APRN Consensus Model Analysis

During my assessment I used the “Seven principles of good prescribing” to aid my decision making (National Prescribing Centre (NPC) 1999). This structured framework allows the prescriber to assess all appropriate factors and problems and make an informed decision whether to issue a prescription or discuss other options with the patient Humphries (2002). Examples of these options would be offering advice about their condition/problem or informing them that the treatment/items they require would be cheaper over the counter, thus making optimum use of the NHS budget, Prescription Pricing Authority (PPA) (2003).

Whiles weighing Ella, I observed that Ella had red and inflamed rash on her face and in the creases of both hands. According to Beckwith and Franklin (2011), to prescribe safely a holistic assessment of the patient has to be completed and the seven steps of the prescribing pyramid was used which are ,examining the patient’s holistic needs, considering an appropriate strategy, considering a choice of product, negotiating a ‘contract’ and achieve concordance with the patient, reviewing the patients on a regular basis, ensuring all record keeping is both accurate and up to date and reflecting on your prescribing for future reference.(NPC, 1999) were used as a decision making

According to the Pearson Report, there is a total of 147,295 Nurse Practitioners throughout the United States (Pearson, 2009). However, for NPs in some states the battle continues over some forms of prescriptive authority or physician involvement in NP prescribing, such as the state of Pennsylvania. State regulatory approaches to NP prescribing range from no authorization for prescribing (in Georgia, 2006 legislation passed which recognized NPs as prescribers, but the rules have not been approved at the time of this writing) to unencumbered prescriptive authority (Arizona, DC, Montana, Oregon, Washington, and Wyoming) (Lugo, O’Grady, Hodnicki & Hanson, 2007).

Since the inception of the Nurse Practitioner (NP) role in the 1960s, NPs have thrived in the delivery of primary healthcare and nurse case management. Despite patient satisfaction with NPs ' style of care, nurses have been critical of NPs, while physicians have been threatened by NP encroachment on MD practice. Balancing assessment, diagnosis, and treatment with caring defines NPs ' success as primary care providers. Understand the role and Scope of Practice of NPs is sometimes difficult for some to understand. The purpose of this paper is to define the role and history of NP, compare and contrast licensure versus certifications, understand NP Scope Of Practice and Standards of Care, discuss how the State Practice Acts regulate FNP practice, discuss credentialing and privileging, and differentiate between legislative and regulatory processes.

Hi Swanthi, great post on the APN Consensus Model. In your post you mentioned many healthcare organizations had “criticized the inconsistencies in APRN practice and brought up concerns of patient safety issues due to these competency irregularities.” Although this model was developed in 2008, there are still many regulations and unclear terms that need to be clarify. I can see for nurses that are just beginning their APRN education will be able to eventually achieve the same licensure, accreditation, credentials, and education (LACE), but what about those are currently practicing now? If I was the APRN that had to take extra courses to be licensed in my state than I would feel a bit dissatisfied when another APRN from another state that required

There are some legal issues, which are very restrictive; thus, affect the advanced nursing practice by hindering APRNs from serving patients better (Stephens, 2015). One of these issues is the requirement that APRNs should have a training arrangement with supervising physicians. Existing healthcare laws limit them from ordering diagnostic tests and prevent them from writing prescriptions for certain

The statutes lay out the rules for collaborative practice and prescriptive authority. A written collaborative practice between the APRN and a physician must be in place for an APRN to work beyond a nursing license. The collaborative physician must be within geographical proximity thirty to fifty miles. There is an exception to the mileage rule for qualifying rural facilities. The physician must review ten percent of all of the APRN’s charts every two weeks and twenty percent of charts/patients that are receiving controlled substances. The written agreement must contain a list of prescriptive medications the physician will allow the APRN to prescribe in agreement with state prescriptive laws. The physician must document a minimum of thirty days of full supervision of the APRN before allowing the APRN to practice without the physician present. And finally, CRNAS are allowed to administer anesthesia without a physician physically present as long as there is one that could be available if

The historic article by Safriet (1992) fully lists and analyzes the major challenges facing the advanced practice nurse (APN). At the time the article was written compared to now, a few aspects are changing. In areas where change has occurred, it has been an exceedingly slow process. Change for APNs is often dependent on legislation and regulatory authorities which receives half-hearted support, at best, from the medical establishment (Safriet, 1992). Since the first day nurses were given any authority to practice outside of regular practice, physicians only objected when it began to encroach upon their perceived hierarchal status or potential for compensation (Hamric, Hanson, Tracy, & O’Grady, 2014). The concern that this

In 2013, the prescriptive scope of practice was expanded for Physicians Assistants to include Schedule II drugs in limited circumstances (South Carolina Academy of Physician Assistants, 2013). These include a one time dosing in a hospital setting and renewals of medications prescribed by an MD (South Carolina Academy of Physician Assistants, 2013). Hopefully, the South Carolina Board of Nursing will, aggressively, pursue both full practice and increased prescriptive authority of Schedule II drugs, for APNPs, in the near future.

What is your opinion about how well prepared APNs should be for the responsibility of prescribing medications? “I believe that Advanced Practice Nurses should take the time to research and familiarize

Many patients need not only a preventive or reactive drug, but adapted a combination of both types of drugs in order to allow maximum relief of their disease. Most doctors agree that the result for maximum relief of the minimum amount of medication

Nurse prescribing has an important contribution to make in improving the service to patients clients within the primary health care setting, its benefits was highlighted in the crown report (DOH, 1989 ) in that patient condition will be managed more effectively , a better use of patient and practitioner’s time with minimum delays, overall improving patient care. Furthermore, the Crown Report published in 1989 (DOH, 1989) suggested that suitably qualified nurses with Health Visitor qualification should be given the authority to prescribe from the most recent Nurse Prescriber’s Formulary (NPF). The National Prescribing Centre (NCP) initiated a tool to aid prescribers in the process of making clinical decisions, also known as ‘The Prescribing

The complete process of prescribing a drug regimen starts from an interview the patient about their past medical history, current treatment, and medication regimen. The practitioner should update patient’s allergies and asks the patient to bring his/her medication bottles to obtain the name of the drug, dosage, and frequency. After obtaining a medical history, assessment is the next step to confirm if physical examination relates to subjective data. The most important step is to get the right diagnosis based on physical examination, past medical history, and pertained test or lab results. Then, select the first-line therapy base on the treatment guideline, and

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency

This subjective assessment forms a series of questions posed to the patient relating to their present condition/problem (Farr 2014a). Important factors that must be taken into consideration prior to treatment, such as patient preferences, contraindications, contributing factors, medication, family medical history, other medical conditions and previous medical investigations, are ascertained during this ‘history-taking’.