Baccalaureate prepared registered nurse Advanced Practice Nurse (APN)
Week 1 discussion Discussion Part One Mary, a baccalaureate prepared registered nurse, has been practicing for fifteen years. Throughout her nursing career, she worked in pediatric, surgical, and emergency departments. She worked as a floor nurse, charge nurse, and was recently offered a position as a nursing supervisor. A stipulation for becoming a nursing supervisor is that Mary must attain a Master of Health Administration degree within 2 years of accepting the position. The offer prompted Mary to contemplate her career. She is interested in returning to college, but she realized that she does not want to pursue working in administration and away from patients. Mary decided to become an Advanced Practice Nurse (APN). Mary knows that working as an APN will allow her the opportunity to make a larger contribution to individuals, environment, health, and nursing. She researched graduate nursing programs and discovered that there are four roles of the APN. Mary must choose one role and apply to a program, but she is unsure about the different roles and their individual scopes of practice. Discussion question: How would you decide? Develop a pros and cons list to assist Mary in making her decision. Include each role of the APN on the list and be certain to provide appropriate rationales and citations. Discussion Part Two A clear definition for the various roles of CNM, CNP, CNS, and CRNA has been convoluted by various state definitions that confuse the roles and often obscure their intended meaning. Such state definitions reveal further confusion with regard to role separation, competency, emphasis, approach, and variation. This misunderstanding extends to nurse educators, providers, reimbursement, and even the public. The lack of clarity regarding initial role preparation versus current certification serves to further frustrate accreditors, consumers, and employers alike. Discussion question: How does your state define the role and scope of the CNP? Provide a correctly formatted citation for your reference resource. Discussion Part Three Mary expressed that she wants to work directly with patients. She is familiar with working in a large hospital system, and prefers to remain in her current town when she graduates. She has considerable clinical experience in pediatric, surgical, and emergency nursing. Discussion question: Based on Mary’s experience and interests, which role would you choose for her, and why? Week 2 discussion Discussion Part One Mary, a registered nurse, decided that she wants to become a CNP. She applied and was accepted to the Family Nurse Practitioner program at Chamberlain College of Nursing. She received a course curriculum which outlined the courses necessary to complete her degree. One of the early courses in the program curriculum is NR-501 Theoretical Basis for Advanced Nursing Practice. You are a student colleague of Mary’s enrolled in the same class. On the class Q & A discussion board, Mary posted, “I took nursing theory classes fifteen years ago in my bachelor’s program. I don’t understand why I need to take theory classes again.” Discussion Question: How would you respond? Develop a logical response to Mary’s post. Provide evidence to support your arguments. Discussion Part Two Mary wrote, “All nursing theories are the same and certainly there is no connection to APN practice.” Discussion Question: How would you respond? Develop a logical response to Mary’s post. Provide evidence to support your arguments. Discussion Part Three The following response on the discussion board was posted by the course instructor: “The advanced practice roles of CNM, CNP, CNS, and CRNA require an intensive set of clinical skills, understandings, and integrative abilities that synthesize advanced practice nursing knowledge.” Discussion Question: What does the course instructor mean by “integrative abilities”? Provide evidence to support your response. Week 3 discussion Discussion Part One You are a Family Nurse Practitioner (FNP) employed as a contact employee in a busy primary care practice for two years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners. The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in three months. You are highly satisfied with your job and want to stay in the group. You see 20 patients per day on average, and take call every third weekend. Discussion Question: What negotiation strategies should you use to propose a contract renewal? Use logical reasoning and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP. Discussion Part Two As revenue generators, NPs must be aware of how their work contributes to the overall revenue of the clinical practice. You see 20 patients per day on average, and take call every third weekend. According to Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on average, brings in $840 per day. Allowing 1 week off for continuing education, 1 week off for illness, and 4 weeks off for vacation, this NP will bring in $193,200 a year, potentially. However, not all bills are paid. With a 90% collection rate—a reasonable collection rate for an efficient practice—this NP actually will bring in $173,800 per year. An NP who sees 24 patients per day will bring in $1344 per day, or $309,120 per year in accounts receivable. With a 90% collection rate, this NP will bring $278,208 to the practice (Buppert, 2011). Discussion Question: In this scenario, what are you “worth” to the practice? Use logical reasoning and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP. Discussion Part Three Establishing a salary can be a challenge for NPs. Deducting 40% of the NP’s gross generated income for overhead expenses (rent, benefits, continuing education, supplies, malpractice, lab expenses, and depreciation of equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the 24-patient-per-day NP. Further deducting 15% of that figure to pay a physician for consultation services leaves $88,638 in salary for the 15-patient-per-day NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for employer profit leaves $79,775 in salary for the 15-patient-per-day NP and $127,699 for the 24-patient-per-day NP (Buppert, 2011). Discussion Question: What salary would you propose for the contract renewal? Use logical reasoning and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP. Week 4 discussion Discussion Part One You are a Family Nurse Practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers. Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of Amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label and the date on the bottle was one week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie, nor do the other providers in the practice. Discussion Question: What is your next logically sound course of action? Provide evidence to support your response. Discussion Part Two Upon further investigation, you learn that Stephanie spoke with the patient and called the medication into the patient’s pharmacy without consulting with a provider. Stephanie claimed that the patient was insistent about needing a prescription. Since Mrs. Smith was coming into the office the following week for an appointment, she didn’t think you would mind if the patient received the prescription early. Discussion Question: What are the ethical-legal concerns associated with this situation? Provide evidence to support your response. Discussion Part Three Due to the incident, you are concerned with office policies and procedure. Upon investigation, you find there isn’t a policy in place to address non-urgent patient requests for prescriptions. Discussion Question: What quality improvement strategies might you implement as an APN in this practice to safeguard your role and assure patient safety? Provide evidence to support your response. Week 5 discussion Discussion Part One You are a Family Nurse Practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff have heated arguments with each other, sometimes in patient areas. Today, one of the back office assistants didn’t come to work. Unfortunately, this pattern of behavior is not unusual in this practice. Your clinical schedule is especially busy. Working without appropriate office staff will negatively influence your ability to spend time with patients, impede the flow of patients through the office, and could impact patient safety. Discussion Question: How should you logically respond in this situation? Provide rationales and evidence to support your decisions. Discussion Part Two Leadership is not random. It is multifaceted and must be communicated as a stated plan to effect a change. Organizational leaders provide a vision and move others toward a common goal. Discussion Question: In this scenario, what evidence-based organizational strategies and management skills might you employ to resolve co-worker conflict? Provide evidence and rationales to support your decisions. Discussion Part Three According to Buppert (2011), quality improvement and patient safety are inextricably intertwined. A work environment that supports teamwork and respect for other people is essential to promote patient safety and quality of care. Unprofessional behavior is disruptive and adversely impacts patient and staff satisfaction, the recruitment and retention of healthcare professionals, communication, teamwork and undermines a culture of safety. Unprofessional behavior is therefore unacceptable. Discussion Question: How does teamwork increase patient safety? Provide evidence and rationales to support your decisions. Week 6 discussion Discussion Part One You are attending a large continuing education conference for primary care providers. In the audience are physicians, nurse practitioners, and physician assistants from all over the country. Seated at your table are physicians and nurse practitioners. Following the lecture on teamwork and interdisciplinary collaboration, a debate ensues at your table. One physician stated: I am against nurse practitioners who want to take my job. There is a huge difference in the two professions. Primary-care physicians receive extensive and diverse medical education and clinical experience. The nurse practitioner should not function as an independent healthcare provider…they should only function in an integrated practice arrangement under the direction and responsible supervision of a practicing, licensed physician. Discussion Question: How would you respond to the physician’s statements? Use logical reasoning and evidence from the literature to support your response. Discussion Part Two A fellow NP at the table responded: An increasing number of practices are scrapping the traditional one-on-one doctor-patient relationship. Instead, patients are receiving care from a group of health professionals who divide up responsibilities that once would have largely been handled by the doctor in charge. While the supervising physician still directly oversees patient care, other medical professionals—nurse practitioners, physician assistants and clinical pharmacists—are performing more functions. These include adjusting medication dosage, ensuring that patients receive tests and helping them to manage chronic diseases. Discussion Question: What are your thoughts on interprofessional collaboration? Provide evidence to support your response. Discussion Part Three The Federal Trade Commission has weighed in on several state battles over scope of practice, arguing that physician groups have no valid reason for blocking such laws other than to thwart competition. Discussion Question: How does “restraint of trade” apply to NP practice limitations? Provide evidence for your response. Week 7 discussion Discussion Part One You have completed your nurse practitioner education, likely one of the most challenging tasks you have ever undertaken. Several of your graduated colleagues live in different states, including California, Washington, and Illinois. After a year of primary care practice in your respective states, you get together for a reunion and share your practice perspectives. It is apparent that your experiences are not equal. Discussion Question: How do licensure, accreditation, certification, and education (LACE) considerations differ for APN clinical roles for these three states: California, Washington and Illinois? Provide evidence for your response. Discussion Part Two Inconsistent regulation of APN role and scope prevent a seamless healthcare system in which APN can practice. Discussion Question: What evidence-based strategies should be implemented to achieve continuity between state regulatory boards? Provide evidence for your response. Discussion Part Three Once a seamless entry into practice is achieved, it will become more likely that independent practice will follow. Discussion Question: Is independent NP practice allowed in your state? Discuss your opinion regarding independent NP practice. Provide evidence for your response. Week 8 discussion Reflection on Achievement of Outcomes Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #5, the MSN Essential IX, and the NP Core Competencies #2. Program Outcome #5 Develop a plan for lifelong personal and professional growth that integrates professional values regarding scholarship, service and global engagement. MSN Essential IX: Master’s-Level Nursing Practice Recognizes that nursing practice, at the master’s level, is broadly defined as any form of nursing intervention that influences healthcare outcomes for individuals, populations, or systems. Master’s-level nursing graduates must have an advanced level of understanding of nursing and relevant sciences as well as the ability to integrate this knowledge into practice. Nursing practice interventions include both direct and indirect care components. Week 6 assignment APN Professional Development Plan Purpose The purpose of this application is to provide the student an opportunity to explore the role of the advanced practice nurse (APN) and develop an APNprofessional development plan. Course Outcomes Through this assignment, the student will demonstrate the ability to: CO1: Synthesize knowledge and concepts from advanced practice nursing with supporting disciplines as a foundation for APN/specialty nurse practitioner practice that is culturally competent and population-specific (PO #1). CO3: Assimilate primary care competencies into APN/specialty nurse practitioner practice that exemplify professional values, scholarship, service, and culturally competent global awareness and support ongoing professional and personal development.(PO #5) CO5: Contribute to the body of advanced practice nursing knowledge through participation in systematic inquiry, utilization of evidence-based practice, and dissemination of findings to support high-quality care and healthcare innovation.(PO #9) CO9: Evaluate strategies for contract negotiation, CV/resume writing, credentialing, national board certification, hospital privileges, and reimbursement (PO #8). CO 10: Develop visionary leadership skills that combine best evidence with nursing expertise to support quality improvement, safety, and change across healthcare organizations and systems (PO #1, 3, 8, and 9). CO 11: Differentiate leadership strategies that strengthen interprofessional collaboration and incorporate an ethic of care, values, and ethical principles into the role of the nurse leader across healthcare organizations and systems (PO #2, 4, 5, 6, and 7). Due Date: Sunday 11:59 p.m. MT at the end of Week6 Total Points Possible: 200 REQUIREMENTS: 1. To complete this application, you will need to access to the following databases: CINAHL, MEDLINE, Cochrane Library, and the Joanna Briggs Institute. You may access these databases through the Chamberlain College of Nursing Online Library. 2. The APN Professional Development Plan paper is worth 200 points and will be graded on quality of information, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric. 3. Create your manuscript using Microsoft Word 2007 (a part of Microsoft Office 2007), which is the required format for all Chamberlain College of Nursing documents. You can tell that the document is saved as a MS Word 2007 document because it will end in “.docx” 4. Follow the directions and grading criteria closely. Any questions about this paper may be posted under the Q & A Forum. 5. The length of the paper is to be no less than 6 and no greater than 8 pages excluding title page and reference pages. 6. APA (2010) format is required with both a title page and reference page. Use the required components of the review as Level 1 headers (upper and lower case, centered): a. Introduction to the APN professional development plan b. APN Scope of Practice c. Personal Assessment d. Networking and Marketing Strategies e. Conclusion PREPARING THE PAPER The following are best practices for preparing this paper: 1. Review Chapter 30- Role Transition: Strategies for Success in the Marketplace in DeNisco and Barker (2015). 2. Nurse practitioners need to take into account the state rules and regulations that guide advanced practice. Research and review the Nurse Practice Act and APN scope of practice guidelines in your particular state.Identify information regarding educational requirements, licensure and regulatory requirements, as well as practice environment details. Review information regarding full, limited, or restricted practice limitations as well as prescriptive authority. 3. Review Guidelines for APN Role Transition Using Benner’s Self-Assessment Tool inCourse Resources. Prior to engaging in pursuit for employment, APNs should complete a comprehensive, honest, affirmative personal assessment to identify their strengths and weaknesses as well as their goals and objectives. Research assessment tools, conduct a personal assessment, and reflect upon your strengths, weaknesses, goals, and objectives. 4. To complete the transition from students to expert nurse practitioners working in the healthcare field, graduating APN students will need to secure their first position. Research local and national professional organizations that advertise employment opportunities for APNs. Identify networking and marketing strategies and provide a rationale for your selections. 5. Write your Curriculum Vitae (CV). Refer to the template on pages 772-773 in DeNisco and Barker (2015). Your CV should not exceed 2 pages in length. 6. When concluding the paper, summarize important aspects of the APN professional development plan. Category Points % Description Introduction to the APN professional development plan 20 10% Introduces the purpose of the paper and addresses all background information elements (who, what, where, when, and why) for the APN professional development plan. APN Scope of Practice 35 18% Provide detailed information regarding education, licensure, and regulatory requirements, as well as practice environment details. Include information regarding full, limited, or restricted practice limitations as well as prescriptive authority. Personal Assessment 25 12% Perform a personal assessment and reflect upon your strengths, weaknesses, goals, and objectives. Networking and Marketing Strategies 25 12% Provide detailed information regarding local and national professional organizations that advertise employment opportunities for APNs. Identify networking and marketing strategies and provide a rationale for your selections Curriculum Vitae 35 18% Provide accurate information regarding the nurse practitioner’s abilities, skills, and accomplishments. Conclusion 20 10% An effective conclusion identifies the main ideas and major conclusions from the body of your manuscript. Minor details should not be included. Summarize important aspects of the APN professional development plan. Clarity of writing 20 10% Use of standard English grammar and sentence structure. No spelling errors or typographical errors. Organized around the required components using appropriate headers. APA format 20 10% All information taken from another source, even if summarized, must be appropriately cited in the manuscript and listed in the references using APA (6th ed.) format: 1. Document setup 2. Title and reference pages 3. Citations in the text and references. Total 200 100 A quality assignment will meet or exceed all of the above requirements