Essay about Standarizing a Physician Assistant´s Scope of Practice

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012). Since Advanced Practice Nurses or Nurse Practitioners (APNs or NPs will be used interchangeably for the purpose of this paper) are one of the fastest growing groups of healthcare providers, and continue to practice and provide care in a range of settings including primary care, it is important to investigate and address any potential barriers to practice. This author believes that allowing APNs to write prescriptions for commonly used controlled substances will help improve timeliness and flexibility in health care delivery; studies have shown that there is a positive impact on high

The listed components are: the board of trustees, administration, medical staff, resource management committee, medical direction for the utilization process, and hospital staff. The Board monitors the process through reports from the Medical Staff 's Executive Committee and the Chief Executive Officer (Chestatee, 2014). The administration responsibility states that the Board has assigned accountability and delegated authority to the Chief Executive Officer for providing the Medical Staff with administrative and technical support for all components of the Utilization process (Chestatee, 2014). The plan (2014) states that the Medical staff fulfills accountability through internal assignment of functions to the Medical Staff, Resource Management Committee, and physicians selected to provide medical direction for the Utilization Process. The Resource Management Committee is responsible for discharging all duties and functions, and must have at least two physicians serving on the committee. Both the medical direction and hospital staff are responsible for the discharge of the utilization process. Including a list of authority and responsibilities gives a brief explanation for the UR plan, and provides readers with the opportunity to see the figures in charge of the process.

Once all patient records have been received the file is then given to the nurses to pull a prescription drug monitoring (PDM) report on the patient. This report provides the clinicians’ information showing controlled substances that the patient has been prescribed, by whom, and dates the medications were filled. This information can help identify “red flags” in a patient’s prescription history. The PDM shows the potential compliance by a patient to adhere to treatment rules by showing if multiple providers have seen a patient and been prescribed narcotic medications. This rule was put into place by the medical director.

Recently, I have been reading publications regarding the “debate” over what type of patients should be seen by which licensed professional. Frequently this discussion revolves around the use of Nurse Practitioners, or Physician Assistants versus Physicians. Well-discussed arguments for both are abundant.

APRNs assume responsibility that are often similar to the those of a physician, often time working side by side or collaborate as a team. APRNs have a significant role in promoting health and providing care to patients in numerous settings.

Depending on the institution’s goals or needs, either provider has the clinical knowledge to effectively fulfill his/her role. For example, In a family practice clinic seeking a PA or NP to manage patient care, with or without the presence of a physician, selecting to hire a NP seems idea simply because NP’s usually have extensive years of clinical assessment skills and expertise which allows them to proficiently care for the individually holistically. On the other hand, some hospitals utilize both NP’s and PA’s as midlevel providers. In this case, the midlevel provider fit in as the ‘middle’ or on-call provider. Depending on the facility policy, these midlevel providers are limited in their prescribing authority. In my experience, midlevel

This mean depending in what state the advance practice nurse is working in they may be under supervision of a physician or in collaboration with them. “Some states allow nurse practitioners to practice without physician oversight, or 'independently'” (). “Other states require physician oversight for nurse practitioner practice, prescribing, or both. States differ in the language they use to describe oversight” (). “The American Nurses Association defines collaboration as physicians and nurses or NPs working together as colleagues, working interdependently within the boundaries of their scope of practice"

In addition, NPs practicing in Wisconsin can prescribe narcotics, with the exception of Schedule I narcotics. The U.S. Department of Justice (n. d.) lists the following as Schedule I drugs: heroin,

In accordance to Balhara (n.d), Schedule I drugs would be ecstasy, heroin, and LSD, Schedule II cocaine, fentanyl, and hydrocodone, Schedule III steroids and ketamine, Schedule IV benzodiazepines, modafinil, and tramadol, and Schedule V diphenoxylate, lacosamide, and pregabalin. While these classifications may be reasonably similar to the controlled substances, they are classified by their ability for one to become addicted or begin to abuse. This classification may be one of the smartest moves the DEA has made. This allows doctors to be able to look at the classifications and see if a drug they are looking to prescribe will result into harm. In instances before, the author of this paper has seen loved ones prescribed medications that the doctor knowingly knew would later have that individual addicted. As they make a profit off the prescription, the Dr. was unaware that his prescribing of fentanyl (enough to kill a horse) would result in his physician’s license being under

In 1983, the Joint Commission opened medical staff membership to non-physician health care professionals, including APRNs, whom the Commission referred to as “limited license practitioners”. Hospitals may decide not to credential and privilege APRNS; that is, their bylaws may not address any non-physician providers at all. If hospital bylaws do address APRNs, the bylaws may include provisions for supervision of APRNS that are more restrictive than state laws. When physicians are required to supervise APRNs, the physician’s workload and perceived liability increase. When physicians are required to cosign all APRN orders, clinical care can be delayed (Brassard & Smolenski, 2011).

HealthCare Issue: With the rapidly growing elder population, the considerable economic burden on healthcare followed by more outpatient office visits, these factors have resulted in an unprecedented strain on the healthcare system. Particularly concerning, is the projected supply of and demand for the healthcare workforce (Administration on Aging, 2016, Anderson, 2014). In response to these pressures, the healthcare industry strives to search for cost effective approaches through redesigning and reducing its work force by increasing the utilization of MAs (Anderson, 2014). Currently medical assistants (MAs) and Advanced Practice Registered Nurses (APRNs) work closely together in various clinical settings delivering quality healthcare to the public. However, the role of the MA presents a unique challenge to the APRN in that APRNs are limited in their ability to effectively and efficiently delegate to MAs (New Hampshire MA Taskforce, 2011). Therefore, APRNs will not be deployed in various clinic settings, thus, confining a physician’s means to expand healthcare access to his/her patients. Clinic workflows and staffing structures can result in situations where an APRN is formally or informally relied upon to delegate to and supervise CMAs (New Hampshire MA Taskforce, 2011). With this in mind, much more attention should be focused on future proposed changes concerning the legal relationship between MAs and APRNs. Current Arkansas jurisdictions allows APRNs to delegate limited

Clinicians play a major role in the enhancement of health promotion and disease prevention. Physician assistants in particular, have greatly contributed to the mission of public health. The PA profession was created “In a time of primary care physician shortages and increasing medical specialization…to improve access to primary care to underserved populations in the United States” (Cawley et al., 2011, p.124). PAs actively participate in disease prevention, intervention, reporting and surveillance. In addition, PAs provide comprehensive patient care that considers the physical, social,

The nurse practitioner scope of practice varies among the fifty states in the United States of America, as an example I can mention two states involved in a study. “For example, whereas in Massachusetts, nurse practitioners can independently diagnose and treat patients and collaborative agreement with a physician is required only for prescriptive authority, in New York, a collaborative agreement with a physician is required for all three aspects of NP practice: treatment, diagnosis, and prescribing authority” (Poghosyan et al., 2015, p. 47).

One disheartening problem with practice authority is that it varies from state to state. “Variability in state regulation of NP practice limits the full deployment of these proven healthcare providers, threatens the quality and safety of NP-delivered care, and limits consumer choice in healthcare access” (Lowery, 2015). Some states allow full practice independence for APRN practice, while other states command all-inclusive dependency on a collaborating physician. The states that require the collaborating physician also have some variances, as some locations require the physician to physically be inside the same building with the practicing APRN and other locations require the physician to be within a certain number of miles of the practicing APRN. “Scope of practice for NPs is

Among many over duties coordinating with the medical professional preforming the medical procedure is also an important aspect of the job.