Role of the Family Nurse Practitioner - Essay Example

Topic: Role of the Family Nurse Practitioner (FNP) To begin with, a family nurse practitioner can be defined as any practicing nurse with a specialty in family medicine (Duderstadt, 2008) that has attained academic credentials to the level of master’s or doctorate degree. According to Fox & Gilman (2000), a family nurse practitioner is trained to provide specialized care to the less fortunate majority of the society particularly children and the aged. Alternatively, Lesley (2007) defines a family nurse practitioner as a primary health care provider who operates in non-conventional settings such as homes and schools at relatively very cheap rates. In a nutshell, it can be concluded that a family nurse practitioner is any nurse specially trained to work with patients of all ages to manage their conditions and must be in possession of a FNP certification (Lugo, O’Gradey, Hodnicki & Hanson, 2007). Entry requirements for one to practice as a family nurse practitioner vary from state to state although some requirements have become basic. Generally, a family nurse practitioner is currently required to possess a minimum of a master’s degree in addition to a post-master’s qualifications as cited by Lesley (2007). Additionally, one is also required to possess a national certification from either the American Nurses Credentialing Center or the American Academy of Nurse Practitioners before being allowed to practice as a family nurse practitioner. Lugo et.al (2007) further explain that this scenario is poised to change because the two bodies are planning to require a doctoral degree in future as the minimum a candidate should present to qualify for the certification test. This will be in addition to the inclusion of a special language at a master’s degree level by some states. In comparing the role of family nurse practitioner with that of family practice physician (FPP), it is noticed that the two register more similarities than differences. From the outset, both are trained to provide continuing and comprehensive health care to each member of the family encompassing all ages regardless of gender and type of problem (Lugo et. al, 2007). Similarly, both roles involve education and training in family practice and operation in a variety of nontraditional settings. Moreover, family physicians may be a good choice for those who do not want to do a lot of procedures or surgeries as opposed to other practitioners. This may allow family physicians to enjoy a more predictable schedule and better quality of life than some other specialists who have to be more available for emergencies or surgeries as viewed by Duderstadt (2008). Physician assistants (PAs) on the hand practice medicine under the supervision of physicians and surgeons. This is in contrast to the provision for FNP who have varying levels of physician collaboration. Duderstadt (2008) reports that family nurse practitioners have been found to function independently of physician involvement. Additionally, Duderstadt (2008) states that “PAs are formally trained to provide diagnostic, therapeutic, and preventive healthcare services as delegated by a physician while FNPs are more independent and often cheaper than physicians”. Also, PAs differ in their requirements for admission to training programs where most applicants have a college degree and some health-related work experience whereas FNPs must have a master’s or doctoral degree in addition to a national certification. Duderstadt (2008) further argue that FNPs work in a variety of settings whereas PAs usually work in a comfortable well-lighted environment. As also stated by Duderstadt (2008), a chiropractor is concerned with the mechanical disorders of the musculoskeletal system, particularly the spine and supporting structures. In comparison, the chiropractor is found to be in a totally different field generally considered complementary and alternative medicine (Lesley, 2007). A chiropractor is thus a licensed medical practitioner with the main treatment method as spinal manipulation while a FNP functions as a primary health care provider (Lesley, 2007). The two practitioners are found to have similar educational pathway where both are required to complete a four to five year degree program in addition to postgraduate studies and national certification (Fox & Gilman, 2000). Moreover, they both take medical history of their patients before prescribing medications within their scope of practice. According to Lesley (2007), a clinical nurse specialist (CNS) is a registered nurse who has completed a master’s or doctorate level of education as a clinical nurse specialist. This compares with a FNP who must have a master’s or doctorate level of education. Just like the FNP, a CNS is considered a “specialist” because of the focused and specialized education received as cited by Duderstadt (2008). He further explains that both act as consultants, educationists, or mentors within their areas of specialization. In this manner, their roles usually go beyond patient care because they both work in community outreach, educating and counseling patients on maintaining health lifestyles. Similarly, both must need national certification even though their certifying boards vary significantly. In addition, both are allowed to prescribe medications and medical treatments for their patients. The Texas State Practice Act for nurse practitioners is very clear on the functions and procedures that a nurse practitioner can perform and not perform. Since a nurse practitioner is a primary health care provider to individuals and groups of individuals in the medically underserved category, it becomes imperative for the care giver to concentrate on health promotion and disease prevention to curtail the proliferation of common acute illnesses among these individuals (Bodenheimer et. al, 2009). To successfully offer these services to their clients, nurse practitioners are authorized to carry out diagnostic and laboratory tests and thus prescribe appropriate medications as the cases may deserve. Moreover, Duderstadt (2008) indicates that a nurse practitioner is permitted to educate and counsel clients and their family members regarding healthy living to facilitate successful health care provision. In the event of a chronic disease afflicting on of the clients, the nurse practitioner is allowed to employ therapeutic procedures to manage the condition (Bodenheimer et. al, 2009). Although nurse practitioners are legally authorized to promote primary health care with some degree of autonomy, it has been demonstrated that they face some limitations. A nurse practitioner is prepared to practice in nonconventional settings which may not present the best of working conditions. This, according to Lesley (2007) prevents them from exercising hospital admissions authority. It is further explained that apart from being unable to admit their clients to the hospital, nurse practitioners are not allowed to follow their clients during their in-patient stay (Lugo et.al, 2007). More disheartening is the fact that they cannot obtain referral information when their clients are discharged from hospital as cited by Lesley (2007). This lack of autonomy in decision-making on the part of the nurse practitioners has resulted in unwarranted delays in the provision of primary care services. In majority of states in the USA, nurse practitioners have been found to lack prescriptive privilege, a fact that has contributed to a lot of delays in treatment. It is reported that cases of prescriptions being written by other care providers with no history of the patient are a common occurrence in many of the states. Similarly, Lugo et.al (2007) further explain that the provision of pre-signed prescription pads for example, could go a long way in reducing the waiting hours for clients before they get treatment. Texas State has on one hand attempted to alleviate this problem by producing working regulations to define the nursing practice. To this effect, the Texas State has allowed authorized nurse practitioners to have independent prescriptive authority for all medications (Lugo et. al, 2007) including controlled drugs. In addition to this provision, authorized nurse practitioners are supposed to have national certification for practice as well as full involvement in diagnosing and treating with no legislative prohibitions whatsoever (Lugo et.al, 2007). But the statute restricts nurse practitioners from prescribing any of the controlled substances. In comparing the status of family nurse practice in Texas with that found in Hawaii, Florida, Mississippi and Tennessee, it is noticed that prescriptive privileges border on a very thin dichotomy in all the states. It is accepted that in Texas, a nurse practitioner may practice and prescribe medication without the supervision of a physician as long as the appropriate procedures are observed (Lugo et. al, 2007). Just like in Texas State, nurse practitioners in Hawaii and Florida require a national certification for practice as well as written authorization for prescriptive agreement (Duderstadt, 2008). Similarly, nurse practitioners in the States of Mississippi and Tennessee need a national certification with CE requirements for practice as indicated by Bodenheimer et.al (2009). In both States, a prescriptive agreement for non-scheduled drugs is required. Likewise, Mississippi and Tennessee states have allowed authorized nurse practitioners to have separate protocol requirement for prescribing medications (Lesley, 2007) including controlled drugs in schedule II-V. Bodenheimer et.al (2009) clarify that both states have a non- discriminatory clause for third-party reimbursement to nurse practitioners particularly the family nurse practitioners who receive Medicaid compensation at 80% of physician payment. In the states of Texas and Hawaii, Medicaid compensates nurse practitioners at 100% of physician payment (Lugo et. al, 2007). Efforts to legally allow for prescriptive authority for schedule V and legend drugs for qualified nurse practitioners in Hawaii are at advanced stages. On the issue of collaboration agreements, it is in record that nurse practitioners in Texas may practice and prescribe medication without the supervision of a physician as long as all the right procedures are observed (Lugo et. al, 2007). But as it pertains to this provision in the states of Florida, Mississippi and Tennessee, collaboration of nurse practitioners with physicians and other health care professionals has been in practice for a long time. This has been noted to result in adverse cost increases generated by supervision requirements and delays in treatment due to lack of total autonomy in decision-making on the part of the nurse practitioners (Lugo et. al, 2007). This has resulted in negative ramifications on the very noble cause of nurse practitioner collaboration with other professionals in the provision of comprehensive health care (Lesley, 2007). From the foregoing essay, it has been illustrated that nurse practitioners must obtain national certification from accredited bodies particularly the American Academy of Nurse Practitioners or the American Nurses Credentialing Center to be permitted to practice. Nurse practitioners in the State of Texas for example work under the rules and regulations stipulated in the State’s Nurse Practice Act as cited by Fox & Gilman (2000). This piece of legislation allows nurse practitioners in Texas State to practice independently of their collaborative physician unless stated otherwise (Lesley, 2007). Additionally, nurse practitioners are allowed to work as both educators and researchers in their endeavors to provide comprehensive health care. It is from the same premise that nurse practitioners in the states of Mississippi, Tennessee, Hawaii and Florida operate as illustrated by Lugo et.al (2007). Research findings further indicate that family nurse practitioners are charged with the role of educating and counseling patients and their families in regard to healthy living (Lesley, 2007). Throughout the history of nurse practice in the United States of America, it is evident that State and Federal legislation have affected the practice of family nurse practitioners in various ways. It is reported that Federal legislation provided funding to support the development of primary care providers both in the mid 1960s and early 1970s as cited by Duderstadt (2008). The net result of this federal funding was the proliferation of nursing programs aimed at preparing nurse practitioners to deliver primary health care to the disadvantaged lot (Duderstadt, 2008). Consequently, these programs were over enrolled due to the increased demand for nurse practitioners thereby threatening the quality of nurses produced. To forestall any further collapse in quality of education in the nursing programs, the minimum qualifications were upgraded from certificate to master’s degree as per the requirements of accrediting bodies (Fox & Gilman, 2000). As of the 1980s, studies show that majority of nursing programs were offering masters or doctoral degree programs in preparation of nurse practitioners for primary care services (Lesley, 2007). To ensure that the quality and effectiveness of nurse practitioner preparation was maintained, Lesley (2007) explains that “the Texas Higher Education Coordinating Board and the Board of Nurse Examiners for the State of Texas studied the standard curriculum requirements for advanced practice designation”. Accordingly, the changes made in Texas effectively strengthened the content requirements for the nursing programs as cited by Duderstadt (2008). Available information indicates that nurse practitioners are generally licensed through nursing boards rather than medical boards (Fox & Gilman, 2000). Since nurse practitioners provide a broad range of health care services, it is imperative to tailor-make a course of study that can make the nursing profession competent and effective in the execution of their tasks. In view of this, it has become necessary for anyone wishing to sit for national certifying examinations for FNP to first of all successfully complete the FNP program. This basic requirement qualifies the student to be eligible for Advanced Registered Nurse Practitioner licensure under Washington State law (Lugo et. al, 2007). Since a master’s degree has become so crucial in the nursing profession, many institutions have come up with flexible programs that cater for any one wishing to upgrade (Lesley, 2007). This is in line with the licensure requirements for new nurse practitioner graduates in the State of Texas who must obtain certification from the American Academy of Nurse Practitioners or the American Nurses Credentialing Center after passing a certification test so as to practice. The Process of application for licensure as a nurse practitioner in any state must be in line with the various certifying organizations which require a minimum of a master’s degree for new entrants. It is worthy noting that before the enforcement of this provision, established nurse practitioners with lesser education qualifications were co-opted in the certification process (Fox & Gilman, 2000). After certification, the candidate is then required to obtain a license to practice in the concerned state. The generally accepted licensing and certification criteria include completion of a masters degree in nursing and certification by an accrediting body (Fox & Gilman, 2000) probably the American Academy of Nurse Practitioners or the American Nurses Credentialing Center. According to Lugo et.al (2007), the license period varies by state where some require biennial relicensing while others require triennial. In the United States, it is common practice that family nurse practitioners are licensed by the state in which they practice by obtaining a national board certification. In this respect, it is noted that most states require nurse practitioners to be nationally certified in order to obtain a practice license. As already mentioned, one must be a graduate of a mater’s or postmaster’s level of education to earn certification. In addition to this, one must submit academic transcripts at the time of application as explained by Lugo et.al (2007). Then finally the candidate must pass the certification examination offered by several bodies in areas of family nurse practitioner. For the process of recertification, it should be noted that the requirements vary from state to state. But all in all, it has been discovered that the nurse practitioner license expires every two years in most states as demonstrated by Fox & Gilman (2000). To this effect therefore, nurse practitioners are required to recertify every five years at the latest. This recertification is necessary for licensure. According to Fox & Gilman (2000), there must be evidence of continuing education (CE) set at seventy five hours every two years for one to qualify for recertification. Thus, both the American Academy of Nurse Practitioners and the American Nurses Credentialing Center require detailed information about a candidate’s CE credits to grant recertification. References Bodenheimer, T., Chen, E. & Bennett, H. (2009). Confronting the growing burden of chronic disease: Can the U. S. health care workforce do the job? Health Affairs, 28(1); 64-74 Duderstadt, K. (2008). Medical Home: Nurse practitioners role in health care delivery to vulnerable populations. Journal of Pediatric Health Care, 22(6):390-393. Fox, J. & Gilman, L. (2000). Pediatric Nurse Practitioner Certification Review. New York: Mosby. Lesley, P. (2007). The Nurse as a Primary Health Care Provider. New York: Genesee Valley Nurses Association. Lugo, N., O’Gradey, E., Hodnicki, D. & Hanson, C. (2007). Ranking state NP regulation: Practice environment and consumer healthcare choice. The American Journal for Nurse Practitioners, 11 (4): 8-24 Read More