency department where I work, the NP does work independently but does have to present their work to a doctor for verification.  The amount of verification is dependent on the reputation the individual has established for themselves based on how they perform their job.  I think that there would be implications for both the NP and the doctor who signed off on the treatment faced with litigation.  The APN does have a license and must protect themselves through due diligence in all matters of patient care.

I appreciate your honesty. I also feel that most NPs are not fully aware of the regulations governing practice in their respective states, nor are NPs fully aware of the liabilities associated with the various APN roles. Even if current and future NPs feel they are knowledgeable about both topics, regulations governing practice and liabilities, they should constantly educate themselves on these matters. In nursing, laws and acceptable practices change all the time. NPs must know the current laws guiding practice at all times. We already know that most physicians view NPs as a threat and that most insurance companies and state/federal policies regarding NPs scope of practice are slow to change; therefore, we must protect ourselves and our profession. The Oregon Nurses Association (2018) has re-posted an article by the Journal for Nurse Practitioners that discusses/gives an overview of APN/NP liability claims. The article contends since the NPs role in healthcare has broadened, it is important that NPs review liability claims to develop “useful risk-management strategies” (Oregon Nurses Association, 2018).

  References

Oregon Nurses Association. (2018). The journal for nurse practitioners’ article: “NP professional liability: A synopsis of the CNA heal. Retrieved from http://www.oregonrn.org/?389

Honestly, I would have thought that NPs were less likely for lawsuits. As nurses we are taught to educate patients, this education helps patients understand more fully what is going on. Often a doctor will walk into a room and give his story then the nurse comes in and explains to the patient in understandable language what is going on. However, an article by Relias (2017), a healthcare information source, analyzing malpractice NP claims found that there was a 13% increase in claims against NPs and stated, “one key finding of this analysis was that the average paid indemnity for a closed claim with an indemnity payment of $10,000 or greater increased to $240,471 per claim” (p. 1). The article stated that the increase was due to increased opioid prescribing and claims related to neonatal care. Every state has specific scope of practice laws for NPs. Whether they are supervised by a physician or not, NPs are expected to be competent in their care and know their scope of practice. I believe that the NP will be responsible primarily for their care, but the physician or healthcare system that employs them will also be held accountable if it is found the NP was not effectively supported.

Resource

Relias. (2017). Nurse practitioner payouts increasing; opioids and neonatal top concerns. Retrieved from www.ahcmeida.com/141982-nurse-practitioner-payouts-increasing-opioids-and-neonatal-top-concerns.

See Also: NR 510 Week 3 Discussion 2