Nursing Scenario Summary

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

Nursing does not always refer to a registered nurse. According to Brenda Nordstrom in lecture notes titled Nursing Education, Licensure, and Scope of Practice (2016), there are four main levels of nursing: certified nursing assistant (CNA), licensed practical nurse (LPN), registered nurse (RN) and advanced practice registered nurse (APRN). Each level has its own list responsibilities and scopes of practice. A scope of practice defines what actions are permitted for the individual to perform as well as the educational requirements and continued competency requirements that are expected of the individual. The purpose of having a scope of practice for each level of nursing is to protect the public from any human errors that may occur as well as hold each healthcare professional accountable for their actions (Nordstrom, 2016). Without a scope of practice, it is possible that someone may harm the patient inadvertently by stepping outside of his or her knowledge base.

In the Texas, state law prohibits Advanced Practice Registered Nurses (APRNs) including nurse practitioners (NPs) from practicing to the full extent of their education and clinical ability. Currently, Texas law requires than an APRN receive approval from an individual physician prior to engaging in the practice of advanced nursing. This type of complex regulatory scheme is outdated and restricts patients’ access to care, creates geographic disparities in services, and unnecessarily increases health care costs. For example, current law requires APRNs to meet periodically face-to-face with a supervising physician; with few physicians choosing to practice in rural areas, many APRNs who are willing to work in rural areas are essentially forbidden from delivering care to these underserved areas.

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

Legislation in our state makes it very difficult for Nurse Practitioners to practice fully. Although the need for NP’s are at an all-time high, especially in Family Practice setting. APN must get a license to practice and have to submit to the board, a written application on forms furnished to the applicant. The original application shall contain the applicant's statements showing the applicant's education and other such pertinent information as the board may require. The applicant shall at least have completed their high school course of study, or the equivalent as determined by the state board of education, and have successfully completed the basic professional curriculum in an accredited or approved school of nursing and earned a professional nursing degree or diploma.

"Many older people fear that a hospital stay could leave them even more disabled than they were before. Unfortunately, there's new reason to believe this fear is justified. Elderly patients who are hospitalized are at much higher risk of cognitive problems afterward, according to a study published on Wednesday in the journal Neurology."

According to the Massachusetts board of nursing (2015), all APRNs, except the CNM are mandated by law to practice in accordance with written prescriptive guidelines developed in collaboration with the nurse and a physician. This regulation which was written in 1994, in no doubt limits the APRN to have the autonomy to practice without interference from a physician

Expanding the scope of practice for APRN remains a controversial issue in Missouri, where I currently reside. Expanding the scope of practice also remains an issue for the health care field nationwide. Stakeholders that I can identify include The American Association of Colleges of Nursing (AACN), The National Organization of Nurse Practitioner Faculties (NONPF), APRN Consensus Work Group, National Council State Boards of Nursing (NCSBN), APRN Advisory Committee, along with other health care organizations, health care educators, and health care providers nationwide (IOM Report., n.d., p. 133). Focusing in on Missouri, the stakeholders for this endeavor include health care

Some duties will be conducting physical exams, making urgent care visits, prescribing medications and providing preventative care to residents. Providing education to families and staff education, attending care plan meetings to ensure quality care is received is also a role of an NP. Adequate documentation for billing Medicare and Medicaid or private insurance for reimbursement of services provided, is an ongoing process for both the physician and facility for payment and an NP could make the process

Advanced practice nurses (APN) improve access to rural and urban primary care (Hunter, Murphy, Babb, & Vallee, 2016). It is difficult as a nurse practitioner (NP) to move between the states and practice due to the differences in laws and regulations within each state. The role of an APN is not fully understood by many people, and continuous education on a NPs scope of practice (SOP) needs to occur. NPs can help the shortage of physicians by providing primary care to those with less complex medical conditions. This gives the physician more time to focus on the complex cases and increase patient satisfaction overall (Bareil, et al., 2015). The APN SOP will be further explored in the following sections as well as a personal assessment,

As of January 2016, 14 states and territories had full prescriptive authority for APRN’s (Phillips, 2016). Of the remaining states, 8 have complete prescriptive authority but require a limited post-licensure collaboration term (Phillips, 2016). The remaining states require physician supervision or collaborative agreement (Phillips, 2016). Although those states without full prescriptive authority made updates, they still do not align with the American Association of Nurse Practitioners (AAPN) position statement regarding prescriptive privilege. The AAPN’s position is clear, advanced practice providers practicing within their scope of practice should have unhindered prescriptive rights ("AANP," 2017).

The scope of practice for advanced practice nurses in various specialties defines what the nurse can and cannot do from a legal perspective (Hamric, Hanson, Tracy, & O'Grady, 2014, p. 561). It is essential to know the scope when it comes to practicing as a nurse practitioner as it defines what you can delegate and what you are responsible for. The scope of practice holds the APRN accountable for the care provided. Currently, the scope of practice differs between states, which makes it more important to be aware of what is expected in

The issue that can create an impact in the practice of the APRNs it is not uniform. One of the main problems in the nursing career is the different type of practice from each state. According to Timmons (2016), each state has their own rules and their regulations for the APRNs. This is the biggest issues in providing the real care to our patients. According to Yee, Boukus, Cross, and Samuel (2013), the clinical role of NPs is governed largely by state scope-of-practice (SOP) laws that determine the range of services NPs can provide and the extent to which they can practice independently. The curriculum and the training are kind of the same almost in every state; nevertheless, the scope of practice is controversial. To benefit the patient’s

Polen KN et al.,(47) in an earlier study suggested a relation between prenatal venlafaxine exposure and congenital anomalies as cardiac anomalies and anencephaly which agreed the findings in the present work. Moreover, a population-based study of more than 2,000 exposed pregnancies was parallel with the results in the present work and stated that overall maternal use of SSRIs in early pregnancy was associated with a 1.7-fold increased risk of congenital cardiac malformations. (48)

Mr. Thathamkulam RN, MSN works as the Nurse Manager (NM) for Eye Clinic. He has demonstrated excellence in his nursing assessment skills, leadership skills, coordination of care for the internal and external customers, collaboration with the interdisciplinary team, and using evidence based research to guide the practice of his employees to impact good patient/family care results. In 2013, he obtained his MSN with an emphasis in Health Care System Education and MBA in management and finance from American Sentinel University and Manav Barti university respectively. He mainly focused his interest in patient’s safety and quality throughout his service in the VA system. He worked as a full time Team Leader and charge nurse for 7 years in Telecare and interim NM for 2 months, where he has demonstrated leadership and management skills prior to the current position. As a leader and charge nurse, he has been maintaining the integrity in work, demonstrated the assertiveness and leadership skills, helped the organizational development, and promoted the client’s and provider’s satisfaction. Mr. Thathamkulam has been functioning in the Nurse Manager (NM) role for the past 5 months and has made changes and improvements for the betterment of the service and at the organizational level.