Advanced Practice in the Health Care System - Essay Example

Advanced Practice in the Health Care System In what way is accountability in advanced nursing practice mandated in current civil legislation and professional guidelines in Australia? 1. INTRODUCTION According to American Heritage dictionary, we can define a nurse as “someone who was educated and trained to care for the sick and disabled” (2000). Looking beyond the denotative meaning, nurses are our modern day heroes, they are more than just someone who provides aid during one’s stay in the hospital, and they could be your best friend especially during emergency situations. They provide the necessary help to ensure that we would come out of the hospital, better than we entered it. In the past years, nurses providing care around the globe has increasingly decline. Estimates show that approximately 72 percent of hospital supervisors reported a nursing shortage at their facilities in October 2004. A previous report also estimated that in the year 2000, approximately 30 states experienced nursing shortage. Unfortunately, these numbers are only increasing. According to the latest projections from the U.S. Bureau of Labor Statistics published in the February 2004 Monthly Labor Review, more than one million new and replacement nurses will be needed by 2012. Nursing is not merely a branch of science but also seen as an art, where it requires special skills to take care of the health of people under various settings. In simpler terms, it is the art of helping people feel better and attain the highest level of general health which is achieved through the selective application of nursing science and strategies (Patricia, 2002). In the medical field, there are also some standards and guidelines for each doctor or nurse on how they should perform their duties and responsibilities in the chosen endeavor. Nurses are seen as assistants to the doctor, the one who is responsible in handling all other things that a doctor cannot or will not do for a patient but defining it more broadly, nursing practitioners (NP) are registered nurses (RN) with one to two years of additional education related to what doctors can provide and this includes adult nurse practitioner, certified nurse midwife, clinical nurse specialist, gastroenterology nurse practitioner, pediatric nurse practitioner, school nurse practitioner, neonatal nurse practitioner, family nurse practitioner and other related practitioners. (Australian Nursing Federation, 2000) Nursing theories and research are the scientific foundation for evidence-based nursing practice. These define the rationale for proper nursing actions and focus nursing care. In addition, understanding the influence of values on human behavior and of the ethical dimensions of nursing practice is essential to responsible and accountable patient care. Sensitivity to the legal implications of professional nursing practice is imperative in today’s culture. As any other profession the nurse practitioner is governed by standards and ethics defined by the state where it is being practiced. The practitioner is accountable to the consequences of his/her actions. 2. LEGAL AND PROFESSIONAL PARAMETERS There are different definitions of performance depending on the aspect that proves to be most important in a chosen field of medicine or in a hospital or clinical setting. It could mean different functions at different stages of development in the patient’s need, the user friendliness of the system. Legally, nurse practitioners are authorized to diagnose, prescribe medication and order X-rays and other laboratory work ( Australian Nursing Federation, 2000) while working closely with doctors, therapists and counselors. The dual role played by the nurse practitioner (a combination of physician and nurse) may confuse other people. As such, they are also referred to as physician extenders, mid-level practitioners and advanced-practice nurses because they are using, retrieval times or the clinical setting operation. Advanced Practice Nurses: Having undergone one to two years of additional education, the registered nurse becomes an advanced nurse practitioner. The umbrella term “Advance practice nurse” is used by some states and nursing associations to cover, collectively, NPs, nurse midwives, clinical nurse specialists (CNSs), and nurse anesthetists. NPs offer a wider range of services to a wider portion of the population as compared with the other specialists. There are some differences in the services ranging from narrow to wide range of services offered by the advanced practitioners as follows: A nurse anesthetist provides a narrow range of services (preoperative assessment, anesthesia administration and recovery management) to a narrow base of patients who received anesthesia. A clinical nurse specialist is a medium range service provider (education, research, administration, consultation, coordination of care, case management, and direct care within definition of registered nurse) to a narrow patient base under the care of a medical specialist. A certified nurse midwife provides a narrow range of services (well- women gynecologic care; pregnancy and childbirth management; antepartum and postpartum care) to a medium-sized base of child bearing women patients. The nurse practitioner provides a wide range of services (education, counseling, health promotion, evaluation, risk assessment, diagnosis, treatment, care coordination, case management) to a wide base of patients, depending upon area of certification. A family nurse practitioner can have a patient base of any age, gender or problem. Services Provided by NPs : NPs may provide services authorized by a state nurse practice act which generally include: Performing physical examinations, obtaining medical histories; Diagnosing and treating health problems; Ordering and interpreting laboratory tests and X-rays; Prescribing medications and other treatments; Providing prenatal care and family planning services, well-child care and immunizations, gynecologic examinations and Pap smears, education on health maintenance and risks, and illness prevention; Case management and coordination of care. Advanced nursing practices in world-wide and in Australia Access to health care is changing in response to the needs of the global community. Health care systems include delivery of goods, services and persons (nurses) who provide these services. Each country or nation attempts to deliver the best health care system suited to its people. As a result of this expansion, the nurse practitioner and advance practice nursing roles are emerging world -wide. However, in Australia, the NP role has developed more slowly, than elsewhere as there are currently only small number of NPs authorized to practice. Regulation of the practice of nursing is governed by state and territorial nursing regulation authorities. The Australian Nursing and Midwifery Council (ANMC) was established in 1992 and works with these authorities to facilitate a national approach to nursing and midwifery regulation. The Government of New South Wales (NSW) enacted the Nurses Amendment (Nurse Practitioners) Act 1998 that provides for recognition and accreditation of nurse practitioners in NSW. In this legislation, nurse practitioners are given limited prescribing privileges. Current legislative restrictions on initiation of medications and diagnostic services are being reduced. Its provisions on adequate education and professional standards are maintained. The role of the nurse practitioner role is still under exploration for implementation in South Australia, Northern Territory, Queensland and Western Australia. A coalition of national nursing organizations endorsed a National Consensus Statement on the Recognition of Nurse Practitioners in Australia (ANF, 2000). The statement proposes a definition of nurse practitioner’s role, educational preparation, scope of practice, career structure, remuneration, authority to practice, protection of the title, and legislative support (ANF, 2000). 3. TRENDS: ACCOUNTABILITY AND INFORMATION Standard of Practice will ensure that the clinical nursing is practiced at a competent level, determining each level of behavior and their professional role. Standards could assist in making sure that the patients received care with outmost knowledge in the end of the nurses and that they are receiving the necessary attention that they ought to have. (2005) Care and service must be delivered without infringing upon basic human rights. The Nurse is accountable to patients to safeguard these rights while providing appropriate nursing care. Care and service must be delivered without infringing upon basic human rights. The Nurse is accountable to patients to safeguard these rights while providing appropriate nursing care. Communicates with the patient, significant others, and health care providers regarding patient care and the nurse's role in the provision of care. It appears that accountability, conduct and code are foremost in the minds of those interested in information. Health services everywhere are in the midst of profound structural change. No health service is stable. A number of key driving forces will continue to transform the practice of medicine and nursing into the next century. Information technology is one of these key forces. As we look beyond the current changes in the National Health Service, the only thing certain is that the future will be different. We may be tired of change. We may even long for a period of stability, but this is not going to happen. Information technology combined with other technological advances will play a significant role. The delivery of healthcare services is an information based activity. Yet we lag behind industry by many decades in the appropriate use of information technology. It is my belief that information technology (e.g. combining powerful hand-held computers and patient data-bases), once harnessed, will support the mobile nature of healthcare and provide a platform for new approaches to clinical practice in hospitals, the clinic and the home. All will be developed in the interests of patients and clients. The information revolution has already changed the nature of our work and education. One question is the implication of technology to nurses, midwives and health visitors, and other professions involved in the delivery of healthcare. This paper will concentrate on the implications and relevance for professional practice of two key words - accountability, and information. Accountability The power to do something inevitably carries with it the responsibility for doing it. Registered practitioners are accountable: able to be called to answer for what has been done. Accountability is an integral and essential element of professional practice for all those who become registered nurses, midwives or health visitors, as it is for other registered health professionals. Accountability extends to include omissions as well as actions, and other things which occur within the sphere of influence and responsibility. Accountability extends to include the quality of delegation and acquiescence with the events around the practitioner. Accountability is not easy. But the essence of professional practice is making judgments in a wide variety of circumstances and being able to be called to account for those judgments. In 1992 the UKCC published and distributed the third edition of "The Code of Professional Conduct for Nurses, Midwives and Health Visitors." This was a significant and important step towards the understanding of accountability. It was a document that was all about accountability, even though the word only appears in print once in the text. It contains seven principles that can be grouped into interests and roles: 1. Interests: a. The primary interest is that of the patient or client. It must be respected and not be overridden by the interests of the practitioners. b. It is to the best interest of the patient, public trust and confidence that practitioners should seek to achieve and maintain high standards of the profession. 2. Roles: a. The role of each person involved in the delivery and exercise of the health care should be spelled out and respected by everyone concerned. b. Practitioners (registered nurse, midwife or health visitor) should be able to justify any action or decision taken in the practice of their profession. Individual accountability can be demonstrated primarily through: Continued competency and Professional development: 1. Continued Competency: It is the professional responsibility of the registered nurse to maintain competency after receiving his/her license from the health profession licensing boards. Registered nurses must renew their licenses on an annual or biannual basis before expiration data and meet other such requirements for license renewal as required by the individual state board of nursing. 2. Professional Development: Professionalism must be lived, not learned. School of nursing curriculum topics (e.g. on history and future trends, professional organizations, and regulations) is not sufficient for developing an involved committed professional. Rather, it is the participation of nursing students in extra curricular activities that enriches academic experiences and fosters professional development. Student Accountability Nursing students already function legally as an exception to the state licensure requirements while enrolled in a nursing program approved by the state board of nursing. Such exception is only granted when the student is engaged in learning activities structured within the study program. Activities outside the formalized clinical practicum of the nursing curriculum constitute illegal practice of nursing. Student nurses and healthcare assistants carry out the instructions of the registered nurse. The registered nurse is the one mainly responsible for the student actions. Accountability for nursing care is shared by the student, faculty and education institution practicing and the clinical agency. The various responsibilities for each of these parties are determined by the respective state board of nursing. The future of the nursing practitioner As the nursing practitioner profession becomes more and more specialized in the future, there will be greater need to define the areas where specialized practitioners should focus on their work. The issue of accountability will become more serious. There will be need for risk management solutions as the nursing practitioner becomes more vulnerable to liability claims. This liability will create clinical, legal, financial and operational challenges to the profession (Nurse Practitioner Claims Study) Future legislations should also consider provisions to protect nursing practitioners against false claims or allegations and to institute standards to reduce these possibilities. Different countries and states will also enact or amend their laws governing the medical profession and what can be delegated to the nursing practitioner. Some are very restrictive in the declarations of their law provisions while others are more liberal and provide more elbow room for the nursing practitioner. With the advances in technology, some of the differences in the legal/professional parameters of different states can already be viewed on-line through the internet. CONCLUSION: There is a growing realization around the world that the nurse practitioner role has the potential to contribute significantly to the solution of current health care delivery problems. The growing consensus in the international nursing community is that the appropriate educational preparation for the role is at the graduate level. The curriculum should reflect the needs of the times that include subjects on accountability and risk management. Professional nurses must be fully aware of the role of the board of nursing and the methods by which rules and regulations are adopted in their state of licensure. In this way, they can be active participants in the development of such regulations. Nurses can use a variety of ways to demonstrate individual accountability: continued competency and professional development. The state boards must have some mechanism to make sure that licensed practitioners maintain or improve their level of competence during renewal of their licenses. REFERENCES: Australian Nursing Federation. (2000). National consensus statement on the recognition of nurse practitioners in Australia. Retrieved January 24, 2002, from http://www.anf.org.au/nno/statment_020128.html Buppert Carolyn. 2004: Nurse Practitioners Business Practice and legal Guide , Jones & Bartlett Pub, UK. Caulfield Helen. 2005 : Vital Notes for Nurses : Accountability , Blackwell Publishing USA. Ladner Patricia K. 2002: Fundamentals of Nursing: Standards and Practices, Thomson & Delnar Pub, UK. Robinson Denise. 2001: Core Concepts in Advanced Practice Nursing, Mosby Inc Canada. Standards of Clinical Nursing Practice and Role Delineation Statements. Revised 2005. SGNA. April 29,2006. http://www.sgna.org/Resources/guidelines/guideline8.cfm Taylor Carol. 2004 : Fundamentals of Nursing : The Art and Science of Nursing Care , Lippincott Williams & Wilkins Pub, UK. Constitution Of The Australian Nurse Practitioners Association, 2003. www.nursepractitioners.org.au/ANPA%20Constitution.pdf Read More