Advanced Practice Roles in Nursing - Essay Example

Final Project Introduction A career in nursing is comprised of a number of areas of specialty, each of which has its different composition. An advanced practice requires one to take a specific role as either a nurse administrator, or nurse practitioner, nurse educator, or nurse informaticist. The roles of these types of professionals vary from research, clinical practice, primary care, administration, and education. Despite the different specialties, these nurses are obliged to adhere to the regulations set by the respective states. In Texas, an advanced practice nurse should abide by the provisions of the Nursing Practice Act (2013) as well as register with the Texas State Board of Nursing. It is also paramount that an advanced nurse should demonstrate leadership skills in their respective areas of specialization. This essay addresses different specialties in nursing with a special focus on the competencies required, legal requirements, as well as the certification requirements. Advanced Practice Roles in Nursing Advanced practice in nursing facilitates the promotion of career that helps in building competencies. Each of the nursing professionals has different duties while others are shared across the strata. As an administrative nurse, one has the obligation of ensuring effective management of resources within a health facility. Closely related this specialty is the nurse informaticist, who deals with the administrative purposes, which requires the integration of computer and information science with knowledge in nursing. This form of nursing integrates with all the other nursing specialties by providing a system of information sharing, data communication, and knowledge sharing in order to promote nursing education, patients’ healthcare, and research. The nursing practitioners have an advanced role from that of the registered nurses since they have advanced in their clinical education in order to be certified as advanced practice registered nurse. A nurse educator plays a specialized role of teaching nursing students in addition to engaging in nursing research as well as facilitating the inculcation of behavior, values, and skills necessary for professionalism to the students. The roles of the different nursing specialties fall under either clinical or non-clinical practices. A nurse educator can perform is required to engage in both clinical and non-clinical practices. Despite the main role of a nurse educator being facilitation of the learning process, curriculum development, research, and inculcating professionalism among the learners, they are obliged to have clinical practice skills in order to guide the students on clinical practice effectively. Contrary to a nurse educator, a nurse informaticist’s roles are inclined more to the non-clinical practice; therefore, their clinical experience is limited. In the same way, a nurse administrator is not directly involved in clinical practices since their main role is coordination of the nursing practices in a healthcare setup such as staff management. The nurse practitioners are directly involved in clinical duties. A nurse practitioner plays a pivotal role in protection of health, health promotion, disease prevention, treatment, and the provision of primary care to the patients. Despite the differential roles taken up by the different professionals, Rhodes, Morris, and Lazenby (2011) have observed that it is obligatory for all nursing professionals to be caring and knowledgeable. Despite the differences among the nursing professionals with advanced practice, a number of similarities exist. All the specialties in nursing are required to adhere to professional ethics at all times in the execution of their duties. It is also a requirement that all nurse specialties provide services that are geared toward promoting the quality of care (Rhodes, Morris and Lazenby, 2011). Planning and leadership skills are a requirement across the board. A nurse practitioner is required to develop a plan of care in order to affect a given form of treatment effectively. As a nurse practitioner, the first step in the treatment process involves stabilizing the patient, then minimizing the physiological condition of the patient and finally, facilitates realization of maximum health potential. Likewise, the rest of the specializations require one to develop initiative and do adequate planning that facilitate reaching of anticipated results. What vary among the specialties are the actual activities and processes that are involved, the skills are similar across the board. It is of essence that a nurse administrator, nurse educator, nurse informaticist and nurse practitioner should have teaching competencies. Through this role, the advanced nursing specialist imparts knowledge to the students, patients, community, and employees. Another colossal role taken up by all the nursing specialties is that of devising systems and policy improvements that add value to the healthcare provision. The nurse educators focus mainly on the scholarly process of enhancing the systems in consultation with the nurse practitioners and the nurse informaticists while the nurse administrators are involved in the implementation process. In addition, as observed by Campinha-Bacoste (2011), all the nursing specialties require cultural competence since they deal with people from diverse cultural affiliations. Further, they will need to communicate with patients, students, communities, and colleagues across the cultural strata (Schmitt, Amy, Aschenbrener & Viggiano, 2011). Individual Advanced Practice Role Among the many specialties available for an advanced practice in nursing, I chose to a practitioner nurse dealing with adults. In particular, I have considered working with Medical Specialists Associated, which is located in Dallas in Texas. In order to execute this role effectively, I will be obliged to adhere to the nursing regulations in Texas as spelt out in the Nursing Practice Act, the Nursing Peer Review Act, and the Nurse Licensure Compact. Nursing regulations are safeguarded by the Texas Board of Nursing (BON), which ensures that those that practice are competent and comply with the set standards. The BON executes its roles by ensuring that it approves the nursing educational programs while at the same time providing regulations for nursing practice. The mandate of the BON is set out in the Nursing Practice Act. As provide in the NPA, an advanced practice nurse should be registered and licensed upon the completion of specialized education, for my case specializing as an adult nurse practitioner. In order to practice nursing in Texas, one has to be licensed. The licensing of nurses is done depending on the level of education and the level of experience, hence a nurse can be allowed to practice’ as a ‘registered nurse’, ‘graduate nurse’, ‘licensed practical nurse’, ‘licensed vocational nurse’, ‘practical nurse’ or ‘vocational nurse’ (Texas Board of Nursing, 2014). A person requiring registration by the Board is required to be free of any criminal record. I addition, it is paramount that for full registration, an advanced nurse ought to sit for the Board examinations for full registration. Upon passing the board examinations, one is given the practicing license, which is signed by the Executive director and the Presiding Officer of the Board and it should bear the seal of the Board. Upon obtaining the license, the adult nurse practitioner is obliged to adhere to professionalism, failure to which it can be revoked. It is important to have the license renewed as set out by the Board. I endeavor to take a role as an adult practitioner nurse at Medical Specialist Associated. In this facility my role will include giving prescriptions, and facilitating the availability of durable medical equipment required by the patients. In addition, I will be required to complete assessments, order tests or labs while at the same time coordinating care with the assigned physician. In order to be effective in this capacity, it will be paramount to have the duties of prescribing medical services as well as the medications to be delegated by the physician as provided in the Nursing Practice Act (2013). At Medical Specialist-Associated, there is a close working relationship between nurse practitioners and the physicians. In addition, I am certain that my role as an adult nurse practitioner will involve people that are based in their homes, group homes as well as assisted living. Key among the anticipated responsibilities is that of educating the patients, their families and caregivers on management of chronic illnesses and the prevention of excessive hospitalization. The facility operates five days in a week (Monday to Friday) from 8:00 am to 5:00 pm (Medical Specialist Associated, 2014). There are nine physicians at the facility, in addition to the internists who ensure that patients get immediate attention. The facility deals with issues to deal with wellness and prevention, management of chronic diseases, testing and labs services, preoperative exams and adult primary care. Leadership Attributes of the Advanced Practice Role Irrespective of the specialty, an advanced practice nursing requires good leadership skills. According to Quillian and Carolan (2009), leadership in nursing is a vital component in the provision of patient care. The first thing is for an advanced nurse to have self-awareness of their leadership style. Upon a personal evaluation, I found out that I am a participative delegative leader. I consider every member of my team as well as decisions made very significant. In addition, I subscribe to the thought that a leader has the obligation of building trust, enhance clarity, and improve productivity while also improving the quality of care among the patients. Angermeier, Dunford, Boss, Boss, and Miller (2009) have argued that participative leadership plays a pivotal role in promoting customer service, reduction in medical errors, improved participation, lower burnout and the employee commitment. As a leader in the healthcare setup, the goals should be to provide quality patient care while ensuring that the employees perceive that their input and thoughts are given a consideration. In delegative leadership, the leader empowers the employees to make their own decisions in order to reach their goals. The leader does not pose as the fountain of knowledge but gives an opportunity to the employees to make decisions on their own. Therefore, delegation acts as a tool that allows nurses and their team members to exhibit effectiveness and efficiency in their operations (White, Gutierrez, Davis, Olson, & McLaughlin, 2011). In this regard, my teaching skills will go a long way into promoting my leadership roles. In addition, I am effective in delegation and do well in providing guidance. It is of essence to consider some of the skills that I need to improve on. Sometimes I tend to over supervise which can easily make the employees lose a sense of responsibility in addition to lack of exercising their creativity. In addition, when patients are over supervised they lack initiative and tend to do what is expected of them only when supervised. It will be paramount to entrench coaching skills in my career in order to ensure I effectively serve the patients. As noted by Toyin (2010), coaching ensures that patients are provided with help and guidance, while ensuring that they account for their decisions and take responsibility for their illnesses. In order to attain the missing skills, I will seek advice from mentors while at the same time reading widely on effective coaching skills as well as effective supervision. I will apply the knowledge acquired in my practice in order to cover up for the lacking leadership attributes. Health Policy and the Advanced Practice Role The provision of quality healthcare is an aspect that requires a change not only in Texas but in United States in entirety. The quality of healthcare was in Texas was rated the worst throughout the country in 2012 according to a report by the Federal Agency for Healthcare Research and Quality. Despite the heavy spending on healthcare, life expectancy in the US is shorter compared to other rich countries across the world (Robert Wood Johnson Foundation, 2012). The National Quality Strategy was the policy developed through the 2010 Affordable Care Act in an attempt to provide a way of facilitating quality improvement. This strategy is grounded on three objectives, firstly, the need to increase the accessibility of healthcare, promoting safety while ensuring that the treatment is patient-centered. Secondly, it entrenches the need to focus on issues to deal with the impact of environmental, behavioral and social issues on health and healthcare, and finally, ensuring that care becomes more affordable (Hofler, 2006). The provisions of National Quality Strategy are in tandem with the need to improve the quality of healthcare in Texas. The major challenge that has hit hard the residents is the increasing number of people without health insurance while at the same time the cost of healthcare continues to rise. In addition, the poor coordination of healthcare makes it expensive. Such makes it difficult accessing quality healthcare services. With the adoption of the Affordable Care Act (Obamacare), the accessibility to a higher-quality health insurance was facilitated. However, a policy regulating the cost of healthcare ought to be devised. The process of implementing a change in the cost of healthcare requires the input of all the stakeholders. Both public and private sectors influence health policies. In order to effect the change, all the phases of a policy development ought to be considered; the formulation, implementation and the evaluation stages. The formulation of the policy will require information, research and ideas from interest groups, key personalities and organizations. The most appropriate strategies of dealing with the cost of healthcare are considered as solutions to the problem stated in the policy. In addition, the resources required for successful implementation of the policy are identified and appropriately planned for. Once a proposal has been brought forth, the players in the public and private sector dealing with health issues give their views on the proposal. Then the interest groups also present their views. Ultimately, the political systems also influence the adoption of policies. A policy that is not in tandem with party (Republicans or Democrats) interests is unlikely to see the light of the day if a party with a majority opposes it. Upon legislation of a policy, the Governor approves it if it is in the scope of a state or by the President if the Senate passed it. Upon passing of the policy, it begins its implementation, for a policy involving costs of healthcare; the nurse administrators have a major stake in the implementation process. Consequently, the policy can be repealed from time to time to reflect the changes in the cost of healthcare (Abood, 2007). As an adult nurse practitioner, I can effectively champion the development of policy through two ways. First is developing a personal initiative to draft a policy and then present it to the relevant policy makers. The policy can presented to the Senate as a bill through our Texas Senator or a bill in the state legislature. Alternatively, the policy can be presented to the Texas Health Care Policy Council for further scrutiny and the subsequent recommendation for the adoption of the policy by the state. Secondly, I would influence the stakeholders in the health sector to think of developing a policy on regulating the cost of health services. Target individuals would include healthcare facilities administrators and the health department within the Governor’s office. A policy on reducing the cost of health care services can have far-reaching effects on the quality of healthcare. First, patients will find healthcare affordable hence, they are able to access health facilities that provide specialized and quality services. Reducing the cost of healthcare means that a supplementary source of financing will meet the deficit that patients are not able to meet. Those that receive their treatments at homes are able to have the physicians and other health personnel visit them from time to time, hence ensuring that hospitalization is reduced. Hospitalization can have detrimental effects to the patient such as exposing them to other infections. Another aspect is that there will be facilitation of the healthcare professionals to follow-up on the patient hence treatment is effectively provided. In the end, the quality of healthcare provided is greatly enhanced. References Abood, S. (2007). Influencing health care in the legislative arena. The Online Journal of Issues in Nursing. Vol 12 (1). Angermeier, I., Dunford, B. B., Boss, A. D., Boss, W. R., & Miller, J. A. (2009). The impact of participative management perceptions on customer service, medical errors, burnout, and turnover intentions/ practitioner application. Journal of healthcare management. 54(2), 40-127. Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of cultural competence. OJIN: The Online Journal of Issues in Nursing. Vol 16(2). Hofler, L.D. (2006). Learning from the best: The benefits of a structured health policy fellowship in developing nursing health policy leaders. Policy, Politics & Nursing Practice 7(2), 110-113. Medical Specialists Associated. (2014). Medical Specialists in Dallas, TX. Retrieved from http://www.msadallas.com/ Rhodes, M., Morris, A. & Lazenby, R. (2011). Nursing at its best: competent and caring. OJIN: The Online Journal of Issues in Nursing. Vol 16(2). Robert Wood Johnson Foundation. (2012). What is the national Quality Strategy? Retrieved from http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/01/what-is-the-national-quality-strategy-.html Schmitt, M, Amy, B, Aschenbrener, C, A & Viggiano T. (2011). Core competencies for interprofessional collaborative practice: Reforming health care by transforming health professional’s education. Journal of the Association of American Medical Colleges. 86 (11). Texas Board of Nursing. (2013). Nursing Practice Act, Nursing Peer Review, & Nurse Licensure Compact Texas occupations code and statutes regulating the practice of nursing as amended September 2013. Retrieved from https://www.bon.texas.gov/laws_and_rules_nursing_practice_act_2013.asp#Sec.301.251 Texas Board of Nursing. (2014). Laws and Rules – Nursing Practice Act. Retrieved from http://bon.texas.gov/laws_and_rules_nursing_practice_act.asp Toyin, T. (2010). Coaching younger practitioners and students using components of the co-active coaching model. American journal of Pharmaceutical Education, 74 (3), 3. White, M. J., Gutierrez, A., Davis, K., Olson, R., & McLaughlin, C. (2011). Delegation knowledge and practice among rehabilitation nurses. Rehabilitation Nursing, 36 (1), 16-24. Read More