“The Final Word”
Give a brief summary evaluation of your community’s health, the major strengths of your community, and the hopes for your community in the future. Also, discuss what has resonated with you in this course.
Submission Instructions:
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare:
Write a 1-page narrative in APA format that addresses the following:
Reply to two other student posts with a reflection of their response. Please make sure to provide citations and references (in APA, 7th ed. format) for your work. (300 words minimum)
PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:
The Nursing Legislation and Advocacy page on the FNA website identifies 4-different ways for you to get involved with advocacy. Discuss which way(s) you would most likely get involved with and why?
One of the four different ways to get involved with advocacy that I would get involved in according to the FNA website would be joining the Barbara Lumpkin Institute to have public policy education readily available to improve the healthcare system. By joining this group, I would be given the opportunity to annual symposium and provide financial support to nurses who are involved in healthcare policy (FNA). I love to enjoy researching different topics and interviewing my colleagues on how we can improve to be as safe as possible. I would emphasize the importance of patient-to-nurse ratios and how to manage the nursing shortage starting with staff burnout. There needs to be more support for bedside nursing as it seems like the rate of people going this route is less and less.
Find and peruse the Barbara Lumpkin Toolkit (BLT). What are your thoughts about the information provided in the toolkit and what did you learn that you didn’t know before?
I think that the Barbra Lumkin Toolkit (BLT) is an excellent tool to use for anyone looking to promote advocacy in the healthcare setting. Advocacy is such an important part of nursing not only for our patients but for ourselves as nurses as well. I especially liked learning about the “Ten Commandments for successful living with your legislator”. Something that I didn’t know before is that anyone can call or write to the legislators regarding their reason for change or alteration to current bills. I think that it is so important that nurses get their voices heard and share their opinions with the people who are involved with making changes to the healthcare system.
References
Florida Nurses Association. Barbara Lumpkin Institute. (n.d.). https://www.floridanurse.org/Links to an external site.
due 10-28-23 @10 am
Read the following article and view the video on the same case. How can this example be used as an illustration of maintaining patient safety and providing safe, effective care? Identify some of the possible barriers that nurses face when acting on what they believe to be the morally correct action in this particular case.
https://www.cpr.org/2015/02/17/for-colorado-mom-story-of-daughters-hospital-death-is-key-to-others-safety/
Make a follow-up of a student's weekly discussion and respond with your opinion regarding to her post
——You don't have to post this in APA format necessarily, it's just giving feedback to the student .
Identify and describe practice barriers for all four APNs' roles in your state and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner, and clinical nurse specialist.
Nurse midwives often struggle with scope of practice limitations and the necessity for collaborative agreements, which can sometimes disrupt their ability to provide comprehensive care. Nurse anesthetists may face restrictions, such as supervision requirements and inconsistent reimbursement policies, limiting their autonomy in anesthesia care. Nurse practitioners and clinical nurse specialists confront barriers like collaborative agreements and scope of practice restrictions, which can affect their capacity to deliver primary and specialized care independently. These state-level obstacles are further complicated by variations in laws and regulations across the country. At the national level, lack of consistency and autonomy make it challenging for APNs to provide consistent, high-quality healthcare (Peterson, 2018).
Identify forms of competition on the state and national level that interfere with APNs' ability to practice independently.
At the state level, one form of competition arises from established healthcare hierarchies and interests. Physicians' groups and medical associations often lobby for laws and regulations that restrict APN autonomy to protect their traditional roles in healthcare. With a limited scope of practice, APNs are sometimes forced to adhere to physician regulations. On the national level, Medicare reimbursement rates and federal funding allocations can be influenced by powerful stakeholders, including pharmaceutical companies, insurance providers, and large healthcare systems. These sources may advocate for regulations that favor their interests instead of that of others (Galvani et al., 2020).
Identify the specific lawmakers by name at the state level (i.e., key members of the state's legislative branch and executive branch of government)
In Florida, the governor Ron DeSantis, is the head of the executive branch. Jeanette Nunez is the lieutenant governor, Ashley Moody is the attorney general, Jimmy Patronis is the chief financial officer, and Wilton Simpson is the agricultural commissioner. On the legislative side, the senate president is Kathleen Passidomo, the house speaker is Paul Renner, the majority leader for the senate is Ben Albritton and for the house is Michael Grant. Lastly, the minority leader for the senate is Lauren Book and for the house is Fentrice Driskell (BallotPedia, 2022).
Discuss interest groups that exist at the state and national levels that influence APN policy.
At the state level, physician groups often advocate for policies that maintain their traditional roles and may oppose measures that grant APNs greater autonomy. Oppositely, nursing associations like the American Association of Nurse Practitioners (AANP) and American Association of Nurse Anesthetists (AANA) work to advance APN practice, pushing for full scope of practice and reimbursement policy changes to enhance access to care. On the national level, there are also national nursing organizations like the National Council of State Boards of Nursing (NCSBN) and the National Council of Nurse Practitioners (NCNP) that actively advocate for APN policy changes that can promote independent practice (Brom et al., 2018).
Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government, and interest groups.
Some methods used to influence change in policy include political campaigns and quality and safety initiatives. Supporting candidates who are sympathetic to APN issues and policy changes through campaign contributions and grassroots mobilization can influence election outcomes, ultimately affecting the composition of legislative and executive branches. APNs can also participate in quality and safety initiatives to demonstrate a commitment to high-quality care and patient well-being can enhance their credibility and influence (Cullerton et al., 2018).
BallotPedia. (2022).
Florida's State Legislature. ballotpedia.
https://ballotpedia.org/Links to an external site.
Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority.
Journal of the American Association of Nurse Practitioners,
30(3), 120–130.
https://doi.org/10.1097/JXX.0000000000000023Links to an external site.
Cullerton, K., Donnet, T., Lee, A., & Gallegos, D. (2018). Effective advocacy strategies for influencing government nutrition policy: a conceptual model.
The international journal of behavioral nutrition and physical activity,
15(1), 83. https://doi.org/10.1186/s12966-018-0716-y
Galvani, A. P., Parpia, A. S., Foster, E. M., Singer, B. H., & Fitzpatrick, M. C. (2020). Improving the prognosis of health care in the USA.
Lancet (London, England),
395(10223), 524–533. https://doi.org/10.1016/S0140-6736(19)33019-3
Peterson M. E. (2018). Barriers to Practice and the Impact on Health Care: A Nurse Practitioner Focus.
Journal of the advanced practitioner in oncology,
8(1), 74–81.
Respond to what he wrote, be argumentative with the answers, and polite. References, and at least 2 paragraphs.
In the last decade, there have been a lot of changes to the model of practice of advanced practice registered nurses (APRNs) in Northern America. During the pandemic, legislative changes enabled nurse practitioners (NPs) in some states to act in the role of medical doctors, thereby empowering them to work to their full scope of practice. This has resulted in a higher quality of care, decreased hospitalization rates, improved access to care, and the creation of an improved working environment for direct care providers (McGilton et al., 2023). For the purpose of this discussion post, the practice agreements, process of certification and licensure as an APRN in North Carolina, the scope of practice of nurse practitioners, how to get Drug Enforcement Administration (DEA) license, and controlled substance prescriptive authority for NPs will be summarized. Also, the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in North Carolina will be explained.
Summary of Findings
Certain criteria need to be met before an individual can be licensed as an Advanced Practice Registered Nurse (APRN) in the state of North Carolina. A lot of information on certification and licensure can be found on
www.ncbon.com
Links to an external site.
, which is the North Carolina Board of Nursing (NCBON) website. One must hold a North Carolina Registered Nurse license or a compact state license that is valid to practice in North Carolina. A master’s or higher degree in nursing must be completed. Additionally, a national certification as a nurse practitioner must be obtained from one of the nationally accredited credentialling bodies, and a registration with the North Carolina Controlled Substance Reporting System (CSRS) is required for those that have prescriptive authority for controlled substances. The North Carolina CSRS exists through the North Carolina Department of Health and Human Services to collect information on dispensed controlled substance prescriptions and make this information available to prescribers and dispensers (North Carolina Department of Health and Human Services, n.d.).
The scope of practice of an APRN in North Carolina required being educationally prepared, nationally certified, and maintenance of competence. The APRN is required to promote and maintain health; prevent illness and disability; diagnose, treat, and manage acute and chronic illnesses; guide and counsel individuals and their families; prescribe, administer, and dispense therapeutic measures, tests, procedures, and drugs; plan for situations beyond the nurse practitioner's scope of practice and expertise by consulting with and referring to other health care providers as appropriate; and evaluate health outcomes (Office of Administrative Hearing, 2019). According to the North Carolina Board of Nursing (2022), nurse practitioners have the approval to prescribe legend drugs and Controlled Substance Schedules II – V, which is consistent with the scope of practice determined by their educational preparation and national certification. Professionals who prescribe controlled substances must fully comply with both North Carolina’s state and federal rules and regulations. A nurse practitioner who administers, dispenses, or prescribes any controlled substance, must be registered with the federal Drug Enforcement Administration (DEA). In North Carolina, this process requires applying for DEA registration, paying the required fees, completing, and submitting DEA for 106.
In North Carolina, an APRN requires a collaborative practice agreement with a licensed physician. Therefore, upon completing an advanced degree and obtaining licensure, an APRN needs to apply for an ‘Initial Approval to Practice’. What this application entails is an active North Carolina Registered Nurse license; the physician’s name, their license number, or email address; and the practice information. After all these have been submitted and approved, the APRN can begin practicing in North Carolina (North Carolina Board of Nursing, n.d.).
Types of Regulations that Exist and the Barriers that May Impact Nurse Practitioner Independent Practice
From the research findings, there are regulations, and some barriers exist that may impact nurse practitioner independent practice in North Carolina. For instance, the scope of practice laws defines the activities and responsibilities that healthcare professionals are allowed to engage in. In North Carolina, there is a need for physician oversight, and there is a need for physician collaboration. Also, we are required to have collaborative practice agreements with physicians. Collaborative Practice Agreement (CPA) is an agreement between the nurse practitioner (NP) and the primary supervising physician addressing how the NP operates the administrative code or rules in their practice (North Carolina Board of Nursing, 2023). These agreements outline the relationship and level of collaboration between the nurse practitioner and the physician. Components that are included in the collaborative practice agreement are the drugs, devices, medical treatments, tests, and procedures that may be prescribed, ordered, and performed by the nurse practitioner. Additionally, prescriptive authority is part of the nurse practitioner approval to practice. A nurse practitioner may prescribe controlled substances; however, the supervising physician must have a DEA registration equal to or greater than the DEA registration of the nurse practitioner that he or she supervises. Finally, regulatory bodies exist to set regulations for APRNs. These boards can influence the level of autonomy nurse practitioners have in their practice in North Carolina.
Some of these regulations pose a major barrier that may impact the nurse practitioner’s ability to practice independently. To begin with, the scope of practice restrictions can be very challenging because it limits the ability to provide care independently. Also, due to the collaborative practice agreements that are needed from a physician, we experience a lot of opposition from physician associations and groups. They cite that they have concerns about patient safety and the need for the role of physicians in the health care team. To add to these barriers, there are challenges as to how the public perceives the role and capabilities of nurse practitioners. Patient and public understanding of the role and capabilities of nurse practitioners can influence the acceptance of independent practice. Educating the public about the training and expertise of nurse practitioners is very crucial for acceptance. Nurse practitioners may also face challenges in being recognized by insurance providers and receiving reimbursement for their services at the same rate as physicians. According to Barnes et al. (2017), in a lot of states, nurse practitioners are reimbursed less than the physician rate, varying from 75% to 100% of physician rates. A lot of legislative processes are ongoing to have nurse practitioners receive 100% reimbursement from Medicare. Currently, reimbursement is only provided at about 85% of the physician rate in most states (Bischof & Greenberg, 2021).
All this information did not come as a surprise to me because during this program, we have been required to carry out research findings on related issues. This has enlightened me to the state regulations for the scope of practice of nurse practitioners in my state. I have educated myself on these requirements and learned a lot from my preceptors and senior colleagues in the field of psychiatric mental health. I believe that I am well prepared for all these upon completion of my degree.
Conclusion
The United States is experiencing shortages of primary care providers, and NPs offer the potential to moderate these shortages (Barnes et al., 2017). As advanced practice registered nurses, it is important to stay updated with the latest regulations and developments in our individual states regarding nurse practitioner practice. It is therefore advisable to consult the state Board of Nursing and other relevant authorities for the most current and accurate information for legal practice.
References
Barnes, H., Maier, C. B., Sarik, D. A., Germack, H. D., Aiken, L. H., & McHugh, M. D. (2017). Effects of regulation and payment policies on nurse practitioners’ clinical practices. Medical Care Research and Review, 74(4), 431–451.
https://doi.org/10.1177/1077558716649109
Links to an external site.
Bischof, A., & Greenberg, S. A. (2021). Post COVID-19 reimbursement parity for nurse practitioners. Online Journal of Issues in Nursing, 26(2).
https://doi.org/10.3912/ojin.vol26no02man03
Links to an external site.
McGilton, K. S., Haslam-Larmer, L., Wills, A., Krassikova, A., Babineau, J., Robert, B., Heer, C., McAiney, C., Dobell, G., Bethell, J., Kay, K., Keatings, M., Kaasalainen, S., Feldman, S., Sidani, S., & Martin-Misener, R. (2023). Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatrics, 23(1).
https://doi.org/10.1186/s12877-023-03798-1
Links to an external site.
the North Carolina Board of Nursing. (2022). Prescribing. Retrieved August 29, 2023, from https://www.ncbon.com/practice-nurse-practitioner-prescribing#:~:text=Nurse%20Practitioner%20approval%20includes%20prescriptive,educational%20preparation%20and%20national%20certification.
North Carolina Board of Nursing. (2023). Collaborative practice guidelines. Retrieved August 29, 2023 from https://www.ncbon.com/practice-nurse-practitioner-collaborative-practice-guidelines#:~:text=Required%20components%20of%20the%20CPA,performed%20by%20the%20nurse%20practitioner.
North Carolina Board of Nursing. (n.d.). Advanced practice registered nurse. Retrieved August 27, 2023, from
Advanced Practice Registered Nurse | North Carolina Board of Nursing (ncbon.com)
Links to an external site.
North Carolina Department of Health and Human Services. (n.d.). NC Controlled Substances Reporting System. Retrieved August 29, 2023, from https://www.ncdhhs.gov/divisions/mental-health-developmental-disabilities-and-substance-use-services/north-carolina-drug-control-unit/nc-controlled-substances-reporting-system
Office of Administrative Hearing. (2019). Scope of practice. Retrieved August 27, 2023, from
http://reports.oah.state.nc.us/ncac/title%2021%20-%20occupational%20licensing%20boards%20and%20commissions/chapter%2036%20-%20nursing/21%20ncac%2036%20.0802.html
Links to an external site.
Cancer treatment is very aggressive in nature. The treatment can lead to symptoms that range from uncomfortable to life-threatening. Complete the Cancer Symptoms Management Table
NUR2870_Module 01_Cancer Symptoms Management Table_v2.docx
Do not forget to include complementary alternative therapy that may help in symptom management.
Identifying and justifying appropriate Study Designs ·
Step 1: A not-for-profit organization called Epidemiologists Without Borders has reached out to student researchers studying epidemiology at Florida National University. The organization has asked for support in the design of three research projects they plan to carry-out in several of the communities where they currently work. Read these three case studies summarized below.
NOTE: You may substitute one of the case-studies outlined below for a case study that is relevant to your own community. If you choose to do so, generate a case-study regarding a public health problem that is relevant and requires epidemiological research. Include the case study when you submit your assignment.
Case study 1:
Vaginal cancer is a rare disease that can often be cured when detected in its early stages. Vaginal cancer occurs more often in women over the age of 50 but can occur at any age. There are usually no symptoms for vaginal cancer. Epidemiologists Without Borders has been awarded a large grant to study the relationship between vaginal cancer and prior exposures to any risk factor among women in a South African city.
Case study 2:
Epidemiologists Without Borders has learned that a large group of employees who have worked in a specific building (building A) of a very large corporation for more than 25 years appear to have high cancer incidence rates. The corporation has a total of 3 office buildings (buildings A, B, and C). Epidemiologists Without Borders would like to conduct research to determine if the rates of cancer incidence among those workers from building A are in fact higher than expected.
Case study 3:
Epidemiologists Without Borders supports the rights to life, health, and dignity for people who use illicit drugs. The organization is concerned about the high rates of HIV infection it has observed in one particular community and suspects that there are many risk factors possibly contributing to this high HIV risk. Currently, the data in this community with respect to the exact HIV incidence rate among injection drug users is of poor quality but estimates indicate that the prevalence is as high as 10-20%. Access to HIV testing is also low in this population. Additional challenges include limited resources, and the difficulty in recruiting people for testing due to their high mobility and hidden social networks.
Epidemiologists without Borders would like to identify potential risk factors for contracting HIV among injection drug users in this community so that it can develop appropriate interventions.
Step 2: Select the most appropriate study design for each of the three case-studies proposed by Epidemiologists Without Borders (or for the one relevant in your community) based on what you have learned in this Week’s Lectures, Readings, PPT’s and modules.
Step 3: Write a letter responding to Epidemiologists Without Borders outlining the study designs that you recommend. Justify why the study designs you selected are appropriate for each of the three case-studies. Your response must also outline at least one benefit and one limitation for each of the study designs you have recommended for each case-study. Your letter to Epidemiologist Without Borders should be clear and concise and contain no more than 450-550 words.
Please be sure to adhere to the following when posting your weekly discussions:
1. Students are to write their name and the appropriate discussion number/discussion title in the title bar for each discussion. For example, Discussion 1: Micheal Cabrera or Discussion 3: Sheila Smith. This is important in identifying that students are submitting original posts as well as response posts as required.
2. Students are to submit their discussions directly onto Blackboard Discussion Board Attachments submitted as discussion board posts will not be graded.
3. As a reminder, all discussion posts must be minimum 350-550 words, references must be cited in APA format 7th Edition, and must include minimum of 3 scholarly resources published within the past 5-7 years (not part of the classroom coursework).
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