Final Project: Advanced Practice Roles in Nursing

Advanced practice nurse are master’s degree holders in nursing with specialties in public health nursing, community health, and nursing practitioner. These nursing roles in the advanced nursing practice are differentiated according to their perspective, knowledge base, and the principles adhered to in providing care to the population. Nursing at the advanced levels requires these practitioners to observe health issues affecting the population; advocate for policy formation at the basic, community and state level; carry out program planning and project management; and advance leadership and creation of partnership (Smith & Rose 2011).

Nurse Practitioners

This category of nurses provide initial, ongoing and comprehensive care to the patients. This category represent the largest section of nurse whose roles are very crucial in enhancing access to quality health. The nurse practitioners will record health history, assess the physical and health conditions of patients as well as carry out diagnosis, treatment and management of the patients (Hamric, et al. 2014). Their roles are widespread and encompasses: promotion of health, disease prevention, health education and offering advice on disease management (O’Grady n.d.).

Nurse Educators

This category of nurses represents the nurse with clinical expertise and teaching skills. They are in charge of upbringing and nurturing new nurses as well as the advancement of practicing clinicians. These nurses require being well conversant with clinical background, good in communication as well as possessing high level of cultural competencies. The nurse are tasked with the responsibilities of carrying out research, publish journal articles, present in professional conferences as well as act as consultant to institutions.

Nursing Administrators

According to the American Association of Colleges of Nursing (2011), this category of nurses is equipped to act in the managerial and leadership positions in the practice environments. They are mainly tasked with the role of facilitating the delivery of quality patient care and coordinate the workflow while managing the care. The administrator may be uncharged of a few nurses, several units, department, or a full health system. These are leaders in nursing and take charge of the development of policies.

Nursing Informatics

These nurses operate with an aim of enhancing information management and better communication in nursing, this is necessary to achieve greater efficiency, minimize costs, as well as increase the quality of patient care. This specialty is a mix of nursing science, computer science and information science for enhanced management in nursing. These practitioners will develop systems that tackles the problems facing patient care. This requires a deep understanding of the nursing process.

The above named categories of nurse perform differently on the core nursing roles as described below.

Clinical Practice and Primary Care

The main role of nurses is to ensure quality deliver of patient care services. A nurse whether a nurse practitioner, nurse educator, nurse informatics, or nurse administrator works to ensure that the clinical practice standards are upheld to the highest possible standards. They all function to ensure development and upholding of programs that uphold the community health needs.

The above named categories of nurses will however operate on different levels to fulfill their roles in the clinical practices as Smith & Rose describes below (2011). The nurse practitioner is involved in the assessment of the health risks and the illness status of the patients. In performing this role, the NP deals with individual and family. The nursing educators basically deal with nursing students as their clients and provide knowledge to these aspiring nurses on the clinical roles of nursing. They are involved in sharing of knowledge and skills on clinical practice to upcoming nurses. The nurse informatics have experience in the nursing background and understand the workflow in the clinical practice and are able to integrate this in developing solutions to assist other nurses. The nursing administrators coordinate the operation in the clinical practice and ensure a smooth running of affairs.

Education

The nurses in the advanced practice are involved in carrying out health education within their scope of work. They identify the groups at risk and provides health intervention to these groups. Through their education they raise the wellness and promote healthy living by advocating importance of proper diet, exercise, stress management and leading healthy lifestyles.

The nursing practitioners enlighten the individuals and families on health matters. The NP receive training on the diagnosis and treatment of various diseases and injuries, drug matters and medical management. The nurse educators provide formal and informal teaching to the practicing nurse as well as the students in nursing. The nursing educators study the theory of nursing, education approaches and the interpretation and application of research findings. The nurse informatics enlightens the nursing staff on the application of new technology for efficient management and processing of information. The administrators are involved in educating the nurses on the new policies developed and their effects to their functioning (Smith and Rose, 2011). 

Administration

Nurses will also perform administrative role with their agency setting. Whether a NP, nurse educator, nurse informatics, or nurse administrator, while performing the administration roles, they serve as decision makers as well as problem solvers. They exercise either direct or indirect authority or monitoring of the staff as well as client’s care.

The nursing practitioners perform their administrative roles in advocating for patients, families, care-providers healthcare team. The nurse educators perform this role by having the authority to determine and develop learning materials and resource facilitate the learning process. The nurse informatics acts in the administrative capacity by being able to determine the best application of information and technology in advancing patient education and improved accessibility of health care systems. The nurse administrators are the major specialists in carrying out administrative roles.  They plan for the delivery of quality health care services in a suitable environment for both the nurse and patients. They design programs that enable the facility to operate efficiently. The nurse administrators make decision on the structure and financing of health care facilities as well as the health outcomes (American Association of Colleges of Nursing, 2011). 

Advanced Practice Role: Nurse Practitioner (NP)

A nurse practitioner (NP) is a medical staff who, according to the American Association of Nurse Practitioners (AANP) (2016), is licensed, and act in autonomy with the focus on people’s health conditions management and also on disease prevention (Lowe et al. 2012). It is common practice for NPs to specialize in specific health areas, for instance, cardiology, oncology, pediatrics, and gynecology among many other specialty healthcare services (Hamric, et al. 2014). It is interesting to note that NPs in the United States are often governed by varied rules and regulations depending on which state one is practicing in. it is in this light that I consider the state of California.

Regulatory and Legal Requirements for NPs in the State of California

In California, the Board of Nursing is responsible for the regulation of the profession of NP. Regulations cover areas such as, licensing (issuance, renewal, suspension, and revocation), practice standards and scope, prescriptive authority, educational requirement, issues regarding collaboration and/or supervision, and reimbursements under Medicaid and by indemnity insurers (Kuo et al. 2013). For one to qualify as a NP in the state of California, it is required that one should possess a registered nurse certificate and have completed a program of study that is in conformity with the board. Such rules and regulations in this state have not defined if a NP is a primary health care giver. On issues of prescription, an NP must be in a collaborative agreement that they will be supervised by a physician in order to prescribe drugs. They (NPs) cannot sign death certificates as well as handicap placards and workers ‘compensation forms. For an NP to practice in the state of California, they must be in a collaborative agreement with a physician. Such an agreement will be necessary for the purposes of supervision and referrals not forgetting the issue of prescription. 

Professional Organizations 

There are various professional organizations available for membership when considering NP as a profession: some are general while others are specialized. General professional organizations in this case are those that take aboard any member who is a registered NP without paying attention to their specialty, for instance, the AANP or the California Association of Nurse Practitioners (CANP). On the other hand, we have specialized professional organizations. As such, this category draws its membership from NPs with a specialized field, for instance, the Gerontological Advanced Practice Nurses Association (GAPNA).

The most conspicuous organization is the American Association of Nurse Practitioners (AANP). Being a national organization, the AANP offers its members a wide array of benefits. For instance, AANP allows its members discounted prices for medical supplies, access to continuing education, research findings and educational resources, accreditation of NPs, and organizing conferences and seminars for its members. On the sensitive area of legislation, AANP offers members an advocacy center, represents members in the legislative process either in federal or state levels, and also provides relevant information and updates to its members. The organization allows for the professional development of its members through provision of grants and scholarships, ensuring the clinical quality of its members work, and offering business and management advice. 

The California Association for Nurse Practitioners (CANP) is the organization at the local level for an NP practicing in California. The association has numerous chapters depending on the location of the members (CANP, 2016). It carries out a series of advocacy works to ensure the betterment of its members. Events such as conferences and seminars are carried out to keep its members informed. The organization offers various educational chances to its members as well as other professional resources. 

The Gerontological Advanced Practice Nurses Association (GAPNA) is one of the specialized professional NP organization. Its membership is limited to NPs specialized in gerontology. It provides its members with specialized attention regarding legislation, trends, and advocacy among many other forms of assistance (GAPNA, 2016). Other professionally specialized organizations include, American Association of Critical-Care Nurses (AACN), National Association of Pediatric Nurse Practitioners (NAPNAP) and Nurse Practitioners in Women’s Health among others.

Required Competencies

To qualify as an NP, according to AANP (2016), there are some competencies that one is required to have besides having certain certifications. The competencies herein mentioned are in most cases obtained in class and to that effect, the following educational qualifications must be met. The first step is to qualify from an accredited four year Bachelor of Science in nursing program. The four year course is necessary for one to get the Registered Nurse (RN) certification. On this note, RN certification can be derived from two agencies, the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). After gaining accreditation from either of the bodies, one is required to gain practical competency in a given specialty for about one or two years in the field before applying for the graduate school. Once experience is obtained from the field, an aspiring NP is ready for a 1.5 to 4 year graduate course . After going through the graduate school, a series of exams from various bodies come in, for instance from the American Association of Nurse Practitioners or the National Certification Corporation (NCC) (Hamric, et al. 2014). The type of body to issue the exam is determined by the kind of specialty the prospective NP wants to practice in. For instance, for one to become an Adult Gerontology Nurse Practitioner (AGNP), one must pursue a graduate degree (MSN Adult Gerontology) and take exams with the American Nurses Credentialing Center (ANCC) to obtain certification which is renewed once every five years after one completes the Continuing Education (CE) hours which are 1000 in this case. 

Predicting the Organization and Setting, Population, and Colleagues with Whom I Plan to Work With.

It is common that as a nurse, I will work with other health staff in a hospital setting. It would be my wish to be stationed at the Ronald Reagan UCLA hospital that is located in the University of California, Los Angeles. The hospital provides a unique and sufficient medical setting due to its wide coverage of the health specialty spectrum. It therefore means that in the hospital, I will be capable of sampling various specialties before deciding on one. I expect the hospital to be populated with highly skilled professionals and a sizeable number of clientele since the hospital is ranked as one of the best in the U.S. 

Leadership Attributes of the Advanced Practice Role:

My Leadership Style

Democratic leadership style is my chosen style as evaluated by Cherry (2016). It is based on the principle of exchanges (transactions) between the employers or management and their employees (McCleskey, 2014). When these transactions occur, the group’s stakeholders can work in a more coordinated format. As a leader in this perspective am able to perform my expected tasks, maintain and improve the existing group status, motivate my members, influence the behavior of the members and above all enhance the group’s efficiency (McCleskey, 2014). According to Sadeghi & Pihie (2012), the style achieves employee motivation through allowing them (group members) to achieve their self-interests, reduced workplace anxiety as it encourages dialogue and improved job satisfaction through achieved group objectives. 

The leadership style is appropriate, according to Memon (2014), where the punishment for failure to follow orders is not apparently outlined but is known. To add on this, the rewards for following the agreed rules between the leader and members are conspicuous and known to all. The principle mentioned here is basically that the group members have agreed to do what their leader instruct in the work environment. That is the members surrender to the authority of their leader (Hamric, et al. 2014).

The pros of the style as discussed by Memon (2014), include the aspect of social exchange where the leaders’ intentions are known to the members. This encourages the subjects to play by the rules of the game since they were involved in the crafting of the rules. As such, where targets are not met, the members are obliged to accept the responsibility just as they would take the reward. Areas of conflict between the leader and their member are therefore minimized since there is a social dimension in the leadership.

The leader or manager can identify the members’ needs in the work environment and, therefore, strives to meet them as they are well pointed out by the members due to the social dimension involved. The leaders are perceived to be more informed, skilled and with the necessary expertise that the members or followers might be falling short of.

Leadership Attributes Currently in My Possession, and Attributes I May need to Develop.

Am a good listener and one who is able to coordinate work and activities especially where there are deadlines and strict objectives to be met. When working as a group, am able to factor in the opinions, views, opinions and interests of majority of the group members with success. It has come to my attention that my fellow workers are concerned about my patience. Am more pressed to get results and in the process something goes wrong. With my thin patience, am bound to be lose with my temper especially with uncooperative members. With this discovery, the need to input a corrective action can never be overruled.  

How to Attain and Evaluate those Missing Attributes

Being cognizant of my weaknesses, it is my wish to adjust to the optimum performing level. To achieve this, engaging in team building activities is a desirable activity. With it, I will learn group dynamics as well as cultivate my patience as well as learn how to cultivate my relationship with rebellious members of any given group. According to Dyer & Dyer (2013), a team that has definite functions can be effectively soldiered together through team activities in the form of team building. The same exposes its members to each other and as such help them learn about each other as well as learn how to best work with them with full information regarding their strengths and weaknesses. 

Health Policy and the Advanced Practice Role

Policy on Health Care Cost

US spending on health care has been on the upward trend over a period of time. US is a heavy spender on health care more than any other developed country (Troy & Wilson, 2014). The heath care accounts for over 17% of the GDP compare to a less than 12% in other developed countries (McClellan & Rivlin, 2014). As study in 2012 indicated that the government health care spending per every covered life basis was 166% greater than that of the private sector on the same basis. In 2012 the government spending on health coverage for employees amounted to $ 578.6 while the expenditure for health care accumulated to over $1 trillion (Troy & Wilson, 2014). 

The US health care system has been mainly supported by the employer-provided health care. The government backed health care system is much higher than the employer based. The programs by the government covers different age and health conditions where the aged are more likely to be prone to chronic illnesses. Another program, the Medicaid covers people with disabilities while other caters for the military. The Medicare, Medicaid and The Military health care programs describe above accounts for over 88% of the government spending on health care (Troy & Wilson, 2014). These program represent the primary care which is foundation of an effective care system which have designed to cater for beneficiaries in key regions (Ayanian & Hamel, 2016).

According to Mukau (2009), the US health care system bears unsustainable costs with poor investment return. It tends to be inequitably distributed thereby leaving a large part of the population inadequately covered. The health care system is pegged on a business model that aims to treat diseases rather promote the good health status of the society. The spending on the government-backed health care system has been on a steady upward trend. The US health care system is divided to the following portions. The outpatient care is the largest portion and with the fastest rising excess spending. The inpatient care, prescription drugs, cost of administration, and insurance are the other components of the health care system. Other sectors include long-term and home-care and the medical equipment (Mukau, 2009). 

The US healthcare system is characterized on supply-sensitive care which depends on resources and capacity as opposed to the medical need. The supply-sensitive care is responsible for over half the Medicare expenditure some with no attributed medical value and leading to wastage (Weisbart, 2012).

The high cost associated with health care needs to change. The disperencies in the covering of the health care system should ensure fairness and equality. The excess wastage in the spending on the health policy should be considered and efficiency given a great priority. Lack of pricing transparency in the health care industry has seen health institution maintain very high rates for their services as there is no comparative information available. McClellan & Rivlin (2014) observes that the health care delivery in the US is inefficient & uncoordinated leading to wasteful spending and contributing to avoidable health issues.

Process of Changing the US Health Care Cost Policy

The health policy on cost refers to a set action that government and health organizations stipulated to perform in order to provide desired health outcome at an affordable cost. The overall health system incorporate both the public and private sector. The policies may be developed by the federal or state government, court ruling, or private organizations. 

The policy making process should involve the entire interested stakeholder in either open or public forum or in a closed system. The characteristics of the policy are influenced by whether decision is made in public or private, scope of issue to be covered, and general nature of the policy.

The policy process is an interactive process where decisions are arrived at on different events on the proposed policy. The first stage is the formulation stage where there is brainstorming on the information, ideas and research findings.  Here, the issue at hand is framed with the goals and objectives being outlined. The best alternative is selected as per the decision making criteria. The second stage involves the implementation where the adopted policy kicks into action. It is turned into a plan of action. Policies by the government are implemented through a regulatory process. The final stage is the evaluation and adjustment phase. The policy effectiveness is measured against the set goals and objectives and any deviation addresses (Abood, 2016).

Efforts to Influence Policy Change

Promoting price transparency in the health care industry would serve a great deal in reducing the costs associated with the health care. RWJF (2016) observes that price and reference pricing as necessary in reducing the costs in the long run. The transparency will be increased through a tool or an application helping consumers gather information on prices and enable them make better and informed decisions.

Promotion of better healthcare campaigns to call for a health care system that promoted healthy living and not just pegged on disease treatment. The disease treatment based system has proved to be not only expensive but also not offering the best quality services. The healthcare system should recognize the need to enlighten the members of the public on how to live healthy live.

The process of policy change requires participation of all stakeholders. In this case, the government, employers, health care providers, and members of the general public are all affected. I would champion and help organize an interactive forum for exchanging ideas. Though the forum, the stakeholders would raise the key issue or changes required for the transformation of the policy. The stakeholder involvement is essential is enhancing support for the policy. Abood (2016) notes that political interaction play a key role in the process of decision making in  determining the components of the healthcare system.

The Affordable Care Act(ACA) is on the right track of providing a streamlined healthcare system. It is introducing health reforms with an intention of improving the lives of Americans. However it is not enough. Even when it is operational, thirty million Americans will still be inadequately covered (Weisbart, 2012). That is why other policy changes are important to help cover up for the shortage. It is only by such efforts that the quality for the entire healthcare system will increase. 

Effect of the Change in Policy on Healthcare Costs to the Healthcare Quality

The increased transparency of prices of healthcare would make the healthcare providers upgrade the quality of their services. The general trend has been that high prices are charged even where they do not deserve simply because the clients do not what is offered elsewhere. The increased transparency would enhance healthy competition to provide the best quality healthcare services (RWJF, 2016).

The need to reduce the costs for healthcare service would stimulate biomedical innovations. Innovation would emerge in form of new knowledge, better drugs, more advanced devices, and procedures leading to better results. Such innovations would lead to improvements in general efficiency and cost (McClellan & Rivlin, 2014). The innovation help improve the outcome of treatments as well as scale down the cost of high quality medical solutions.

The cost reform policy of the healthcare sector is bound to enhance quality of the services provide through better coordination, increased efficiency and better approaches towards care delivery and management of ailments. The new system would break the yoke of the old in-efficient system. The fee-for-service currently in use compensates healthcare providers on the basis of volume and intensity of services with no regard to the quality offered. The policy would promote coordination of care among providers while applying new and highly innovative methods.

References.

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