The contents, statements, views and opinions contained herein are the sole expressions of the respective authors and not of Jones & Bartlett Learning, LLC. However, they are not responsible for errors, omissions, or for any outcomes associated with the use of the contents of this book and assume no responsibility for the use of the products and procedures described.
Prescribing
Hospital Privileges
Negligence and Malpractice
Risk Management
Reimbursement for Nurse Practitioner Services
The Employed Nurse Practitioner
Practice Ownership: Legal and Business Considerations
Lawmaking and Health Policy
Promoting the Profession to the Public
Standards of Care for Nurse Practitioner Practice
Measuring Nurse Practitioner Performance
Resolving Ethical Dilemmas
Strategies for Nurse Practitioners
Frequently Asked Questions from Nurse Practioners
Preface
What Is a Nurse Practitioner?
It is their combination of skills of both a doctor and a nurse that seems confusing.
Definition of Nurse Practitioner
A board of nursing defines an NP as follows: “A nurse practitioner (NP) is an RN [registered nurse] who has earned a special license as an NP through additional education and experience in a particular specialty area of practice. In California state law, "nurse practitioner" means a registered nurse who possesses additional training and skills in physical diagnosis, psychosocial assessment, and management of health-disease needs in primary health care and who has been trained in a program in compliance with board standards. as specified in article 1484".
Physician Extender
Mid-Level Practitioner
For example, in Minnesota, "'Mid-level practitioner' means a nurse practitioner, nurse midwife, nurse anesthetist, advanced clinical nurse specialist, or physician assistant" [MINN.
Nonphysician Practitioner
Advanced Practice Nurse
Registered nurse - midwife: a narrow range of services (gynecological care of healthy women, management of pregnancy and childbirth, . antenatal and postnatal care) for a medium-sized patient base (maternity). Nurse Practitioner: A wide range of services. evaluation, diagnosis, treatment, education, risk assessment, health promotion, case . management, care coordination, counseling) to a wide range of patients, depending on the area of certification; a family nurse practitioner can have a patient base of any age, gender or problem.
Services Provided by NPs
Consults with other health care providers about established clients who have been admitted to hospital, home care, rehabilitation or nursing homes. Corresponds with insurance companies, employers, government agencies and other healthcare providers about established clients as needed. Manages care of clients; develops plan for.
Preparation and License Requirements
Participates in community programs and health fairs, school programs and workplace programs. As needed, represents the practice or profession as an NP before local and state administrative bodies, agencies and private companies. In Pennsylvania, NPs must have an RN license, a master's degree, and certification from a national organization; must submit evidence of ongoing training in medical diagnostics and therapeutics;
Initials
Areas of Practice
Legal History of NPs
The next legal hurdle became apparent with the enrollment of a large percentage of the population in managed care plans. The next legal hurdle is obtaining the legal authority to medically manage patients within an NP's scope of practice, without mandatory physician cooperation.
Demographics
So NPs met with leaders in managed-care organizations and tried to persuade them to allow NPs to be. As of the publication date of this book, NPs in 23 states and the District of Columbia can practice without a physician collaboration or supervision mandate.
NPs in Primary Care
Definition of Primary Care
There are over 222,000 NPs in the United States, according to the American Association of Nurse Practitioners.
Legal Authority of NPs to Be Primary Care Providers
In Maryland, a clause in state law regulating health maintenance organizations has been interpreted to prohibit anyone except a.
NPs as Team Members in Secondary and Tertiary Care
NP Versus Physician Assistant
What Is the Difference?
NPs practice under their own licenses and in some states may practice independently of physician involvement.
Definition and Scope of Practice of PAs Compared with NPs
The nurse practice act of at least one state, Oregon, includes hospital admissions in the NP practice area. PAs are authorized to prescribe medications in all 50 states, the District of Columbia and Guam.
Physician Involvement with PA Practice
Education
PAs are trained in programs that use the medical model and are designed to complement medical education. The American Academy of Physician Assistants describes PA training as follows: PA training includes instruction in core sciences including anatomy, physiology,.
Licensure Requirements
Certification Requirements
History of PAs
Abbreviations: AA, associate of arts degree; BA, bachelor of arts degree; BS, bachelor of science degree;. Data from the American Nurses Credentialing Center, the American Academy of Physician Assistants, and the American Academy of Family Physicians.
NP Versus Physician: What Is the Difference?
Definition and Scope of Practice of Physicians
Educational Requirements of Physicians
NP Versus RN: What Is the Difference?
Definition of RN
Registered professional nurse” or “RN” means an individual licensed under this article to engage in the practice of nursing, the scope of which includes teaching.
Scope of Practice of RNs
Education of RNs
Supervision of RNs
NP Versus Clincial Nurse
Specialist: What Is the Difference?
The distinction between CNSs and NPs is important to advanced practice nurses, but probably not as important to those not in the field.
Definition and Scope of Practice of CNSs
Education of CNSs
Physician Supervision of CNSs
Abbreviations: APN, advanced practice nurse; AMCB, American Midwifery Certification Board; ANCC, American Nurses Credentialing Center; BA, Bachelor of Arts; BS, Bachelor of Science; CNS, clinical nurse specialist; CRNA, Certified Registered Nurse Anesthetist; NBCRNA, National Board of Certification and Recertification of Nurse Anesthetists; NCC, National Certification Corporation; NP, nurse practitioner; PNCB, Pediatric Nursing Certification Board; RN, Registered Nurse. Data from American Nurses Credentialing Center, American Association of Nurse Anesthetists, and American College of Nurse-Midwives websites.
Where Do Nurse Practitioners Practice?
The NP Doctorate
The DNP degree more accurately reflects current clinical competencies and includes preparation for the changing healthcare system. The NP who wants to advance as a faculty member at a university needs a doctorate, and the DNP is a way to meet a university's requirement that assistant professors have a terminal degree.
Use of the Title “Doctor”
Some hospitals have policies about who can use the title "Doctor." For NPs who have completed truly clinical PhDs (such as heart failure NPs who have devoted their entire PhD efforts to learning about heart failure management), it can be. Recognition of the title "Doctor" for doctorate-prepared nurse practitioners facilitates equity within the health care system.
Notes
State-by- State Definitions of Nurse
Alabama
Alaska
Arizona
If applying for certification after July 1, 2004, have a national nursing certificate issued by a national certification body recognized by the council. Client assessment, data synthesis and analysis, and advanced level understanding and application of nursing principles.
Arkansas
To be licensed as a registered nurse, a registered nurse must have a certificate or an academic degree that proves passing.
California
Nurse Practitioner” means a registered nurse who possesses additional training and skills in physical diagnosis, psychosocial assessment, and management of health-disease needs in primary health care and who has been trained in a board-compliant program.
Colorado
The board shall establish reasonable criteria for designating specific role and population focuses, based on currently accepted professional standards. A nurse listed on the Advanced Practice Register is entitled to use the title “advanced practice nurse” or, if authorized by the board, the title “certified nurse midwife,” “clinical nurse specialist,” “certified registered nurse ' to feed. anesthetist' or 'nurse'.
Connecticut
Delaware
Advanced practice registered nurse” shall include certified nurse practitioners, certified registered anesthetists, certified nurse midwives, or clinical nurse specialists. For those advanced practice nurses who do not perform independent acts of diagnosis or prescribing, authority granted within the scope of practice rules and regulations promulgated by the Board of Nursing; and.
District of Columbia
Performing other functions identified in Title VI of this Act and in accordance with.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Certified Nurse Practitioner” means an ARNP trained in nursing disciplines who has advanced nursing knowledge, physical and psychosocial.
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
The NP is held accountable under the RN license for the nursing actions that he or she may perform.
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
Certified nurses may be known as primary care providers or acute care providers.
South Carolina
Nurses performing delegated medical actions must have a supervising physician or dentist available for consultation and must.
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Advanced Nurse Practitioner” means a registered nurse who has substantial theoretical knowledge in a specialized area of nursing practice and competent clinical use of the knowledge in implementing the nursing process, and who has met the further requirements of Title 19, Statutory Rules for the West Virginia Board of Directors. examiners for.
Wisconsin
Wyoming
State-by- State Titles for Nurse
Practitioners
Legal Nurse Practitioner Scope of
Establishing that the NP is a professional entity, not just a "non-physician," a "physician extender," or whatever an agency, employer, or delegating physician decides an NP is 7. However, federal agencies and private companies may have policies relating to. The NP's scope of practice and professional societies may have accepted certain tasks, functions, activities and decisions as part of the NP's scope of practice.
Professional Association
Definition of Scope of Practice
Statutory Versus Regulatory NP Scope of Practice
Then, only NPs in states where the NPs' scope of practice is clearly defined to include medicine. A vaguely worded nursing practice act stating, for example, that the NP's scope of practice includes.
Physician Challenges to NP Scope of Practice
It is difficult to argue to managed care executives, state administrators, and legislators that “nursing practice acts” are the necessary acts to perform. However, the Missouri Supreme Court, after analyzing the nurse practice act, noted that the legislature had deleted a requirement that a.
Need for Clarity of Scope of Practice
According to Oklahoma's statutory definition of NP scope of practice, an NP can prescribe, but it is unclear what else an NP can do. See Appendix 2-A for each state's law regarding PN's scope of practice.
NP Scope of Practice Compared with Registered Nurse Scope of
The scope of practice of the nurse practitioner includes learning the theory and practice of advanced practical nursing. The nurse practitioner shall provide health care services only within the scope of nursing practice for which he/she is educationally prepared and competent.
NP and Physician Scope of Practice Compared
The liberal use of the word "any" distinguishes the physician's scope of practice from the NP's scope of practice. There are no laws that authorize as broad a scope of practice for NPs as Mississippi law authorizes for physician practice.
Can an NP Work Outside the NP’s Certification?
The answer to whether the NP should take over the job in each of these scenarios can be found by. However, if something goes wrong with an NP's patient and the hospital and the NP are sued, the plaintiff can claim that the NP was not qualified.
Controversy About FNPs Working in Hospitals
If something goes wrong and the FNP working in acute care is sued, the first thing the plaintiff's attorney will ask is, "What qualifies you to provide emergency services (or critical care, acute care, or specialty care)?" An NP who is board certified in acute care and/or urgent care may refer to. An FNP-certified NP will be at a disadvantage because FNP programs do not prepare NPs to provide services in acute care.
An Individual NP’s Portfolio
The advanced practice nurse can perform only those functions that are within the scope of practice and which are. For example, if an NP in Texas is certified by the American Academy of Nurse Practitioners (AANP), the NP must carry in his or her portfolio a one-page document from the AANP website titled Scope of Practice for Nurse Practitioners .
Mandated Physician Involvement
National Provider Identifier and any other provider numbers needed for reimbursement Drug Enforcement Agency number and state controlled substance prescriber number Certificate of professional liability insurance Copy of state law addressing the NP's scope of practice, prescriptions , the qualifications and requirements for the doctor's cooperation, if any. Finally, it saves time if one keeps documents related to one's professional practice in one place.
Involvement Required for NP Practice
A protocol is a written instrument that guides the GP in collecting data from the patient and recommends specific action based on the data collected. It consists of mutually agreed upon medical guidelines between the physician and the NP that define their guidelines.
Infection Protocol: Initial Visit
RATIONALE
SYMPTOMS A. CYSTITIS
PYELONEPHRITIS
- HISTORY
- PHYSICAL EXAM
- LAB TESTS INTIAL URINALYSIS A. Consult supervising physician if
- TREATMENT ANTIBACTERIAL TREATMENT
- REPEAT URINALYSIS
If organism found in patient's urine is not listed in the table below, consult a supervising physician for treatment. If symptoms are present for more than 48 hours, use 5-day treatment. treat with first agent, repeat UA and culture and consult supervising physician.
Scope of Practice
The patient's doctor or qualified registered nurse has certified in writing that v. A registered nurse is authorized to perform the work of senior nursing, which may include prescribing, administering and.
