NURS 682 Miami Dade College Nursing Development Replies – Description
Gelila Tilahun YesterdayJul 10 at 8:36amManage Discussion EntryHello class and Professor,APRNs can utilize evidence-based practice to evaluate research and evidence and then make quantitative and qualitative decisions regarding patient care. The use of evidence-based practice has a significant impact on nursing and patient outcomes. There have been several organizations that have implemented competency-based, nurse-led programs in order to improve the efficacy of interventions, procedures, and recommendations while minimizing costs and safety concerns (Stevens, 2018). EBP creates a structure on which practice can be built. It improves quality because it underscores the need for redesigning care that is effective, safe, and efficient. With emerging evidence, APRNs must be able to critically analyze, evaluate, and appraise the evidence’s utility. APRNs should become translators of research into practice and policy, using the competencies they learned. Treatment that considers research and proven methods for improving care often yields high-quality outcomes. The most critical issue regarding APRN credentialing and licensure is the state licensure and practice. Practice regulation is governed by state licensing laws. It is often the case that the law restricts the practice of APRNs to the optimum despite their training and education. APRNs are not permitted to discharge or admit patients under Texas hospital licensing regulations (Altman et al., 2016). APRNs face a significant issue of restricted practice.A number of barriers limit the scope of practice for APRNs, such as the inability to receive reimbursement for incidental services independently, which limits the availability of care and inhibits the development of independent practices (Peterson, 2017). It is common for practitioners with similar national certifications and education preparations to experience restrictions during their relocation from one state to another. Poor APRN administration relations, such as different treatment than other colleagues despite similar functions and lack of inadequate support, are barriers to progress. Some organizational policies limit autonomy, such as the inability to prescribe medication (Schirle et al., 2020). Preferential resources supplied to physician colleagues and lack of support and resources hinder progress in the practice.There has been a continued deterioration of care quality, an increase in costs, the development of disruptions in care, and a reduction in access to care as a result of current institutional rules, state practices, and laws. The Nursing Practice Act (NPA) influences APRN practice policies. The nursing body is authorized to discipline nurses for violating regulations and laws (Moore et al., 2020). APRN policies should be aligned with the NPA and the law. There is no excuse for substandard nursing practice or noncompliance when one is ignorant. According to the NPA, APRN policies should protect the public from harmful and unsafe practices. It has been my experience that any adverse actions taken against a nurse must comply with both the law and the act before disciplinary action can be taken.References:Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing barriers to practice and care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US).Moore, C., Kabbe, A., Gibson, T. S., & Letvak, S. (2020). The pursuit of nurse practitioner practice legislation: a case study. Policy, Politics, & Nursing Practice, 21(4), 222-232.Peterson, M. E. (2017). Barriers to practice and the impact on health care: a nurse practitioner focus. Journal of the advanced practitioner in oncology, 8(1), 74.Schirle, L., Norful, A. A., Rudner, N., & Poghosyan, L. (2020). Organizational facilitators and barriers to optimal APRN practice: An integrative review. Health care management review, 45(4), 311.Stevens, K. (May 31, 2018). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN: The Online Journal of Issues in Nursing Vol. 18, Manuscript
Michelle OrlichYesterdayJul 10 at 5:01pmManage Discussion EntryHi Professor and Class,Identify the issue you think is most important regarding APRN credentialing and licensure.Uniformity is one of the most important points when discussing APRN credentialing or licensure. For licensing although most specialty organizations provide licensing for professional nursing practice, few offer certifications at a practice level. The organizations that offer advanced practice examinations are often at the specialty level of the APRN regulatory model. One example of this license nonuniformity is the psychiatric mental health CNS or NP; this licensing comes through the ANCC instead of the American Psychiatric Nurses Association (APNA), from which the latter considered offering certification for advanced practice psychiatric mental health nurses (Blair, 2019). With credentialing, one of the concerns related to certification is the multiplicity of acronyms used to indicate certification and that each certifying body uses its own credentials. The frequent change in credentials and the variety of terms used to indicate advanced practice nursing confuse the consumer and other healthcare professionals. As regulatory bodies become more uniform and certification corporations align their examinations with the APRN regulatory model, there may be more consistency and understanding of the titles that reflect advanced practice (Blair, 2019).What barriers or challenges have slowed the progress of advanced practice registered nursing?The barriers or challenges that have slowed the progress of advanced practice registered nursing include a lack of understanding of the APRN role, lack of professional recognition, poor physician relations, and poor administrator relations. Common restrictions involve requirements for physician signatures for prescriptive and hospital admission capabilities, the inability of APRNs to be listed as a provider of record or carry their own patient panel, and electronic health records that do not capture APRN care. These practices interfere with patient communication and the ability of APRNs to provide proper follow-up care, limit patient choice of providers, render APRN care invisible and limit the practice to the full extent of their advanced training and certification, and decrease the types and amounts of health care services, that can be provided for people who need care (Kleinpell et al., 2022).Identify a current legislative policy on the local, state, or national level that will influence policies of APRN practice.One of the current state laws which, in a way, can influence APRN practice is Assembly Bill 890, which Governor Gavin Newsom signed in September 2020. This law created two new NP categories that can function within a defined scope of practice without standardized procedures. These new categories are 103 NP and 104 NP. With 103, NPs can work under the provisions outlined in Business and Profession Code Section 2837.103. This NP works in a group setting with at least one physician and surgeon within the population focus of their National Certification (California Board of Registered Nursing [BRN], n.d.).On the other hand, 104 NP still works in Business and Professions Code Section 2837.104, but NP may work independently within the population focus of their National Certification. However, with this law, the licensee must first work as a 103 NP in good standing for at least three years before becoming a 104 NP. Consequently, the Board is only able to certify 103 NPs at this time and will not be able to certify 104 NPs until 2026 (BRN, n.d.).References:Blair, K. A. (2019). Advanced practice nursing roles: Core concepts for professional development. (6th edition). Springer Publishing Company. https://online.vitalsource.com/reader/books/9780826161536/epubcfi/6/10[%3Bvnd.vst.idref%3DCopyright]!/4 Links to an external site.Links to an external site.California Board of Registered Nursing. (n.d.). Assembly Bill 890 (Wood, Chapter 265, Statutes of 2020). https://www.rn.ca.gov/practice/ab890.shtmlLinks to an external site.Kleinpell, R., Myers, C., Likes, W., & Schorn, M. N. (2022, April/June). Breaking down institutional barriers to advanced practice registered nurse practice. Nursing Administration Quarterly, 46(2), 137–143. https://doi.org/10.1097/NAQ.0000000000000518Links to an external site.
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