PART1 Scholar Practitioner
Develop a personal philosophy and framework acknowledging professional and accrediting agency competencies relating to the role and scope of practice of the family nurse practitioner.
Identify a nurse theorist or professional accrediting agency that provides the foundation for this philosophy development.
Secondarily, identify variations in prescriptive authority among APNs.
Compare prescribing privileges from the state within you will practice and compare to another state.
Discuss similarities and differences with a focus on client safety concerns or initiatives.
Students are expected to:
Post a response to each classmate. No more than 100 words include in-text citations and at least 1 reference APA style. Please be respectful.
Helens response:
Personal Philosophy
I believe that all human beings are whole. Therefore the whole human being walks into my clinic but some disturbance has caused illness. This disturbance may be an emotional issue that has caused stress and that stress has led to disease. This is an example and there are many root causes of disease. So, I think in a way that seeks out the root cause of the discomfort so that the effect can be modified.
Nurse Theorist
Martha Rogers theory of Unitary Human Beings depicts nursing as an art and a science. Nurses promote health and well-being (Nursing Theory, 2018). When there is a change in the pattern and the organization of human energy fields, observable events manifest (Nursing Theory, 2018). Rogers theory describes human beings as indivisible with an energy field that can be identified by a pattern and cant be predicted from its parts (Nursing theory, 2018). People have the capacity to participate in change. Rogers describes health as an expression of the life process. Health includes characteristics from environmental and human fields (Nursing Theory, 2018). Therefore health and illness are part of the same continuum. Multiple events in a persons life demonstrate the extent to which the person is healthy (Nursing Theory, 2018).
Comparison of Prescribing privileges
Louisiana (LA) is one of 15 states with reduced practice authority (American Association of Nurse Practitioners, 2017). NPs in the state of Louisiana must have a collaborative agreement with a physician in order to have prescriptive authority (Louisiana State Board of Nursing (LSBN), 2018). Additionally, in the state of LA, NPs must complete 500 hours of work in the clinical specialty for which the applicant was educated immediately prior to applying for prescriptive authority (LSBN, 2018). Additionally, the NP must have 45 contact hours in pharmacology, and 45 contact hours in physiology/pathophysiology or a 3 hour college course in each (LSBN, 2018). In contrast, the state of Arizona voted into law full practice authority for NPs in 2001 (Arizona Nurse Practitioner Council, 2017). The State Board authorizes NPs to prescribe and dispense within the population of focus in the NP is licensed in the state and submits evidence of 45 contact hours in pharmacology or clinical management of drug therapy (Arizona State Board of Nursing, 2017).
References:
American Association of Nurse Pratitioners. (2017). State practice environment. Retrieved from https://www.aanp.org/legislation-regulation/state-
American Nurse Practitioner Council. (2017). What year was the Arizona Nurse Practice Act modernized to give NPs full practice authority? Retrieved from https://arizonanp.enpnetwork.com/nurse-practitioner-news/57821-arizona-nurse-practice-act-aprn-scope-of-practice-proposed-revisions-for-aprn-consensus-and-aprn-multistate-compact-models-
Nursing Theory. (2018). Science of unitary human beings. Retrieved from http://www.nursing-theory.org/theories-and-models/
Rebeccas Response:
Personal Philosophy
I aim to not only give my patients the best possible medical care possible, but to also treat them and focus on them as a whole person and to evaluate not just the symptoms but their environment and other factors as well. I believe that there is more to treating just the symptoms. For example, if a patient comes in with high blood pressure I would not want to just put the patient on HTN medication. I would look at the patient as a whole and not only discuss their blood pressure, I would also discuss diet, exercise, personal life, and any other issues necessary to discuss.
Theory
I think that Jean Watsons Theory represents my philosophy best. Her theory of Philosophy and Science of Caring has four major concepts: human being, health, environment/society, and nursing. Jean Watson refers to the human being as a valued person in and of him or herself to be cared for, respected, nurtured, understood and assisted; in general a philosophical view of a person as a fully functional integrated self. Human is viewed as greater than and different from the sum of his or her parts. The nursing model states that nursing is concerned with promoting health, preventing illness, caring for the sick and restoring health. It focuses on health promotion, as well as the treatment of diseases. Watson believed that holistic health care is central to the practice of caring in nursing. She defines nursing as a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic and ethical human transactions. (Petiprin, A., 2016).
Prescriptive Authority
Prescriptive authority is the ability of advanced practice registered nurses to prescribe, without limitation, legend and controlled drugs, devices, adjunct health/medical services, durable medical goods, and other equipment and supplies (Stokowski, L., 2018). Nurse practitioners, being highly educated and experienced in the field of nursing, are given prescriptive authority to varying degrees across the United States. The extent of a nurse practitioners prescriptive authority largely varies by the schedule of the drug in question, with some states allowing a larger degree of prescriptive authority to nurse practitioners and some regulating this prescriptive authority more closely. I live in California, the most populous U.S. state with nearly 40 million people. California keeps NPs under restricted practice authority, which requires them to have an agreement with a supervising physician to prescribe medicines, interpret diagnostic tests, and offer other essential services (Cox, K., 2017). Other states, such as Oregon and Nevada, while neighboring California, are considered Full Practice States meaning NPs can prescribe, diagnose, and treat patients without a physicians oversight (Simmons University, 2016).
References
Petiprin, A. (2016). Jean Watson Nursing Theory. Retrieved September 10, 2018, from http://www.nursing-theory.org/theories-and-models/
Stokowski, L. (2018, January). APRN Prescribing Law: A State-by-State Summary. Retrieved September 10, 2018, from https://www.medscape.com/viewarticle
Simmons University. (2016, October 25). Where Can Nurse Practitioners Work Without Physician Supervision? Retrieved September 10, 2018, from https://onlinenursing.simmons.edu/nursing-blog/nur
Cox, K. (2017). California Nurse Practitioner Full Practice Authority (FPA). Retrieved September 10, 2018, from https://www.nursepractitionerschools.com/blog/cali
PART2-Topic
You have been called to testify in front of a regulatory committee that is reviewing the credentialing and clinical privilege rules for APNs. Because of your experience in the field you are considered an expert in this area.
Explain in detail the difference between APN certification and credentialing.
Then explain the meaning of clinical privilege.
Why are certification, credentialing, and clinical privileges important to patient safety?
Students are expected to:
Post a response to each classmate. No more than 100 words include in-text citations and at least 1 reference APA style. Please be respectful.
Rebeccas Response:
Difference between APN Certification and Credentialing
Credentialing is a term applied to processes used to designate that an individual, programme, institution or product have met established standards set by an agent, such as a governmental or non-governmental entity, recognized as qualified to carry out this task. The standards may be minimal and mandatory or above the minimum and voluntary. Licensure, registration, accreditation, approval, certification, recognition or endorsement may be used to describe different credentialing processes. Credentials may be periodically renewed as a means of assuring continued quality and they may be withdrawn when standards of competence or behavior are no longer met.
Certification is a process by which a non-governmental agency or association certifies that an individual licensed to practice a profession has met certain predetermined standards specified by that profession for specialty practice. Its purpose is to assure various publics that an individual has mastered a body of knowledge and acquired skills in a particular specialty. For APNs, these individuals would receive a professional certification. This is the voluntary process by which a non-governmental entity grants a time-limited recognition and use of a credential to an individual after verifying that he or she has met predetermined and standardized criteria. It is the vehicle that a profession or occupation uses to differentiate among its members, using standards, sometimes developed through a consensus-driven process, based on existing legal and psychometric requirements (American Nurses Credentialing Center, 2018).
Clinical Privilege
Clinical privileges mean the authorization by a health care entity to a physician or other health care practitioner for the provision of health care services, including privileges and membership on the medical staff (US Legal, Inc., 2018). It is the process in which the organized medical staff evaluates and recommends an individual practitioner be allowed to provide specific patient care services in their healthcare facility within well-defined training criteria.
Importance for Patient Safety
Above all else, patient safety is by far the number one priority. A good clinic should always perform credentialing and privileging on all of its health care professionals. It not only protects patients and the clinic by lowering the risk of medical errors that may be caused by incompetent providers, but it also enhances the reputation and credibility of the clinic in the eyes of providers and within the health care community. Credentialing helps ensure that clinic practitioners are duly qualified, licensed, and board certified, and do not have a lengthy history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances (Smolenski, M., 2005).
References
American Nurses Credentialing Center. (2018). Credentialing Definitions. Retrieved September 10, 2018, from https://www.nursingworld.org/education-events/facu
US Legal, Inc. (2018). Clinical Privileges Law and Legal Definition. Retrieved September 10, 2018, from https://definitions.uslegal.com/c/clinical-privile
Smolenski, M. (2005). Credentialing, certification, and competence: Issues for new and seasoned nurse practitioners. Journal of the American Association of Nurse Practitioners, 17(6), 201-204. Retrieved September 10, 2018.
Helens response:
APN Certification and Credentialing
Certification programs must be accredited by the American Board of Nursing Specialties or by the National Commission for Certifying Agencies (Tracy & OGrady, 2019). A document that attests to an achievement is a certification. Certification for APNs is derived by the completion of an examination given by a certifying body that focuses on the area of study and practice of the APN. Certification by examination is a requirement of the state board of nursing for licensure. Credentialing is the collection and verification of an advanced practice nurses qualifications, evidenced by passing a certification examination (Tracy & OGrady, 2019). It is also evidenced by the issuance of a license by the state BON (Tracy & OGrady, 2019). Credentialing is congruent with education and certification.
Clinical Privilege
According to the U.S. Department of Health and Human Services (n.d.), clinical privileges mean the authorization by a health care entity to a physician, dentist or other health care practitioner for the provision of health care services, including privileges and membership on the medical staff. The services provided by the practitioner should be within well-defined training criteria. All NPs should be privileged to perform services that allow them to perform to the fullest extent of their education and training, certification and licensure (National Association of Pediatric Nurse Practitioners, 2015). Through the process of credentialing and privileging, NPs demonstrates competence and skills that ensure patient safety.
Patient Safety
Certification, credentialing and clinical privileges are important to patient safety because without them a clinician is not competent to provide care to the patient. The Joint Commission (2018) has established National Patient Safety Goals as a standard that may be utilized to improve patient safety, thereby improving the quality of care. According to the Institute of Medicine (2014), a person or organization is fundamentally altered by going through credentialing and is expected to improve performance of duties thereby improving patient safety.
References:
Institute of Medicine. (2014). Challenges and opportunities in nurse credentialing research design. Retrieved from https://nam.edu/wp-content/uploads/2015/06/Credent
National Association of Pediatric Nurse Practitioners. (2015). Position statement on credentialing and privileging for nurse practitioners. Journal of Pediatric Healthcare, 30(2), 20-21. Doi: https://doi.org/10.1016/j.pedhc.2015.11.006
The Joint Commission. (2018). National patient safety goals. Retrieved from https://www.compass-clinical.com/the-joint-commiss
Tracy, M.F., & OGrady, E.T. (2019). Advanced Practice Nursing.(6th ed.). St. Louis, MO: Elsevier
US Legal. (2016). Clinical privileges law and definition. Retrieved from https://definitions.uslegal.com/c/clinical-privile.
