WEEK 1 Advanced Practice Nurse Will Pla

Primary care shortage solution - NPs provide approximately 205,000 solutions to the primary care shortage facing America today by offering high-quality, cost-effective, patient-centered health care.

There is an imbalance between primary and specialty care services in the U.S. health care delivery system.

According to Health Resources and Services Administration If the system for providing primary care in 2020 were to stay fundamentally the same as today, there will be an estimated shortage of 20,400 primary care physicians ("Projecting the Supply and Demand for Primary Care Practitioners Through 2020," n.d.). In addition this projection doesn’t include the decreasing number of people perusing the medical degree and the baby boomers retiring form this filed of science. In the hand we are experiencing a significant increase in NPs and PAs. Considering this projected shortage, which is actually a very frightening situation the increasing number of NPs and PAs, can effectively be integrated; we could reduce the number of physician shortage by over 69 percent in 2020.

Currently, there is still a large shortage of primary care practitioners in the United States. The margin between available providers and those in need continues to grow. Many people without proper access to care have to delay seeking help for what ails them ("Health Wanted," 2012). Glicken & Miller (2013) state that approximately 16,000 primary care providers would be necessary to meet the existing demand. Rural communities would represent the area of greatest need followed closely by low-income urban areas. The number of underserved individuals is estimated to have reached fifty-seven million. This demand will only increase, as 52,000 primary care providers are expected to be needed by the year 2025 (Glicken & Miller, 2013, p.1883-1889).

There have been concerns regarding the identification and credentialing of advanced practiced registered nurses (APRNs). A APRN is a registered nurse who has successfully completed an accredited graduate-level education program, in which the individual is well prepared and successfully passed the nationwide certification examination (APRN Consensus Model, 2008). However, there are still debating issues of who would fall under the APRN category. The National Council of State Boards of Nursing (NCSBN) has identified four APRNs who are deem fit to be called ARPNs; however, only two will be named. They would be certified registered nurse anesthetists (CRNAs) and certified nurse practitioners (CNPs). Whereas, the nurse informatics and the nurse administrations are not considered to be APRNs; although, they are still license registered nurses but they do not provide direct patient care and are not required to take the national certification examination (ARPN Consensus Model, 2008).

Among older adults aged 65 years and older are found to have difficulty in reading and to comprehend discharge instructions. This has been found to be a concern regarding continuing care and re-admission concerns throughout urban and rural hospitals. Does the integration of Advanced Practice Nurse (APN) guiding discharge education, along with a follow-up contact with the patient after discharge effect compliance and readmission rates, more than not having an APN guiding discharge teaching to help decrease readmission rates?

Advance Practice Registered Nurse (APRN) is a broad term that is used to define the masters prepared nurse that participates directly in patient care. This definition includes four different facets of nursing: certified nurse-midwives, nurse anesthetists, clinical nurse specialists and nurse practitioners (Joel, 2009). Of these four professions that are included in the APRN definition, Western Carolina University offers two: nurse anesthetist and nurse practitioner. Nurse educator and nurse leader, which are also offered at Western Carolina University, are not currently included in this definition.

Due to the massive popularity and use of the P value in scientific research studies Advanced Practice Registered Nurse (APRN) in primary care settings must administer care based on the best available scientific evidence. In healthcare where frequency and volume of scientific studies overwhelm APRN’s and health care professionals, they are having to implement and rely on many statistical metrics to make crucial decisions. APRN’s in their daily practice will have to think critically through the research process and review the statistical data in such a manner that they can determine and decide on the best available evidence.

According to Freudenberg and Olden, one way to reduce the health disparities is by making the availability of primary care physicians better. (Buchbinder, 2012, p. 327) A primary care physician in the United States make less money than a specialist, so the amount of doctor's choosing to go in to primary care is significantly less than those who choose to enter a specialty. A primary care physician is like the captain at the head of a person's health they are in charge of screenings and counseling and to address the burden of chronic disease. In addition, which specialists if any are necessary to help manage the patient's disease if it is outside of the scope of practice for the primary care. Raising the amounts insurance pays to primary care

On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into

In the United States there is a current and expanding shortage of primary care providers. A recent study by the American Academy of Family Physicians in 2013 estimated a total shortage of 12,000-31,000 primary care physicians and 28,000-63,0000 non-primary care physicians (Porter, 2015). Many factors contribute to the shortfall of providers in primary care including, but not limited to: rising education costs, length of training programs, rising number of patients over 65 years, and insurance reimbursement changes (Porter, 2015). It is estimated that in the next 10 years and onward, the shortage of providers in primary care will continue to grow (Porter, 2015). Many theories

“The Association of American Medical Colleges expects a shortage of up to 31,100 primary care doctors and up to 63,700 other physicians by 2025”(Consumer Report, August 2015). NPs are capable to conduct physical exams, diagnose, treat illness, prescribe medication (not all), order and interpret tests, counsel a patient and perform surgery with assistance. In 18 states, NP are performing majority of primary care and able to treat minor illness without a physician supervision and It would be beneficial if the other state get on board of having an NP fill the gap.

As a future advanced practice registered nurse (APRNs) I have thus far acquired the advanced knowledge on theories and philosophies, reflective practice, ways of knowing and unknowing that will only prepare me in the future practice as I provide quality nursing care. The knowledge is critical in decision-making allowing me to collaborate effectively with a multidisciplinary team, patients, and their families to promote quality care and positive outcomes. As APRNs, in order to develop nursing theories the ability to use reflection and have an open mind to different concepts and possibilities in nursing care is crucial. It only takes a few minutes to apply Watson theory of caring to sit with a patient and hold their hand to influence the patient’s outcome and promote a healing environment. Newman’s model focuses on the individual and their interaction with the environment (Warelow, 2013).

The healthcare landscape and provision of healthcare has undergone significant transformation over the past decade(s) in response to healthcare reforms, policy agendas, advancing technologies, and shifting consumer needs. Although a vast number of Americans still struggle without health insurance, the opportunities opened up in the healthcare marketplace through health reforms have led to an influx of patients seeking care, in turn, creating a disparity between primary care supply and demand. Recognizing that today’s consumers often seek care from sources other than traditional or conventional health care options such as the doctor’s office, many health systems have evolved to meet this demand as seen through the growing array of health care

However, the scarcity of primary care health professionals is as much a problem of distribution as it is of the workforce size, according to an analysis of data from the Agency for Healthcare Research and Quality. Therefore, the United States do not manage or actively regulate the number, type, or geographic distribution of its health workforce. Nevertheless, health care professionals select how and where to work (Maldistribution of Primary Care Workforce Challenges Efforts”, para. 1-2). On the other hand, the United states has about 80 primary care physicians for every 100,000 individuals. Still, rural areas have 68 per 100,000, compared to urban areas, which have 84 per 100,000. Yet, the AHRQ data show that a total of 46,981