Tag: Clinical-Nursing

NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations

Each state has different regulations, titles, scopes of practice, and regulatory standards (Milstead & Short, 2019, pp. 65) yet they have similar standards for education requirements. As a registered nurse and future advanced practicing registered nurse (APRN) in the state of Michigan, Nurse Practitioners are not recognized as a primary care provider as an individual (NCSLSOP, n.d.).  This means as an APRN I would require a Physician to overlook or delegate ‘tasks’ to maintain care for patients in the state of Michigan. That being stated, Michigan APRNs may prescribe nonscheduled drugs without a delegated physician (NCSLSOP, n.d.), but can prescribe schedules II-V controlled substances if a physician where to delegate the task to an APRN (NCSLSOP, n.d.). Schedules II-V controlled substances would include but not limited to Dilaudid, Methadone, Ketamine, Xanax, Ativan, Phenergan with Codeine, and more (Diversion Control Division, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

Comparing Michigan, a single licensure state, to a state included in the Nurse Licensure Compact (NCL) is slightly different for APRNS. Arizona for an example allows APRNs to practice independently without the licensure of a physician compared to Michigan and they are recognized as primary care providers (NCSLSOP, n.d.). That being said, APRNs must work within the guideline and regulations of the state board of nursing, BON, (Milstead & Short, 2019) and they must practice within their scope as well as population focus (NCSLSOP, n.d.). As an RN we are licensed and regulated by our BON and must continuously monitor for changes to verify that we are adhering our care within our scope of practice, especially if one is a travel nurse or if you have recently moved to a different state since state specific practices can vary (Milstead & Short, 2019). To adhere to the regulations as an APRN one should research the states BON for their regulations as well as monitoring the jobs you apply for as an APRN. Some states, such as Arizona, allows APRNs to work without a delegating physician as I stated earlier, but that APRN has to apply for positions within their population focus, such as a Psychiatric mental health NP should not apply for a Pediatric primary care position in Arizona. Although, Arizona allows APRNs to work within their full scope of their education and experience, does not mean every state allows that and research should be done to validate proper and safe care is provided for communities. With the proper education and training, APRNs should be able to work within their scope and practice, as long as the care they are providing are within the guidelines of their BON or delegated from their overseeing Physician NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

References

Diversion Control Division. (2021, March). 
Scheduling actions controlled substances regulated chemicals.
 U.S. Department of Justice. https://www.deadiversion.usdoj.gov/schedules/orangebook/orangebook.pdf

Milstead, J. A., & Short, N.M. (2019). 
Health policy and politics: A nurse’s guide 
(6
th
 ed.). Burlington, MA: Jones Bartlett Learning.

Milstead, J. A., & Short, N.M. (2019). 
Health policy and politics: A nurse’s guide 
(6
th
 ed., pp 57-84). Burlington, MA: Jones Bartlett Learning.

NCSLSOP. (n.d.). Nurse Practitioners
. Scope of practice policy. 
Retrieved March 30, 2021, from https://scopeofpracticepolicy.org/practitioners/nurse-practitioners/?fbclid=IwAR0xWHuSPdq8iCfp0dAnEfL-tXd6M0vdq6MY9_Aunw54FsUC5fcXW_a1g3A NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations

response

I was surprised to learn from your post that Michigan remains a single licensure state, so I looked around and found on the Michigan Health and Hospital Association (2020) that the Michigan House Bill 4042 passed both chambers but was vetoed by the governor December 30
th
. Representative Mary Whiteford did reintroduce the legislation as HB 4046 for the 2021-2022 legislative session and hopefully it will pass and continue all the way through.

It is important to note that the Enhanced Nursing Licensure Compact (eNLC) was implemented in 2018 to include new standards like state and federal fingerprint based criminal background checks that the original Nursing Licensure Compact (NLC) did not have (Gaines, 2021). The eNLC will allow practitioners who travel to practice in multiple states without delay, and this is especially important when examining the current pandemic and the increased importance of advanced practice registered nurses. There are continued concerns that do need to be addressed in the eNLC as it moves forward like how to properly discipline, loss of state revenue, and how to work with the increase need for telehealth NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

References

Gaines, K. (2021, March 7). Compact nursing states list 2021. 
Nurse.
 Retrieved from https://nurse.org/articles/enhanced-compact-multi-state-license-eNLC/

Michigan Health and Hospital Association. (2020). 
Nurse Licensure Compact passes the house. 
Retrieved from https://mha.org/Newsroom/ID/2351/Nurse-Licensure-Compact-Passes-the-House

Discussion: Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions.

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To Prepare:

Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

Consider how key regulations may impact nursing practice.

Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion.NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

By Day 3 of Week 5

Post
 a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

By Day 6 of Week 5

Respond
 to at least 
two
 of your colleagues
* on two different days
and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

Professional Nursing and State-Level Regulations

Throughout the years, the evolution of Advanced Practice Registered Nurses (APRN) has been inconsistent due to the U.S. Constitution giving states the right to establish laws governing professions and occupations. Thus, each state has unique titles, scopes of practice, and regulatory standards (Milstead & Short, 2019). According to the American Nurses Association (ANA) (n.d.), “APRN practice is typically defined by the Nurse Practice Act and governed by the Board of Nursing, but other laws and regulations may impact practice, and other boards may play a role”. APRNs who have legal authority to practice within the full scope of their education and experience, the state permits those NPs to evaluate patients; initiate and manage treatments; diagnose, order, and interpret diagnostic tests; and prescribe medications and controlled substances (State Practice Environment, 2021).

Currently in my state of practice, Virginia, a Nurse Practitioner (NP) with a current license may qualify for autonomous practice after the completion of having five years of full-time clinical experience, a total of 9,000 hours, under a patient care team physician. An NP that has been authorized to practice autonomously can only practice within the scope of the NP’s clinical and professional training and limits of the NP’s knowledge and experience, consult and collaborate with other health care providers based on a patient’s clinical condition, and establish a plan for referral of complex medical cases and emergencies to other health care providers. Another regulation that Virginia has is that unless an NP has been authorized for autonomous practice, the NP may only prescribe Schedule II-VI drugs after meeting certain criteria, having authorization from the Boards of Nursing and Medicine, and obtaining registration from the U.S. Drug Enforcement Administration (DEA). An example of one of these criteria includes having authorization to prescribe medications through a practice agreement with a
collaborating physician
(Laws and Regulations, 2018).

In the state of North Carolina, NPs are not allowed to practice autonomously at any given time and must have a collaborative practice agreement with a primary supervising physician. For an NP to prescribe medications in North Carolina, the NP has to have authorization by the physician approved by the boards as the NP’s supervisor and the supervising physician has stated the drugs that the NP may prescribe in the collaborative practice agreement. In order to prescribe controlled substances, the NP must have an assigned DEA number that is entered on each prescription. This is similar to the regulation stated by Virginia; however, in North Carolina, NPs can prescribe Schedule II-IV drugs with the additional ability to prescribe Schedule V drugs. (Nurse Practitioner Laws & Rules: North Carolina Board of Nursing, 2021) NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations.

References

APRN state law and regulation
. American Nurses Association. (n.d.).

https://www.nursingworld.org/practice-policy/advocacy/state/aprn-state-law-and-

regulation/

Laws and regulations
. Virginia Board of Nursing. (2018, July 6).

http://www.dhp.virginia.gov/Boards/Nursing/PractitionerResources/LawsRegulations/

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6
th
 ed.).

Burlington, MA: Jones & Bartlett Learning.

Nurse practitioner laws & rules: North carolina board of nursing
. North Carolina Board of

Nursing. (2021).

https://www.ncbon.com/practice-nurse-practitioner-nurse-practitioner-laws-rules

State practice environment
. American Association of Nurse Practitioners. (2021, January 1).

https://www.aanp.org/advocacy/state/state-practice-environment NURS 6050 week 5 Discussion: Professional Nursing and State-Level Regulations

Role of the RN/APRN in Policy Evaluation Essay

Two opportunities in which nurses or APRNs can become involved in policy review are getting to know your elected officials and attending meetings for the board of nursing.  Your elected official represents you and the community.  The hospital I worked for had a nurse’s union.  Issues within the hospital 
directly affecting the community
, and neither side would give in,
 and the union discussed it with the then-elected mayor at the time.  These constant visits to the mayor’s office evolved into a relationship between the union and the mayor.  After merging with another hospital system, the hospital I worked for wanted to terminate their pediatrics department and transfer it to the other hospital.  
 The union informed the mayor of the hospital’s intention, town hall meetings were held, and it was also found to be a violation of a treaty between the city and the hospital. As nurses, we have a strong influence 
on policy
 (Brokaw, 2016).  The mayor that my union formulated a relationship with is now a senator
, and he continues to advocate for changes in healthcare Role of the RN/APRN in Policy Evaluation Essay.
 

Attending state board of nursing meetings 
is important if you are interested in the policy review.  The board of nursing has a lawyer that lobbies for changes.  
Nurses are not familiar with legality.  Hence the reason a lawyer is a part of the board of nursing.  Issues are introduced at the board meeting, discussed, and then voted on whether to present to the constituent.   These meetings are very intense because many lobbyists are present, and according to which policy is being discussed, they know which senator to approach.  At one of the meetings I attended, the subject was the legalization of marijuana and how it will affect the APRN’s ability to prescribe?   Removing marijuana from the drug screen toxicology was also brought up.  If someone smoked in a state where marijuana is legal and travel to another state where marijuana is illegal, have they committed a crime.  Another topic discussed was the impaired nurses.  Penalties and years of suspension, working back towards license redemption, and should they go back to the bedside.  There is a log keeping track of the impaired nurses and their progress Role of the RN/APRN in Policy Evaluation Essay.  
 

Challenges to policy review are convincing nurses to get involved, lack communication, collaboration, and information sharing among nurses, and change t
he nurse-physician role (Rasheed, Younas, & Mehdi , 2020).  Nurses feel as though they are subordinates to physicians, and the gender role of men being in the position of authority are other challenges that nurses face (Rasheed, Younas, & Mehdi , 2020).  Nurses fail to realize that they do have an excessive influence concerning policy changes as the largest profession in size and direct interaction with the patient gives nurses a more powerful and louder voice.

Two strategies that may help bridge the gap and get more nurses involved are networking.  My union president took advantage of any opportunity she had to get more nurses involved.  There were chain text messages of upcoming meetings, and in the breakroom, many flyers were posted.  When attending the board meetings, we went in groups.  Groups held more accountability for each other Role of the RN/APRN in Policy Evaluation Essay.
 
 

References

Brokaw, J. J. (2016, September 22). 
The nursing profession’s potential impact on policy and politics
. Retrieved from American Nurses: https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics

Rasheed, S. P., Younas, A., & Mehdi , F. (2020, May 25). Challenges, extent of involvement, and the impact of nurses’ involvement in politics and policy making in in last two decades: an integrative review. 
Journal of Nursing Scholarship, 52
(4), 446 – 455. Retrieved from https://doi.org/10.1111/jnu.12567

Shethna, J. (n.d.). 
13 Basic benefits of joining a professional organization
. Retrieved April 11, 2021, from EDUCBA: https://www.educba.com/joining-a-professional-organization/ Role of the RN/APRN in Policy Evaluation Essay

 response 1

 Registered Nurses (RNs) and Advanced Practicing Registered Nurses (APRNs) have several ways and opportunities to be involved with policy review. I was recently affiliated with a hospitals nursing union where we went on strike due to inappropriate nursing staffing ratios, health care plans, wages, and much more. I can attest that getting your local mayor and local representatives on your side is very beneficial and can aide in making changes. After creating a relationship with several local community members, several doors of opportunities can open, such as becoming a board member of other groups and actively participating within the union to review policies and to make changes happen. Even if that means a strike is necessarily. Just as you stated and Milstead and Short (2019) has mentioned, we can make change with numbers especially with nurses being one of the largest healthcare group.

Regarding the portion where you mention the policy changes in your area regarding marijuana use in legal states and then traveling to other states where it is illegal. I live in a state where recreational marijuana use is legal, except several employers in my area will not tolerate it. Employers have found it difficult to validate when the use occurred, so they do hold the right to fire employees for testing positive if positive for marijuana on a drug test (Barreiro, n.d.). So, it is interesting how some employers do not mind, as long as it is legal, while others can and will fire you if a drug screen is positive. As a nurse, we can advocate and change policy if we bring our concerns to the table. I am not saying it is right, but I am not saying it is wrong either. There is definitely a gray area in this subject, especially in this day and age Role of the RN/APRN in Policy Evaluation Essay.

Nursing is all about networking and making connections and it will continue to be that way. Nurses create a strong influence on people since we are always meeting and taking care of new people. Not only will these connections help make change, but they will always help us become more well-rounded and educate of us, nurses, on other topics that may influence our care and policies. Especially, if some of our connections are individuals that are elected officials, for they have the ability to make changes higher up, which is why we should continue to monitor congress.gov (n.d.) and reach out to governors’ regarding their ideas and plans. Especially because we have a professional obligation to involve ourselves with finding new solutions in health care (Laureate Education, 2018) Role of the RN/APRN in Policy Evaluation Essay.

Reference

Barreiro, S. (n.d.). 
State laws on off-duty marijuana use. 
NOLO. Retrieved April 27, 2021, from https://www.nolo.com/legal-encyclopedia/state-laws-on-off-duty-marijuana-use.html#michigan

Congress.gov. (n.d.). Retrieved April 27, 2021 from https://www.congress.gov/

Laureate Education (Producer). (2018). 
Program policy and evaluation
 [Video file]. Baltimore, MD: Author.

Milstead, J. A., & Short, N.M. (2019). 
Health policy and politics: A nurse’s guide 
(6
th
 ed.). Burlington, MA: Jones Bartlett Learning.

 

response 2

Nurses spend more time with their patients and are ready to stand up for important issues to their patients. Nurses are taught to be caregivers and advocates, and they are never quiet when it comes to advocacy. However, nurse’s involvement in politics is usually not evidence.

I do agree with you on your recommendations. Nurses need to start from the basics by voting and getting to know their elected officials and calling the offices of these officers to advocate for policies they support Role of the RN/APRN in Policy Evaluation Essay. The nurse can develop and established contacts with legislators and forge relationships with elected officials (Milstead & Short, 2019).

Participating in a professional organization is also recommended; nurses can go the extra mile by seeking experienced nurse advocate for mentorship. There are still challenges nurses to face concerning impacting politics in total, and one of them is the view of the publics of nurses. A research poll of the public opinion of nurses showed that nurses are perceived as caregivers and not as decision-makers (Nitzky, 2018). suppose the workplace provides support and avenue for nurses to participate in their workplace policy, and employers respect and promote the nurses’ contributions. In that case, the public will start to view nurses differently.

Reference

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6
th
 ed.). Burlington, MA:

Jones & Bartlett Learning.

NItzky, A. (2018). How to lead change in nursing through political action. 
Oncology Nursing News Role of the RN/APRN in Policy Evaluation Essay
.

https://www.oncnursingnews.com/view/how-to-lead-change-in-nursing-through-political-
action

sample response 3

I support the fact that nurses should attend meetings conducted by the board of nursing. They have first to join professional nursing organizations before they can get the opportunity to participate in the meetings. While at the meetings, they can raise policy issues they have seen affecting healthcare delivery at their facilities and propose changes (Matthew, 2012). Through professional organizations, nurses can gain access to politicians who have a strong influence on decision-making. Therefore, nurses can participate indirectly in policy review by joining professional organizations, allowing them to interact with policymakers and give them ideas (Matthew, 2012).

Nurses need to become more involved in policy review by collaborating with other healthcare providers. Physicians should allow nurses to pursue leadership positions instead of having them working under them all the time. Some nurses are afraid to speak up before physicians and other healthcare personnel because they have not been allowed to do so. I think that nurses should not be intimidated by their positions as they strongly influence policymaking and review. Physicians need to provide nurses with training and mentorship to take up active advocacy roles (Turale & Kunaviktikul, 2019). Their voices need to be heard, and they should advocate for their best interests and that of their clients Role of the RN/APRN in Policy Evaluation Essay.

References

Matthews, J. (2012). Role of professional organizations in advocating for the nursing profession. 
Online J Issues Nurs
, 
17
(3).

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. 
International nursing review
, 
66
(3), 302-304 Role of the RN/APRN in Policy Evaluation Essay.

Discussion: The Role of the RN/APRN in Policy Evaluation

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?

In this Discussion, you will reflect on the role of professional nurses in policy evaluation Role of the RN/APRN in Policy Evaluation Essay.

To Prepare:

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.

Review the Resources and reflect on the role of professional nurses in policy evaluation.

By Day 3 of Week 9

Post
 an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in 
policy review
.
 Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

By Day 6 of Week 9

Respond
 to at least 
two
 of your colleagues
* on two different days
 by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.

As members of the largest segment of the healthcare workforce, nurses have an important role in policy and program evaluation” (Milstead & Short, 2019, p. 117). Nurses have a huge role in patient care and advocacy.  They are, in most cases, the last line of defense for the patient. Therefore, a nurse’s role in policy and program change are the most important part of the team Role of the RN/APRN in Policy Evaluation Essay.

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The first opportunity to participate through the workplace, as part of a committee. “Working on organizational boards or involvement in shared governance offers firsthand knowledge” (Jurns, 2019). Most facilities offer committees to assist and get people involved in policy making and leadership. Take advantage and ask your leadership how to get involved. The second opportunity is to work with local politicians on policy that could be part of the legislative process. Politicians look for expert advice from healthcare professionals to implement change in healthcare policy. This would be an excellent way to give input into policy or programs.

 

One challenge for these opportunities is finding a point champion with the knowledge and skills necessary to lead a team for a change of policy. “Having a skilled and knowledgeable point champion and adequate resources are key to a successful evaluation” (Milstead & Short, 2019, p. 122). This person not only should be knowledgeable on the subject but be able to lead and communicate with his/her team. Another challenge would be any ethical dilemmas that may arise from changes in policy. Many organizations, including the CDC has ethical guidelines that you can follow to make sure any policy changes are ethically correct, so its important to review some of these guidelines before making any important decisions Role of the RN/APRN in Policy Evaluation Essay.

“When implementing policies or programs designed to improve the health of populations and communities, professional nurses must adopt strategies to minimize evaluation challenges” (Milstead & Short, 2019, p. 122). The first strategy I would recommend is to contact your local politician and ask how you could get involved. Every state website has the email and phone numbers of all the local politicians and how you may contact them regarding policy and legislation. The second strategy I would use would be recognizing any possible conflicts that may arise between the members of your team.  Remember that nothing will ever get final if there is conflict and indecisiveness amongst the team.  Negotiate and compromise as much as you can and listen to one another’s concerns.

 
References

 
Milstead, J. A., & Short, N. M. (2019). 
Health policy and politics: A nurse’s guide
 (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Jurns, C. (2019). Policy Advocacy Motivators and Barriers: Research Results and Applications Role of the RN/APRN in Policy Evaluation Essay. 
Online Journal of Issues in Nursing
, 
24
(3), N.PAG. 
https://doi-org.ezp.waldenulibrary.org/10.3912/OJIN.Vol24No03PPT63

response

As you and Milstead & Short (2019) has stated, nurses are one of the largest healthcare workforces and we supply an exponential amount of money for healthcare policies, lobbyists, and more. That being said, we should be a large sum of the individuals that participate within health care policy making and evaluation. Being an advocate and actively participating in your community I think is very important. Those are the people that know you and should know you and will speak highly of you. As we all know, word of mouth travels fast, positively and negatively, especially within the healthcare field. Somehow a patient will know someone, who knows someone, that is related to a politician Role of the RN/APRN in Policy Evaluation Essay.

Hopefully, at this point in time in our career, that is a good thing. At least for myself, I want to advocate for my community members and if that means I can speak directly to a politician regarding a health care concern, I would be ecstatic. Nurses are great at communicating concerns, identifying issues, and of course providing recommendations (Olson, 2020). The whole ISBAR (identify, situation, background, assessment, and recommendation) is a great tool to utilize not only when speaking to healthcare providers, but also politicians, making it easy and relatable for non-healthcare providers to relate to situations and influence their decisions (Milstead & Short 2019).

As we know, there are always challenges, even with the best communications skills. You mentioned that having the skills and knowledge are keys to success, which I could not agree more with. Knowing how to approach issues appropriately can be difficult if you do not have to proper tools or any for that matter. Although, finding a mentor or a reputable resources or organization to aid in yourself growth is important, especially if you want to begin your adventure with policy review Role of the RN/APRN in Policy Evaluation Essay. Knowing where to start and how to find it is only the beginning and sometimes, we may not be aware of an issue until is it in legislation (Laureate Education, 2018). So, finding an organization or induvial to walk you through the steps and assist you to speak up when the time is right (Milstead & Short, 2019) is very important and something we are learning, especially in this course.

Resources

Milstead, J. A., & Short, N.M. (2019). 
Health policy and politics: A nurse’s guide 
(6
th
 ed.). Burlington, MA: Jones Bartlett Learning.

Laureate Education (Producer). (2018) 
Program policy and evaluation 
[Video file]. Baltimore, MD: Author.

Olson, K. (2020). 
Influence through policy: four steps YOU can take
. Nursing Centered. Retrieved April 28, 2021, from https://nursingcentered.sigmanursing.org/commentary/more-commentary/Vol42_2_influence-through-policy-four-steps-you-can-take Role of the RN/APRN in Policy Evaluation Essay

NURS 6050 Discussion: Professional Nursing and State-Level Regulations

APRN Prescriptive Authority for Arkansas and Texas

Prescriptive authority in the state of Arkansas for APRNs requires that the APRN be licensed in the state of Arkansas with prescribing practices within the scope of practice per the practitioner’s certification category. Within one year of beginning an APRN level pharmacology course, the practitioner must complete 300 hours of experience with a qualified preceptor and submit a collaborative practice agreement with an Arkansas licensed physician who has an unrestricted DEA registration number. After meeting these requirements, only then can an APRN prescribe legend drugs and medicines or therapeutic devices specific to the practitioner’s area of practice. For controlled drugs, only Schedule III through V may be prescribed by an APRN. With the exception of hydrocodone combination products, an APRN may not prescribe Schedule I and II controlled substances (
Arkansas Department of Health
2018) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

In the state of Texas, prescriptive authority for APRNs requires the practitioner have successful completion of graduate level pharmacotherapeutics, advanced pathophysiology, and advanced health assessment. The practitioner must also complete 45 hours per course of preceptor experience with a qualified preceptor. If an APRN has prescriptive authority in another state, the practitioner must meet the education requirements of Texas before being able to have
prescriptive authority
. The practitioner also has the ability to authorize or prevent the use of generic substitutions on prescription drugs. Unlike Arkansas, APRNs in Texas are allowed to prescribe Schedule II controlled substances, but only in the hospital setting (
Practice – APRN Scope of Practice
2019) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

APRN Delegation Regulations for Arkansas and Texas

In the state of Arkansas, an APRN may delegate certain tasks to nurses and/or unlicensed staff. The task may include noninvasive treatments, collection and documentation of data, ambulation, positioning, or turning, and personal hygiene. Tasks that should not be delegated include physical assessments, formulation of the patient’s plan of care, transmitting verbal or telephone orders, and an APRN cannot delegate to unlicensed staff the calling in of prescriptions to the pharmacy (
Arkansas Department of Health
 2018).

One of the major differences in delegation for the state of Texas is that unlike Arkansas, administration of medication to a patient may be delegated to a medication aide in correctional health, long term care facilities, and home health agencies. All other general criteria for delegation apply for the state of Texas as well, with the responsibility of determining competence of the delegate resting on the delegating APRN (
Practice – APRN Scope of Practice
 2019).

Prescriptive Authority and Delegation for APRNs with Full Practice Authority

Prescriptive authority and delegation regulations for APRNs with full practice authority may be affected by the continuous state and national barriers that prevent qualifying practitioners from practicing to their full extent. If allowed to work to their full extent of education and training, APRNs will be able to provide services to vulnerable populations, such as minorities and the uninsured (Bosse et al., 2017) NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

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References

Arkansas Department of Health. (2018, December 29). https://www.healthy.arkansas.gov/programs-services/topics/arsbn-adv.-practice.

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., Vanhook, P., & Poghosyan, L. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. 
Nursing Outlook
, 
65
(6), 761–765. https://doi.org/10.1016/j.outlook.2017.10.002

Practice – APRN Scope of Practice
. Texas Board of Nursing – Practice – APRN Scope of Practice. (2019). https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.

Discussion: Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

To Prepare:

Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

Consider how key regulations may impact nursing practice.

Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..

By Day 3 of Week 5

Post
a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

By Day 6 of Week 5

Respond
 to at least 
two
 of your colleagues
* on two different days
 and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.

In New Jersey, while an advanced practice nurse (APN) or nurse practitioner (NP) cannot practice independently, they are recognized as primary care providers.  Otherwise known as a joint protocol, they require “collaboration, and a written protocol with a physician is required when prescribing medications” (NCSLSOP Scope of Practice Policy, 2021).  This collaboration also extends to prescription writing for all medications (The State of New Jersey, n.d.).    The APNs that I have worked with, prescription pads have a medical doctor’s name and NPI number written on them.  When the APNs introduce themselves, they inform the staff of the name of which doctor they are collaborating with.

In comparison, all advanced practice nurses in Florida do not require collaboration.  HB 607 (Autonomous Practice) is a bill that was passed on March 11, 2020, allowing APNs to be autonomous (FLANP).  They can practice independently, including prescription writing of any drug (NCSLSOP Scope of Practice Policy, 2021). Every nurse practitioner does not have to be autonomous, as it is a choice to be independent or collaborate.   Those who choose to practice autonomously will require additional continuing education hours that include “three graduate-level semester classes in differential diagnosis, three graduate-level semester classes in pharmacology” (FLANP)
, 
and 3,000 hours of supervision.
  
 
The APNs 
who 
choose to continue to collaborate will do so under the supervision of a doctor and cannot prescribe control substances NURS 6050 Discussion: Professional Nursing and State-Level Regulations.

While I agree that APNs should practice independently, I agree with the mandatory supervision hours.  Even though nurses are encouraged to advance their education, the balance requires hands-on care and practice.  We do not want book competent nurses that are deficient in critical thinking due to a lack of clinical exposure. The job of the state board of nursing and as a regulatory body is to protect the public from harm.  Florida’s board of nursing made great strife in going from a restricted status of APN licensure to independent status, yet put the correct stipulations in place to protect the public.

References

FLANP.
 (n.d.). Retrieved from Florida Association of Nurse Practitioners: https://www.flanp.org/page/AutonomousPractice

NCSLSOP Scope of Practice Policy
. (2021). Retrieved from National Organizations for State and Local Officials: https://scopeofpracticepolicy.org/states/nj/

The State of New Jersey
. (n.d.). Retrieved from New Jersey Division of Consumer Affairs: https://www.njconsumeraffairs.gov/nur/Pages/APN-Certification NURS 6050 Discussion: Professional Nursing and State-Level Regulations

Role of the RN/APRN in Policy Evaluation Essay Example

Nurses are very familiar with the evaluation process, as it is the last stage of the nursing process. However, the process of evaluating policy implementation is different from evaluating nursing interventions. During and after policy implementation, policies must be evaluated to determine their effectiveness and observe any unintended consequences (Milstead & Short, 2019). Evaluation can occur either formally or informally, but a formal review is the gold standard, as informal reviews may lead to skewed and inaccurate findings (Milstead & Short, 2019). Evaluation can also occur on an ongoing basis or as a final analysis, but doing both allows a better view of the whole picture (Yoder-Wise, 2019). Data can be collected during review or evaluation in various ways, such as interviews, focus groups, questionnaires, and literature reviews (Moule et al., 2017) Role of the RN/APRN in Policy Evaluation Essay Example.
 

Post an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in policy review.

One way that nurses can be involved in policy review is to join a committee within their organization. The hospital that I work at has numerous committees that implement small changes regularly. One of the changes recently implemented by a unit council (a council specific to each unit) was that nursing assistants would not be assigned patients. Before, nursing assistants were not assigned to patients. Instead, they just helped out where it was needed. Nursing assistants have tasks they need to take ownership of, but sometimes these tasks were not done, and patients’ needs were going unmet. An example of this is that foley catheter care was to be done twice daily by nursing assistants, but audits showed that it was not being done. Subsequently, patients were at increased risk for developing catheter-associated urinary tract infections (CAUTIs). The unit council voted to start assigning nursing assistants to specific patients. Our evaluation shows that foley care is being done more effectively now, and patients receive higher quality care Role of the RN/APRN in Policy Evaluation Essay Example.

Another way to participate in policy review is to join a professional nursing organization (Williams, Phillips, & Koyoma, 2018). Professional nursing associations advocate for causes on many different topics such as reducing gun violence, improving nurses’ health, safe staffing, and much more (American Nurses Association, n.d.).
 

Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges.

Many challenges may be faced through policy review or evaluation. One possibility is that during evaluation, nurses or other staff may feel that their work (or the quality of their work) is being evaluated as opposed to the policy itself (Moule et al., 2017). One way to overcome this is to engage a partnership with staff, ensure them of the policy’s purpose, and, therefore, the evaluation’s purpose (Moule et al., 2017) Role of the RN/APRN in Policy Evaluation Essay Example.

Other challenges include ethical dilemmas (Milstead & Short, 2019). Many professional organizations have created ethical guidelines for evaluation processes. Key considerations include beneficence, safety, autonomy, and justice, according to the ANA code of ethics (Milstead & Short, 2019). If patient data is involved, privacy should always be maintained per The Health Insurance Portability and Accountability Act of 1996 (HIPAA) (Milstead & Short, 2019). Most challenges can be avoided through thoughtful planning and implementation (Milstead & Short, 2019).

Recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

One of the great things about working at a magnet hospital is that the hospital encourages shared governance, a practice that empowers nurses to improve work experiences and patient outcomes (Joseph & Bogue, 2016). One way the hospital promotes shared governance is through committees. The hospital and committee members encourage other members of the hospital, especially nurses, to join these committees. One way my nurse manager advocates for these opportunities is through quarterly emails. She sends out emails asking if any staff members would like to join any hospital committees to make a difference Role of the RN/APRN in Policy Evaluation Essay Example.

Ways to advocate for joining a professional nurse organization include communicating the benefits of joining an association. These benefits include continuing education, networking opportunities, and improvement of the profession.

References

American Nurses Association. (n.d.). Advocacy. Retrieved April 23, 2021, from 
https://www.nursingworld.org/practice-policy/advocacy/

Crumley, C. (2020). The Benefits of Active Engagement in Nursing Professional Organizations: A View From Here. Journal of Wound, Ostomy and Continence Nursing. https://doi-org.ezp.waldenulibrary.org/10.1097/WON.0000000000000700

Joseph, M. L., & Bogue, R. J. (2016). A theory-based approach to nursing shared governance. Nursing Outlook, 64(4), 339–351. https://doi-org.ezp.waldenulibrary.org/10.1016/j.outlook.2016.01.004

Moule, P., Armoogum, J., Douglass, E., & Taylor, D. J. (2017). Evaluation and its importance for nursing practice. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 31(35), 55–63. https://doi-org.ezp.waldenulibrary.org/10.7748/ns.2017.e10782

Williams, S.D., Phillips, J.M., & Koyoma, K. (2018). Nurse advocacy: Adopting a health in all policies approach. OJIN: The Online Journal of Issues in Nursing 23(1). DOI: 10.3912/OJIN.Vol23No03Man01 Role of the RN/APRN in Policy Evaluation Essay Example.

Yoder- Wise, P. S. (2019) A framework for planned policy change. Nursing Forum 55(1), pp. 45-53. 
https://doi-org.ezp.waldenulibrary.org/10.1111/nuf.12381

Discussion: The Role of the RN/APRN in Policy Evaluation

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making. A critical component of any policy design is evaluation of the results. How comfortable are you with the thought of becoming involved with such matters?

Some nurses may be hesitant to get involved with policy evaluation. The preference may be to focus on the care and well-being of their patients; some nurses may feel ill-equipped to enter the realm of policy and political activities. However, as you have examined previously, who better to advocate for patients and effective programs and polices than nurses? Already patient advocates in interactions with doctors and leadership, why not with government and regulatory agencies?

In this Discussion, you will reflect on the role of professional nurses in policy evaluation Role of the RN/APRN in Policy Evaluation Essay Example.

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To Prepare:

In the Module 4 Discussion, you considered how professional nurses can become involved in policy-making.

Review the Resources and reflect on the role of professional nurses in policy evaluation.

By Day 3 of Week 9

Post
 an explanation of at least two opportunities that currently exist for RNs and APRNs to actively participate in 
policy review
.
 Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities. Be specific and provide examples.

By Day 6 of Week 9

Respond
 to at least 
two
 of your colleagues
* on two different days
 by suggesting additional opportunities or recommendations for overcoming the challenges described by your colleagues.

I agree with you that nurses can take advantage of the opportunities in their facilities by joining organizational committees. Change starts within the facility as it progresses upwards in the healthcare organizational ladder. Nurses can work together towards advocating for improvement in healthcare policies (Tomajan, 2012). Apart from joining committees, nurses can take up leadership positions to put them at the forefront of policy decision-making and review. Nurses should not shy away from seeking leadership positions, exceptionally if they are qualified Role of the RN/APRN in Policy Evaluation Essay Example. I am currently pursuing my Master’s program at Walden to increase my eligibility for an administrative position in the future. Furthermore, becoming a member of a professional organization is another way that nurses can get opportunities to participate in the policy review. Frequent policy evaluation is necessary to facilitate their amendment or elimination.

I also think the hospital leadership must encourage nurses to seek leadership positions (Arab et al., 2014). Nurses are motivated by the effective leadership of others to pursue administrative positions as well. On the other hand, if the current leadership is not good, nurses are likely to be discouraged from seeking committee membership and leadership Role of the RN/APRN in Policy Evaluation Essay Example.

References

Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. 
Iranian journal of nursing and midwifery research
, 
19
(3), 315.

Tomajan, K. (2012). Advocating for nurses and nursing. 
OJIN: The Online Journal of Issues in Nursing
, 
17
(1), 4.

 

response 2

Unit councils are a great way for nurses to start the process of being involved in policy review. My neonatal intensive care unit has a unit based council (UBC) consisting of bedside nurses, nurse leaders, physicians and more that meets regularly to discuss issues affecting the unit and possible solutions. “Health policy can be used as an instrument to incentivize collaboration and teamwork where none previously existed” (Milstead & Short, 2019). Within your facility an issue presented itself that had the potential for patient harm and through interprofessional collaboration and policy review, your team was able to find a solution that was proven to be implementable and effective.  Your mention of nurses feeling their work is being evaluated instead of the policy was something I had not considered. I believe that if establishments provided nurses with the appropriate policy training, then there may be a decrease in those feelings. Turale and & Kunaviktikul (2019) discuss the importance of educating nurses about the policy process by providing them with policy training programs so nurses can confidently collaborate with other healthcare providers to help shape policies. In 
Health policy and politics 
(Laureate, 2018) it is discussed how important it is to be involved in a national association because they exert tremendous influence on the process, and how important it is to be an active member on boards and committees to become an expert in nursing. Being involved in facility committees can provide nurses the opportunity to help important stakeholders understand the issues being presented and what their impact would be Role of the RN/APRN in Policy Evaluation Essay Example.

References

Laureate Education (Producer). (2018). 
Health policy and politics
 [Video file]. Baltimore, MD: Author.

Milstead, J. A., & Short, N. M. (2019). 
Health policy and politics: A nurse’s guide
 (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Turale, S., & Kunaviktikul, W. (2019). The contribution of nurses to health policy and advocacy requires leaders to provide training and mentorship. 
International Nursing Review, 66
(3), 302-304. https://doi.org/10.1111/inr.12550

 

sample response 3

I enjoyed your post! The section that stood out to me the most was discussing ethical dilemmas in policy making. It is important when developing policies that ethical considerations are taken into account. Is the policy change going to promote the four areas of nursing ethics: autonomy, beneficence, justice and non maleficence (Knight et al., 2020)? Ethical considerations are important today regarding COVID vaccinations in particular. The United States is divided on this issue and there is a sample of the population to expects everyone to be vaccinated and a sample of the population who wants to have the choice to be vaccinated or not. Colleges are beginning to consider requiring students be vaccinated in order to attend their schools for example (Durand, 2021). Parents are upset by this as the vaccine has only been approved for emergency use and is not fully FDA approved at this time. The question then is…can a college require someone to get a vaccine that is not fully approved by the FDA? They understand that vaccines are normally required to attend schools but those vaccines have FDA approval. As a nurse I can see both sides of this coin and it is definitely a dilemma. One good thing (in my opinion) that has come out of the COVID lockdowns is that I feel we have realized that there is so much technology can do for us and it has opened the doors for many different platforms for learning and working Role of the RN/APRN in Policy Evaluation Essay Example.

References

Durand, L. (2021, April 16). Debate over universities mandating COVID-19 vaccination for students in the fall. 
UWIRE Text
.

Knight, S., Hayhoe, B. W., Frith, L., Ashworth, M., Sajid, I., & Papanikitas, A. (2020). Ethics education and moral decision-making in clinical commissioning: an interview study. 
British Journal of General Practice
, 
70
(690), e45–e54. https://doi-org.ezp.waldenulibrary.org/10.3399/bjgp19X707129

 

sample response 4

Thank you for the in-depth discussion post this week! I enjoyed reading your thoughts on barriers and solutions in regards to nurses in the policy-making arena. I think all of us in the class agree that the two most effective methods for nurses to enter the policymaking world of healthcare is by joining nursing organizations and becoming more active within the company they work for. “Nursing organizations with legislative departments provide analysis on current issues in health policy and tips on how to communicate with legislators. Many also offer workshops on nursing advocacy, or legislative days at the state house, both excellent places to begin an advocacy career” (Oestberg, 2013). The groups or members within nursing organizations who are dedicated to policy change can provide a mentor for learning how the legislative aspect of healthcare works. Often a barrier to participation is the lack of understanding of how the process works Role of the RN/APRN in Policy Evaluation Essay Example.

I appreciate how you explained how working within a magnet status hospital changes a lot for nurses in policymaking. In my area of Hampton Roads, VA the major hospital system, Sentara, is working towards achieving magnet status at all of their hospitals. “A fundamental requirement of hospitals applying for Magnet status is that they must demonstrate an effective shared governance structure. Shared governance is a decision-making model focused on empowering the people who care for the patients” (Collins, 2017). As you stated, magnet status hospitals develop committees with all healthcare provider members, dedicated to reviewing, changing, and developing new healthcare policies within the hospital Role of the RN/APRN in Policy Evaluation Essay Example.

References
 

Collins, R. (2017, October). Magnet hospitals and shared governance: Empowering frontline nurses. Vocera. https://www.vocera.com/blog/magnet-hospitals-and-shared-governance-empowering-frontline-nurses

Oestberg, F. (2013, May). Getting involved in policy and politics. Nursing 2020 Critical Care. https://journals.lww.com/nursingcriticalcare/fulltext/2013/05000/getting_involved_in_policy_and_politics.10.aspx Role of the RN/APRN in Policy Evaluation Essay Example

Discussion: Professional Nursing and State-Level Regulations

In Pennsylvania, nurse practitioners are considered primary care providers. They can diagnose, treat, order, and perform tests and prescribe medications. However, they must have a written collaboration with a physician (Pennsylvania Coalition of Nurse Practitioners, n.d.). A federal waiver to dispense buprenorphine-containing products is obtainable through proper training and physician oversight (Pennsylvania Coalition of Nurse Practitioners, n.d.) Discussion: Professional Nursing and State-Level Regulations.

In contrast, Washington D.C. allows nurse practitioners to function independently without physician oversight, including prescribing controlled substances under the state board of nursing authority (American Association of Nurse Practitioners, n.d.). Allowing nurse practitioners to practice within their education’s full scope helps expand the community’s medical resources. Every state should implement this idea to provide greater access to primary care.

For nurse practitioners in Pennsylvania to adhere to these regulations, they can not open a primary care practice. Instead, they must join a team that operates with a physician at the team’s head. The physician provides oversight of the nurse practitioner and their practice. If the physician manages those with opioid addictions, the nurse practitioner working with them can become trained and eligible to prescribe buprenorphine under the physician’s guidance. To do so, a nurse practitioner must complete 24 hours of training, demonstrate the ability to treat and manage opiate use disorder, and be licensed to prescribe Schedule III, IV, or V medications for pain (American Society of Addiction Medicine, n.d.) Discussion: Professional Nursing and State-Level Regulations.

References

American Association of Nurse Practitioners. (n.d.).  State practice environment.  https://www.aanp.org/advocacy/state/state-practice-environment

American Society of Addiction Medicine. (n.d.).  Buprenorphine waiver management.  https://www.asam.org/advocacy/practice-resources/buprenorphine-waiver-management

Pennsylvania Coalition of Nurse Practitioners. (n.d.).  Scope of practice.  https://www.pacnp.org/page/ScopeofPractic e

sample response

I agree with your statement on all states needing to allow APRNs to practice without a collaborating physician. As you stated above , it will provide greater access to health care. According to 
Neff
 et. 
al
, a
llowing
 
NPs
 full autonomy to practice may be a relatively simple policy mechanism for states to improve access to p
rimary
care (2018). This statement shows that research has been done and studies have shown this to be factual. In Pennsylvania , APRNs practice regulations are much like those of South Carolina. The scope of practice in South Carolina is delegated and APRNs can prescribe legend drugs and schedule II controlled substances by a certain amount and time frame (NCSBN,n.d) Discussion: Professional Nursing and State-Level Regulations. Overall, I believe states should look into how to align the regulations and scopes of practices to be alike,hence; APRNs could easily practice in any state and it will help to improve access to health care. Thank you for the knowledge of what regulations are for Pennsylvania and Washington, DC.

References

National Council of State Boards of Nursing (NCSBN). (n.d). Retrieved April 2, 2021, from https.//www/ncsbn.org/index.htm

Neff, D.F, Yoon, S.H., Steiner, R.L., Bumbach, M.D., Everhrt, D., & Harman J.S. (2018). The impact of nurse practitioner regulations on population access to care.
Nursing Outlook, 66
(4), 379-385. doi: 10.1016/j.outlook.208.03.001

response 2

I agree that nurse practitioners should be given the opportunity to practice independently if they choose. Many states have placed restriction on NP in there prescriptive authority and practice. The medical associations are the leading proponents of restricting NP prescriptive and practice, they believe the NP and physician should work together to provide safe and quality healthcare (Park et al., 2018) Discussion: Professional Nursing and State-Level Regulations. Many physicians I have spoken too have said they are not comfortable with all NP practicing independently. The other side of the coin is that there are many NP that do not want to work independent and feel more comfortable with assistance from a physician. Primary care providers are in demand as many physicians have chosen other career pathways. Nurse practitioners have been shown to have less malpractice lawsuits and improved patient satisfaction (Kraus and DuBois, 2016). At the end of the day it really depends on the nurse practitioners comfort level to work independently.

Kraus, E. & DuBois, J.M. (2016). Knowing your limits: A qualitative study of physicians and nurse practitioner perspectives on NP independence in primary care. 
Journal of General Internal Medicine
, 32(3), 284-290. 
https://doi-org.ezp.waldenulibrary.org/10.1007/s11606-016-3896-7

Park, J., Athey, E., Pericak, A., Pulcini, J. & Greene, J. (2018). To what extent are state scopr of practice laws related to nurse practitioners’ day-to-day practice autonomy. 
Medical Care Research and Review,
 75(1), 66-87. 
https://doi-org.ezp.waldenulibrary.org/10.1177%2F1077558716677826

Discussion: Professional Nursing and State-Level Regulations

Boards of Nursing (BONs) exist in all 50 states, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. Similar entities may also exist for different regions. The mission of BONs is the protection of the public through the regulation of nursing practice. BONs put into practice state/region regulations for nurses that, among other things, lay out the requirements for licensure and define the scope of nursing practice in that state/region.

It can be a valuable exercise to compare regulations among various state/regional boards of nursing. Doing so can help share insights that could be useful should there be future changes in a state/region. In addition, nurses may find the need to be licensed in multiple states or regions Discussion: Professional Nursing and State-Level Regulations.

To Prepare:

Review the Resources and reflect on the mission of state/regional boards of nursing as the protection of the public through the regulation of nursing practice.

Consider how key regulations may impact nursing practice.

Review key regulations for nursing practice of your state’s/region’s board of nursing and those of at least one other state/region and select at least two APRN regulations to focus on for this Discussion..

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By Day 3 of Week 5

Post
 a comparison of at least two APRN board of nursing regulations in your state/region with those of at least one other state/region. Describe how they may differ. Be specific and provide examples. Then, explain how the regulations you selected may apply to Advanced Practice Registered Nurses (APRNs) who have legal authority to practice within the full scope of their education and experience. Provide at least one example of how APRNs may adhere to the two regulations you selected.

By Day 6 of Week 5

Respond
 to at least 
two
 of your colleagues
* on two different days
and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples Discussion: Professional Nursing and State-Level Regulations.

Initial Discussion post

The mission of all boards of nursing (BON) is to protect the public. The BONs protect the public through regulatory processes. One regulatory practice used to ensure competency in a nurse is setting specific criteria to sit for a licensure examination (Milstead and Short, 2019). All BONs require new nurses to pass the National Council Licensure Examination (NCLEX) before they are given state licensure as a registered nurse. The BONs use Nurse Practice Acts to provide specific details of what a nurse can do or not do (Milstead and Short, 2019). Some nursing practice acts that the BON may provide requirements for licensure, educational standards, and scopes of practice (Milstead and Short, 2019). There are different regulations in each state, so it is essential to know the state regulations where you practice.

There are regulations in the state board of nursing that may affect the way nurses practice. The nurse practice acts that may restrict nurses from specific procedures are one-way BONs influence nurses’ care. Compact nursing licensure in several states helps nurses make smooth transitions from one state to another to provide care to patients. Sometimes the BONs’ repeal of regulations may also affect nurses’ care (Laureate Education, 2018). It is important to know current regulations and get involved in the regulatory process when it may affect our practice negatively Discussion: Professional Nursing and State-Level Regulations.

The states of Wyoming and Soth Carolina were used to compare Advanced Practice Registered Nurses (APRN) practice acts. In Wyoming, APRNs are allowed to function independently and, in South Carolina, must practice under a physician (AANP, n.d.). Nurse practitioners should have the right to practice independently and without oversite by physicians. Nurse practitioners provide care to underserved populations and rural areas (Bosse et al., 2017). The other regulation that affects APRN’s care is that they are not compensated 100% for Medicaid and Medicare patients. APRNs receive between 80% to 85% of the payment a physician would receive for the same care (Bosse et al., 2017). APRNs have made progress but still, need to be able to practice at the full scope of their education.

American Association of Nurse Practitioners. (n.d.). 
State practice environment
. https://www.aanp.org/advocacy/state/state-practice-environment

Bosse, J., Simmonds, K., Hansen, C., Pulcini, J., Dunphy, L. & Vanhook, P. (2017). Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care. 
Nursing Outlook
, 65, 761-765. 
https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554%2817%2930558-4

Laureate Education (Producer). (2018). The Regulatory Process [Video file]. Baltimore, MD: Author.

Milstead, J.A. & Short, N.M. (2019). 
Health policy and politics: A nurse’s guide
(6th ed.). Jones & Bartlett Learning Discussion: Professional Nursing and State-Level Regulations.

response

Travel nursing seems to be the popular choice lately. I never thought about how this would impact an advanced practice registered nurse (APRN) crossing state boundaries when each state has particular practice restrictions. Varying regulations make it nearly impossible for APRNs to practice in other states (Milstead & Short, 2019).

Pennsylvania is similar to South Carolina when it comes to APRN practice. All nurse practitioners must operate under a
physician’s guidance,
limiting access to quality healthcare for many Americans. I agree that nurse practitioners should be able to function as independent providers.

After reading your post, I did more research on Medicare payment policies and found some interesting facts. You describe an “incident to” billing, which leaves nurse practitioners’ quality care unrecognized (MedPAC, 2019). This issue occurs when patient care is billed under a supervising physician, even though a nurse practitioner managed the care. I would like to see all 50 states recognize nurse practitioners as independent providers and reimburse them accordingly.

References

MedPAC. (2019). 
Improving Medicare’s payment policies for advanced practice registered nurses and physician assistants. 
http://www.medpac.gov/-blog-/the-commission-recommends-aprns-and-pas-bill-medicare-directly-/2019/02/15/improving-medicare%27s-payment-policies-for-aprns-and-pas

Milstead, J., & Short, N. (2019). 
Health policy and politics: A nurse’s guide. 
Jones & Bartlett Discussion: Professional Nursing and State-Level Regulations.

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Main Post

Nurse informaticists and information technology professionals are crucial to keep a hospital running. Unfortunately, we often only see these professionals when new software or technology is rolling out or there is a malfunction of some type. Of course, these professionals are continuing to keep things running without always working with bedside health professionals. As time goes on in health care, the more computer proficient we all become. Ways, the bedside health care worker, can be a better student for the nurse informaticist or information technology professional is to pay attention. As much as many of us hate learning new technology, if we pay attention to the expert, we can streamline whatever new software or product. If you pay attention during the demonstration of new software and become a superuser for the floor, fewer information classes will be needed for new software. In reverse, the information technology professional or nurse informaticist also needs to listen to feedback. The bedside nurse will work will the latest software and give valuable information on how to make software and technology more user-friendly. For instance, if there is a long, arduous computer program for the operating room and the bedside nurse has feedback on how to shorten the form, it is a win-win Discussion: Interaction Between Nurse Informaticists and Other Specialists. Nursing informatics continues to grow, and most bedside nurses today use substantially more technology than they did even five years ago. This evolution helps give nurses programs that safeguard the patient and nurse. The profession of nursing informatics also continues to grow, with colleges now offering specific nursing informatics degree programs. It has been shown that nurses that are competent in nursing informatics increase patient safety (Jouparinejad et al., 2020). The nurse informaticist may also safeguard the patient to avoid the patient’s record being stolen by the dark web (Kim, 2020). No matter what your role in nursing is going forward in health care, nurses must have some competencies in nursing informatics (Murphy et al., 2018).

References

Jouparinejad, S., Foroughameri, G., Khajouei, R., & Farokhzadian, J. (2020). Improving the informatics

competency of critical care nurses: results of an interventional study in the southeast of Iran Discussion: Interaction Between Nurse Informaticists and Other Specialists.

BMC Medical Informatics and Decision Making, 20(1), 220.

https://doi-org.ezp.waldenulibrary.org/10.1186/s12911-020-01244-5

Kim, L. (2020). Cybercrime, ransomware, and the informatics nurse. Nursing Management, 51(5), 10–12.

https://doi-org.ezp.waldenulibrary.org/10.1097/01.NUMA.0000659448.63050.f1

Murphy, J., Honey, M., Newbold, S., Weber, P., & Wu, Y. H. (2018). Forecasting Informatics

Competencies for Nurses in the Future of Connected Health. Studies in Health Technology and

Informatics, 250, 58–59 Discussion: Interaction Between Nurse Informaticists and Other Specialists.

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

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In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post
 a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

By Day 6 of Week 3

Respond
 to at least 
two
 of your colleagues
* on two different days
, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions Discussion: Interaction Between Nurse Informaticists and Other Specialists.

response

I share your concern since I have gone through the same issue. Superusers on the floor is a great idea. Feedback by nurses is also important. According to Murphy (2010), nursing informatics today has evolved to be an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health information technology that supports safe, high-quality, patient-centric care. Nurses are a patient’s lifeline in numerous ways. In today’s digital world, nurses must be aware of the risk of data and system tampering. The incorporation of informatics makes up able to detect potential threats and problems associated with the integrity and security of the data system. For example, it assists in compliance with HIPPA. The software installed will provide the data regarding each user. Due to the strict recommendation that only team members who are directly involved in patient care are allowed to look u patient information, the branch of nursing informatics reduces cybercrime as well.

                                                                                             References

Kim, Lee JD, CISSP, CIPP/US, FHIMSS Cybercrime, ransomware, and the informatics nurse, Nursing Management (Springhouse): May 2020 – Volume 51 – Issue 5 – p 10-12 DOI: 10.1097/01.NUMA.0000659448.63050.f1

Murphy, J. (2010). Nursing informatics: The intersection of nursing, computer, and information

sciences. Nursing Economics, 28(3), 204-7.

https://search.proquest.com/docview/577364695?accountid=6724

HIPAA Checklist: Securing Healthcare Organizations with Zero Trust

 

 

response 2

Great post! This information is very accurate. Technology is advancing every day with the Electronic Health Record (HER) and documentation systems. The physicians, nursing staff and healthcare team does try their best to keep things going if there is a malfunction. The facility I work in has down time every so often during night shift. It is planned ahead of time so we can plan with additional staff as well as have paper documentation and forms ready incase of an emergency or new orders are obtained. During down time, there are risks of increased error, orders being missed or not complete and increase in time management. These things are some of the reasons to why technology is important in the health care setting to being with (2019, AHP) Discussion: Interaction Between Nurse Informaticists and Other Specialists.

The facility I work in has super-users as well. Each unit has designated staff that go through additional education courses on the roll out of new equipment or technology. This helps patient care, nurse competency and keeps things moving on the unit. Nurses are knowledge workers every day. They learn and process expertise in a particular area or field of study and distribute their knowledge through teaching, demonstration, and patient care to create the biggest benefit possible (2017, McGonigle & Mastrian).

References

Avant Healthcare Professionals. (2019, September 1
st
). How Technology is Impacting Nursing

Practice in 2020. https://www.avanthealthcare.com/blog/articles/how-technology-is-

impacting-nursing-practice-in-2019.stml.

McGonigle, D., & Mastrian, K.G. (2017). Nursing Informatics and the Foundation of Knowledge

(4
th
 ed.). Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537-

551). Burlington, MA: Jones & Bartlett Learning Discussion: Interaction Between Nurse Informaticists and Other Specialists.

NURS 6051 Assignment: The Nurse Leader as Knowledge Worker

The Nurse Leader as a Knowledge Worker

Transforming Nursing and Healthcare Through Technology

The Concept of Knowledge Workers

Greatly related to the purpose of nursing and its process

A serial and goal-oriented endeavor that involves:

Steps and actions

Operations

Performance

The concept has evolved consistent with healthcare reform’s emphasis on:

More access

Higher quality

Lower costs

Today, knowledge workers utilize technology and data systems to:

Engage in evidence-based decision making

Speed up diagnosis and treatment NURS 6051 Assignment: The Nurse Leader as Knowledge Worker

The Concept of a Knowledge Worker

The concept is significantly related to the purpose of nursing. According to Conrad and Sherrod (2011), any exploration of the epistemological foundation of the profession must consider nursing as a process. It is a serial and goal-oriented endeavor that involves various steps, actions, operations, and performance between a patient and a practitioner. The concept of a knowledge worker has evolved consistent with healthcare’s reform emphasis on more access, higher quality, and lower costs (Pritchard, 2006). These factors have incentivized the application of technology and the creation of systems for data aggregation and analysis. Furthermore, the concept of knowledge workers has changed as the need for standardization has grown. Today, knowledge workers are required to utilize technology and data systems to engage in evidence-based decision-making. They should also use the technology to speed up diagnosis and treatment through better medical and nursing information sharing NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

Nursing Informatics

Combines nursing with information and analytical sciences

Supports identification, description, administration, and representation of data

Nursing informatics plays roles, such as:

Aiding in healthcare promotion

Dealing with current challenges like an aging population or nurse shortages

Most value stems from documentation

Nursing Informatics

As a specialty, nursing informatics combines nursing with information and analytical sciences to support identification, description, administration, and representation of data, information, and knowledge in practice. According to Darvish et al. (2014), nursing informatics plays numerous roles. It aids in healthcare promotion. Tellingly, a technologically rich environment facilitates a higher quality of care and improves patient safety. Nursing informatics also helps healthcare institutions and organizations better deal with current challenges, including an aging population, shortage of doctors and nurses, and incidence and prevalence of chronic conditions through the provision of data. Majorly, value has been realized through documentation – electronic charting – which ensures that nurses can obtain information quickly and efficiently to improve workflow NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

Nurse Leaders as Knowledge Workers: Their Role

Nurse leaders need skills to gather and analyze data.

They play key roles, including:

Harnessing the potential of electronic systems

Translating patient findings

Advocating for the integration of technology

Empowering others to aggregate data and recognize patterns

Technology role models and change agents

The Role of a Nurse Leader as a Knowledge Worker

Nurse leaders need to develop skills for gathering data, its analysis and have the capacity to identify clinical trends and patterns. In patient-care delivery and decision making, they should possess essential knowledge worker skills, including data gathering and knowledge usage and building. The nurse manager should also be equipped with the required tools necessary to harness the potential of electronic data systems. They should be ready and prepared to translate patient findings and associated information into knowledge to inform and drive positive patient outcomes (Westra et al., 2015). Nurse leaders should also advocate for integrating electronic technologies in their departments, motivate adoption by instilling a sense of excitement for the changes and promote literacy. Additionally, the nurse leader must empower others to aggregate data and recognize patterns to deliver seamless and effective patient-care services. As technology role models, nurse leaders must possess competence in dealing with data, EMRs, and online research. They are also change agents and departmental gatekeepers regarding the need to implement new systems or not. Finally, as critical communicators, nurse leaders appraise others of data findings, benchmarks, and the outcomes posted by a department or unit NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

Hypothetical Scenario

Involves a male patient

Complained of a cough after visiting the psychiatric medical surgical unit

Patient had labored breathing, limited oxygen, and elevated respiration

Data that could be used in the scenario includes:

Values from the DynaMap, vitals machine, or respiratory rate

Images from the x-ray

Numeric data from digital monitors and magnetic resonance imaging outputs

Other data includes the patient’s complaints and any further assessment

The hypothetical scenario involved a personal experience, where a male patient complained of a cough after visiting the psychiatric medical unit. The patient experienced labored breathing, oxygen was on the lower end, and the respiratory rate was elevated. A chest x-ray was ordered. Data that could be used in the scenario includes values from the DynaMap, vitals machine, and the respiratory rate. Other data includes the x-ray image, graphic monitor displays, and a magnetic resonance imaging output. Furthermore, the patient’s complaints and further assessment can be done to provide more data. The EMR provides an archive for future reference NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

Hypothetical Scenario Cont’d

The data can provide knowledge, such as:

Steps or actions needed to identify the cause of the problem

The condition presented by the patient, such as pneumonia or pulmonary embolism

Whether presented symptoms are just a false alarm and inconsequential

Knowledge-based systems can show steps to be taken or evidence-based practice

New or entry nurses can rely on knowledge based software, including:

Mosby Nursing Skills

Lippincott Nursing

Knowledge provided by the data includes steps to identify the problem facing the patient, the exact condition they suffer from, or establishment of a false alarm. Nurses can use knowledge-based systems to identify the steps to follow or evidence-based practice. Common systems used by entry level nurses include Mosby Nursing Skills and Lippincott Nursing NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

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References

Conrad, S., & Sherrod, D. (2011). Nurse managers as knowledge workers. 
Nursing Management
, 
42
(2), 47-48.

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The role of nursing informatics on promoting quality of health care and the need for appropriate education. 
Global Journal of Health Science
, 
6
(6), 11.

Pritchard, A. M. (2006). Leadership, innovation, and knowledge workers in health-care reform. 
The Canadian Nurse
, 
102
(5), 13.

Westra, B. L., Clancy, T. R., Sensmeier, J., Warren, J. J., Weaver, C., & Delaney, C. W. (2015). Nursing knowledge: Big data science—Implications for nurse leaders. 
Nursing Administration Quarterly
, 
39
(4), 304-310.

 

Assignment:
The Nurse Leader as Knowledge Worker

The term “knowledge worker” was first coined by management consultant and author Peter Drucker in his book,
The Landmarks of Tomorrow
 (1959). Drucker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services. Does this sound familiar?

Nurses are very much knowledge workers. What has changed since Drucker’s time are the ways that knowledge can be acquired. The volume of data that can now be generated and the tools used to access this data have evolved significantly in recent years and helped healthcare professionals (among many others) to assume the role of knowledge worker in new and powerful ways.

In this Assignment, you will consider the evolving role of the nurse leader and how this evolution has led nurse leaders to assume the role of knowledge worker. You will prepare a PowerPoint presentation with an infographic (graphic that visually represents information, data, or knowledge. Infographics are intended to present information quickly and clearly.) to educate others on the role of nurse as knowledge worker.

Reference: Drucker, P. (1959). The landmarks of tomorrow. New York, NY: HarperCollins Publishers.

To Prepare:

Review the concepts of informatics as presented in the Resources.

Reflect on the role of a nurse leader as a knowledge worker.

Consider how knowledge may be informed by data that is collected/accessed NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

The Assignment:

Explain the concept of a knowledge worker.

Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

Include one slide that visually represents the role of a nurse leader as knowledge worker.

Your PowerPoint should Include the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data that you could use, how the data might be accessed/collected, and what knowledge might be derived from that data. Be sure to incorporate feedback received from your colleagues’ responses.

NURS_5051_Module01_Week02_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Develop a 5- to 6-slide PowerPoint presentation that addresses the following:

·   Explain the concept of a knowledge worker.

·   Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.

32 
(32%)
 – 35 
(35%)

The presentation clearly and accurately explains the concept of a knowledge worker.

The presentation clearly and accurately defines and explains nursing informatics with a detailed explanation of the role of the nurse leader as a knowledge worker.

Includes: 3 or more peer-reviewed sources and 2 or more course resources.

28 
(28%)
 – 31 
(31%)

The presentation explains the concept of a knowledge worker.

The presentation defines and explains nursing informatics with an explanation of the role of the nurse leader as a knowledge worker.

Includes: 2 peer-reviewed sources and 2 course resources.

25 
(25%)
 – 27 
(27%)

The presentation inaccurately or vaguely explains the concept of a knowledge worker.

The presentation inaccurately or vaguely defines and explains nursing informatics with an inaccurate or vague explanation of the role of the nurse leader as a knowledge worker.

Includes: 1 peer-reviewed sources and 1 course resources.

0 
(0%)
 – 24 
(24%)

The presentation inaccurately and vaguely explains the concept of a knowledge worker or is missing.

The presentation inaccurately and vaguely defines and explains nursing informatics with an inaccurate and vague explanation of the role of the nurse leader as a knowledge worker or is missing.

Includes: 1 or fewer resources.

·   Develop a simple infographic to help explain these concepts.

14 
(14%)
 – 15 
(15%)

The presentation provides an accurate and detailed infographic that helps explain the concepts related to the presentation.

12 
(12%)
 – 13 
(13%)

The presentation provides an infographic that helps explain the concepts related to the presentation.

11 
(11%)
 – 11 
(11%)

The presentation provides an infographic related to the concepts of the presentation that is inaccurate or vague.

0 
(0%)
 – 10 
(10%)

The infographic provided in the presentation related to the concepts of the presentation is inaccurate and vague, or is missing.

·   Present the hypothetical scenario you originally shared in the Discussion Forum. Include your examination of the data you could use, how the data might be accessed/collected, and what knowledge might be derived from the data. Be sure to incorporate feedback received from your colleagues’ replies.

32 
(32%)
 – 35 
(35%)

The presentation clearly and thoroughly includes the hypothetical scenario originally shared in the Discussion Forum, including a detailed and accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data NURS 6051 Assignment: The Nurse Leader as Knowledge Worker.

28 
(28%)
 – 31 
(31%)

The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an accurate examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data.

25 
(25%)
 – 27 
(27%)

The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague or inaccurate.

0 
(0%)
 – 24 
(24%)

The presentation includes the hypothetical scenario originally shared in the Discussion Forum, including an examination of the data used, how the data might be accessed/collected, and the knowledge that could be derived from the data that is vague and inaccurate, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%- 79% of the time.

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (1-2) grammar, spelling, and punctuation errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3-4) grammar, spelling, and punctuation errors. 0  (0%)  – 3  (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5  (5%)  – 5  (5%) Uses correct APA format with no errors. 4  (4%)  – 4  (4%) Contains a few (1-2) APA format errors. 3.5  (3.5%)  – 3.5  (3.5%) Contains several (3-4) APA format errors. 0  (0%)  – 3  (3%) Contains many (≥ 5) APA format errors. Total Points: 100 Name: NURS_5051_Module01_Week02_Assignment_Rubric NURS 6051 Assignment: The Nurse Leader as Knowledge Worker

Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion

By Day 3 of Week 1

Post
 a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

 

I work in a nursing home part-time. There is a nursing shortage currently possibly due to Covid 19, as some nurses I know are laid off and abusing the unemployment extra money. It could also be the facility that constantly had problems stemming from management. There is an average of 75 residents in the facility at any given time. The nursing home utilized trained medical assistants (TMA) on a medication cart during some shifts and two licensed nurses in the building at night, LPNs and 2-3 CNAs. There is an abundance of office people that only work from 9-5 and have all weekends off. When nurses in hospitals complain of nursing to staff ratio, they have nothing in nursing homes. I feel that after you have lived your entire life working, raising a family, and contributing to society—you deserve better than going to a nursing home. The residents may or may not get bathed regularly, the food is horrible and not nutritional, and many things fall through the cracks. One thing that would be beneficial is if management used the Management Information System outlined in the text to develop routine reports for decision making (McGonigle & Garver Mastrian, 2018). A periodic report used by management could schedule CNAs and nursing staff according to resident needs

Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion

.

My other job is comprehensive home care. We are in the dark ages as we still use paper charting. I have tried to suggest using an electronic system so I would be able to bring a laptop to my client’s homes when assessing them. Sweeney reiterates, “Providers who do not typically use an EHR are now finding themselves in a learning curve while still maintaining their patient caseload and providing comprehensive care (para 4).” Our home care agency just changed the entire paperwork trail for the third time in three years, and electronic records would save time and money in the long run. The home care agency did incorporate electronic training in the field staff as home care is a rural entity. Some of my clients are veterans. The Veteran Administration uses telehealth and other components to keep their patients in communication with the providers, such as electronic scales and blood pressure monitors that send data directly to their provider. A few clients also have IPads to communicate face to face. In The Future of Home Health Care: Workshop Summary (Demiris, Kaushal, & Nilsen, 2015),

Nilsen noted that the workshop started from the assumption that technology could enhance health outside of hospitals and nursing homes by improving and sustaining health and increasing the quality of life; by allowing people to live at home longer; by reducing health care costs, especially the cost of unnecessary hospitalizations and rehospitalizations; and by reducing the strain on the health care workforce and family caregivers Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion. Further, the participants looked for ways to use technology’s strengths to facilitate communication and data collection.

Since working home care after starting in a nursing home and assisted living, I strive to keep my clients healthier in their home, hoping they can enjoy living out their lives in the place they have worked hard to achieve.

References

Demiris, G., Kaushal, R., & Nilsen, W. J. (2015, August 4). 
The Future of Home Health Care: Workshop Summary.
 (N. A. Press, Producer) Retrieved 2021, from NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.: https://www.ncbi.nlm.nih.gov/books/NBK315926/?report=printable

McGonigle, D., & Garver Mastrian, K. (2018). 
Nursing Informatics and the Foundation of Knowledge
 (Fourth ed.). (J. &. Learning, Ed.) Retrieved 2021

Sweeney, J. (2017, Winter). Healthcare Informatics. 
Online Journal of Nursing Informatics, 21
(1).

 

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues
* on two different days
, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion.

response

Your post concerning the staffing issues and nursing homes hit home with me.  As a teenager, I volunteered once a week on the weekends at a local nursing home. I would spend time with the residents, and they would typically want to sit and talk, or occasionally they would ask me to read to them.  You could tell, though, that they just wanted to spend time with someone.  It was heartbreaking to hear their life stories, to know that they have gone through and then see that no one visits them. Your statement that the residents deserve better than a life in a nursing home is true in many cases.

Nevertheless, the disappointing truth is that people need skilled facilities and nursing homes in many cases as they age.  Data from the Nursing Home Abuse Center (2019) states that 1.4 million people live in nursing homes in the United States.  According to the National Institute of Aging (2021), skilled living facilities are needed for services that include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion.

Since data shows there is a significant need for skilled facilities to provide various services to the elderly, the least we can do is provide proper care.  Proper care will not happen without adequate staffing. The evidence that proper staffing is crucial in health care is staggering.  Data and research repeatedly demonstrate that staffing ratios affect every aspect of patient care, including length of stay and mortality rate.  Even though I already responded to our classmate Joseph with this information, I will include the information for you again for reference.  Halm et al. (2005) indicates a direct correlation between staffing ratios and patient mortality rates.  Griffiths et al. (2018) directly correlate staffing ratios and patients’ length of stay.

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For supervisors still not convinced that staffing at nursing homes is crucial, they should refer to the guidelines set forth by Medicare and Medicaid.  The Reform of Requirements for Long-Term Care Facilities Act, which went into effect as of November 28, 2016, has precise wording for nursing home staff ratios (Centers for Medicare and Medicaid Services, 2021).  This Act states that a nursing home “must have sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident, as determined by resident assessment and individual plans of care in considering the number, acuity, and diagnoses of the facility’s resident population in accordance with the facility assessment required at Section 483.70(e)” (Cornell Law, 2021).

Hopefully, one day we will see a time when nursing homes have the staff they need, and the patients obtain the care they deserve Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion.

REFERENCES

Centers for Medicare and Medicaid Services. (2021, April 9). 
Nursing Homes | CMS
. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Nursing-Homes

Cho, E., Park, J., Choi, M., Lee, H. S., & Kim, E. Y. (2017). Associations of Nurse Staffing and Education With the Length of Stay of Surgical Patients. 
Journal of Nursing Scholarship
, 
50
(2), 210–218. https://doi.org/10.1111/jnu.12366

Cornell Law. (2021). 
42 CFR § 483.35 – Nursing services.
 LII / Legal Information Institute. https://www.law.cornell.edu/cfr/text/42/483.35#:%7E:text=%C2%A7%20483.35%20Nursing%20services.,-The%20facility%20must&text=(3)%20The%20facility%20must%20ensure,in%20the%20plan%20of%20care.

Griffiths, P., Ball, J., Bloor, K., Böhning, D., Briggs, J., Dall’Ora, C., Iongh, A. D., Jones, J., Kovacs, C., Maruotti, A., Meredith, P., Prytherch, D., Saucedo, A. R., Redfern, O., Schmidt, P., Sinden, N., & Smith, G. (2018). Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study. 
Health Services and Delivery Research
, 
6
(38), 1–120. https://doi.org/10.3310/hsdr06380

Halm, M., Peterson, M., Kandels, M., Sabo, J., Blalock, M., Braden, R., Gryczman, A., Krisko-hagel, K., Larson, D., Lemay, D., Sisler, B., Strom, L., & Topham, D. (2005). Hospital Nurse Staffing and Patient Mortality, Emotional Exhaustion, and Job Dissatisfaction. 
Clinical Nurse Specialist
, 
19
(5), 241–251. https://doi.org/10.1097/00002800-200509000-00007

National Institute of Aging. (2021). 
Residential Facilities, Assisted Living, and Nursing Homes
. https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes

Nursing Home Abuse Center. (2019, October 18). 
Facts and Statistics about U.S. Nursing Homes
. https://www.nursinghomeabusecenter.org/informative/facts-statistics-nursing-homes/#:%7E:text=Across%20the%20U.S.%2C%20there%20are,are%2085%2D94%20years%20old Nursing Staffing Essay – The Application of Data to Problem-Solving Discussion.

Discussion: The Application of Data to Problem-Solving

In the modern era, there are few professions that do not to some extent rely on data. Stockbrokers rely on market data to advise clients on financial matters. Meteorologists rely on weather data to forecast weather conditions, while realtors rely on data to advise on the purchase and sale of property. In these and other cases, data not only helps solve problems, but adds to the practitioner’s and the discipline’s body of knowledge.

Of course, the nursing profession also relies heavily on data. The field of nursing informatics aims to make sure nurses have access to the appropriate date to solve healthcare problems, make decisions in the interest of patients, and add to knowledge.

In this Discussion, you will consider a scenario that would benefit from access to data and how such access could facilitate both problem-solving and knowledge formation.

To Prepare:

Reflect on the concepts of informatics and knowledge work as presented in the Resources.

Consider a hypothetical scenario based on your own healthcare practice or organization that would require or benefit from the access/collection and application of data. Your scenario may involve a patient, staff, or management problem or gap.

By Day 3 of Week 1

Post
 a description of the focus of your scenario. Describe the data that could be used and how the data might be collected and accessed. What knowledge might be derived from that data? How would a nurse leader use clinical reasoning and judgment in the formation of knowledge from this experience?

 

I agree that healthcare is another field that relies on data and statistical analysis in treatment, management, and preventative care. Currently I work in a Rehabilitation and Long Term Care Facility, we are currency performing COVID testing on all of our staff and employees based on the state average of positive COVID 19 cases. Currently in Arizona we are at 2.9% positivity rate based on the past 7 days (Ritchie et al., 2020). Whenever we reach above 5% we must test our staff weekly, and below 5% we must test monthly.

 

This method of testing concurrently uses the data to appropriately test whilst adding to the ongoing data collection and continuing the overall accuracy of this disease and disease process. This is important to see when and where the spikes occur in positivity, and mitigate for the staffing shortages that may occur in this instance.

 

Another term that people may be well accustomed to now is “contact tracing”.Contact tracing works to help slow the spread of diseases, for example COVID- 19. Contact tracing usually takes place in the community, like clinics, labs, schools and hospitals. Contact tracing works by sending  the names and demographics of people diagnosed with COVID- 19 to the local health department. The health department then further explores who the infected person has been in contact with and anonymously notifies those individuals to seek testing and begin quarantine (Marshall, 2021).

 

A clinical leader would use contact tracing as a method of understanding the characteristics of the disease (Keeling, 2020). For example the demographics, geographical location, socioeconomic status, employment status and time of year in which those are contracting the illness. With this information you can plan to order more PPE, sticiter isolation and quarantine protocols, limit visitation time(s) within a facility and many more methods to mitigate the risks of infecting more people.

Hannah Ritchie, Esteban Ortiz-Ospina, Diana Beltekian, Edouard Mathieu, Joe Hasell, Bobbie Macdonald, Charlie Giattino, Cameron Appel, Lucas Rodés-Guirao and Max Roser (2020) – “Coronavirus Pandemic (COVID-19)”. Published online at OurWorldInData.org. Retrieved from: ‘https://ourworldindata.org/coronavirus’ [Online Resource]

Keeling, M. J., Hollingsworth, T. D., & Read, J. M. (2020). Efficacy of contact tracing for the containment of the 2019 novel coronavirus (COVID-19). Journal of Epidemiology and Community Health. https://doi.org/10.1136/jech-2020-214051

Marshall , W. F. (2021, May 18). Can contact tracing stop coronavirus? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/covid-19-contact-tracing/faq-20488330.

 

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues
* on two different days
, asking questions to help clarify the scenario and application of data, or offering additional/alternative ideas for the application of nursing informatics principles.

Response 1

Thank you for the informative post. I agree, Informatics is essential in healthcare, from electronic medical records (EMRs) and key performance indicators (KPIs) to big data. Informatics can improve outcomes for patients and assist healthcare professionals with continuity of care. In the past, the United States’ healthcare data has been utilized primarily for billing, internal organizational management, and regulatory reporting, and public health officials have primarily focused on data of communicable diseases and reportable events (Gamache Kharrazi, and Weiner, 2018). There are currently multiple attempts to integrate these data sources to improve outcomes for patients and communities. Most health organizations and facilities do government reporting on KPIs through the National Healthcare Safety Network (NHSN) that is managed by the Centers for Disease Control and Prevention Division of Healthcare Quality Promotion (ODPHP, n.d). NHSN is the nation’s most widely used healthcare-associated infection (HAI) tracking system that provides the country with data needed to identify problem areas and measures prevention efforts to eliminate HAIs (ODPHP, n.d) eventually. Over the next decade, the healthcare data will more than double. In 2015 an international survey was conducted and identified education, research, practice, visibility, and collaboration as the five key areas where healthcare informatics need to improve (Mordi, Guignard-Duff, Hall, New, and Lang, 2020). As patient data grows at an ever-increasing rate, we must remain mindful of potential liabilities related to HIPAA and the risk of a potential data breach (Sweeney, 2017). Healthcare informatics combined with the patient data received will help guide future treatment options and innovation.  
 

 

References 
 

Office of Disease Prevention and Health Promotion [ODPHP] (n.d). National Healthcare Safety Network (NHSN).
https://health.gov/healthypeople/objectives-and-data/data-sources-and-methods/data-sources/national-healthcare-safety-network-nhsn

 

Gamache, R., Kharrazi, H., & Weiner, J. P. (2018). Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities. Yearbook of medical informatics, 27(1), 199–206. 
https://doi.org/10.1055/s-0038-1667081
 
 

 

Mordi, I. R., Guignard-Duff, M., Hall, C., New, B. J. M., & Lang, C. C. (2020). Use of Population-Based Health Informatics Research to Improve Care for Patients with

Cardiovascular Diseases. 
Diseases (Basel, Switzerland)
, 
8
(4). 
https://doi-org.ezp.waldenulibrary.org/10.3390/diseases8040047

 

Sweeney, J. (Feb, 2017). Healthcare Informatics. Online Journal of Nursing Informatics (OJNI), 21( 
1
), Available at 
http://www.himss.org/ojni
 
 

 

response 2

I also work in the same type of setting and, at our facility in Minnesota, we are currently testing weekly based on cases in our county. Minnesota Department of Health is the guideline that nursing homes follow. As of April 30, 2021, fully vaccinated asymptomatic staff does not need testing as part of routine staff screening. However, MDH states that regardless of vaccination, employers have to test immediately. If the asymptomatic staff has high-risk exposure or symptomless resident has prolonged close contact with a positive person, testing occurs again on day 5-7 (COVID-19 Testing Recommendations for Long-term Care Facilities, 2021). Does your facility use information collected to benefit them in the future, or do they pass the data off to the state of Arizona? I do not think our facility utilizes statistical numbers for future reference, and I am unsure if they even share much with MDH.

I found a collaborative webinar series pdf with some great informatics resources searching for nursing informatics and the pandemic. Therefore, I am posting the link below for your review.

https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-NIWG-ANI-Clinical-Informatics-3.pdf

Page 52 of this document has several more helpful links from the CDC and the WHO, such as where to report, clean and disinfect the virus, cope with stress, self-care, and more. Some of the links do not work, but most do.

The pandemic will change how people collect information and utilize it; moreover, the future of health may move in increased telehealth making health care more affordable and accessible. Telehealth could benefit the increasing elderly population as fewer nursing homes and assisted living facilities have long waiting lists. I would like to see increased income potential for personal care attendants (PCAs) and home health aides (HHA) so people could remain in their own homes. Informatics could assist in this direction as the internet has expanded to reach remote areas, more people know how to use computers, iPads, and cellphones. McGonigle & Garver Mastrian say the future of health care will be dependent on the use of clinical documentation systems and clinical decision support (p. 123, 2018).

I dream of a health care field that shares information of the patient, without jeopardizing HIPAA, in a faster and more thorough way so that collaboration and communication between multiple providers alleviate duplication of medicines and cohesiveness of customer care. Unfortunately, things get missed and fall through the cracks in health care due to lack of time, communication, follow-through, shift change, or multiple caregivers.

Best wishes for the rest of the semester,

Diane Ward

References

COVID-19 Testing Recommendations for Long-term Care Facilities
. (2021, April 30). Retrieved 2021, from MINNESOTA DEPARTMENT OF HEALTH: https://www.health.state.mn.us/diseases/coronavirus/hcp/ltctestrec.pdf

McGonigle, D., & Garver Mastrian, K. (2018). 
Nursing Informatics and the Foundation of Knowledge
 (Fourth ed.). Burlington, Maine: Jones & Bartlett Learning. Retrieved 2021

Nursing Informatics in Times of COVID-19: Achievements, Challenges, and New Ideas
. (2020, April 14). Retrieved 2021, from American Medical Informatics Association: https://www.amia.org/sites/default/files/AMIA-COVID19-Webinar-Series-NIWG-ANI-Clinical-Informatics-3.pdf