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Nurses are increasingly expanding and extending their practice scope beyond primary registration in every aspect of health care. Currently, nurses are commonly working in a range of settings situated in urban and local communities. They operate in private practices at an advanced level of practice in all areas, such as community health, mental health, sexual health, general practice, ambulatory care clinics, public health departments, hospitals, HMOs, free standing health clinics, school-based health clinics and employee health departments (Scope of practice – framework for nurses and midwives, 2005). The Royal College of Nursing developed the first formal education and training program for prospective nurse practitioner in the early 1990’s in UK. Then in 2008 initial educational competencies for nurse practitioners was emerged by RCN. It was grounds on disease screening, consultancy skills, chronic disease management, physical examination, health counseling and education plus minor injury management. Moreover, in the same year International Council of Nurses (ICN) has given the broad definition of advance practice nursing, i.e. “An Advanced Practice Nurse/Nurse Practitioner is a registered nurse who has obtained the complex decision making skills, expert knowledge base and clinical proficiencies for extended practice, the personality of which are shaped by the country or context in which they are credentialed to practice and for their entry level masters degree is recommended”. Further, according to European Working Time Directive (2009), the work hours for APN is reduced to 48 hours a week, which was earlier 58 hours.
The term expanded clinical practice means nurses taking on liabilities traditionally attributed to physicians, such as clinical diagnosis, assessment and treatment. Such practice also refers to latest interdisciplinary models under which nurses take initiatives, which are aimed towards improving care of patient, such as the transitional care models development or nurse-led clinics. The huge scope of ANP’s may develop a new dynamic in interdisciplinary cooperation particularly among nurses and physicians. Their expanded competencies that enable them for taking on more responsibilities in medical patient care can be seen as an extra value by few physicians. The ANP’s role introduction demands the redefinition of nurse-physicians cooperation in medicinal care in which shaping appropriate mix of skills to attain optimal results.
Thus, ANP has given new chances for nurses in relation to professional development and career pathways as well as the RCN is working in partnership with NMC (Nursing and Midwifery Council) along with health units of UK, to determine and implement adequate strategies to attain improved public protection and patient safety. Research has demonstrated that advance nurse practitioners can provide effective and efficient patients services (Nurse Practitioners and Nurse Midwives, 2011). The RCN acknowledges ANP’s and notes that ANP’s should be monitored to ensure patient safety and improved patient care by the NMC. Unfortunately, this monitoring/registration have not occurred (Slater, 2001).
Adequate governance makes able the employer to assure the local people that nurses are positioned to advanced roles in the manner that their fitness to practice could be confirmed as planned, purposeful and underpinned through proper education, which is both safe and measurable. In the long run, governance allows employers to plan for redesign of service plus build new advance roles of nursing in a more targeted and meaningful manner than before (North and Hughes, 2012). This essay will reflect on the author’s professional development progressing towards an advanced practitioner’s role. The advanced practitioner’s domain and the effectiveness to patient care and the organization will also be critically discussed.
Whilst ANP’s have developed clinical, research, management and teaching skills to a higher level, often working to the equivalent of junior doctors/registrars, they are still restricted in some areas. For example, it is still a lawful requirement for doctors to sign Med 3 ill certificates. The condition is extremely frustrating for both ANPs in primary care and practice nurses, who accomplished a full assessment of patient and made the decision that duration of absence from work is required to facilitate an individual’s return to health then must ask a General Practitioner (GP) to sign the sick certificate. For several years the RCN has lobbied for nurses to be capable to sign both new well and sick certificates, but at the time of writing no progress has been attained (Smolenski, 2005). ANPs are capable to conduct an adequate home visits as well as are increasingly growing their remit to offer care in the patients home that is house bound with long term and acute health issues. Non-medical prescribing developments mean that more ANPs are now competent to provide a prescription where necessary. Though, where ANPs is not an autonomous prescriber, tactics required to be in place, for the reason to evade undue delay for the patient in getting a prescription for treatment as well as to prevent cooperation of common standard of care, which the patient would get from a GP (Leese, 2006).
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In addition to above, maternity care is an area where legislation lays down that only a practicing midwife or a registered medical practitioner could offer care for a pregnant woman. A group approach requires being in place so that when pregnancy assessment is warranted a GP along with midwife could see the woman (North and Hughes, 2012). When there is no midwife involved to the practice, good communication and links required to be in position for easy referral. Having a better working relationship with the local supervisor of midwife will increase overall care. ANP should also be registered practicing midwife and can care for pregnant women so long as they carry on to meet requirements of NMC. It comprises notifying their practice intention, annually meeting with midwives local supervisors and maintaining the requirements of PREP (Post registration and education practice) for midwifery (Banham and Connelly, 2002).
Local policies and protocols required being in place, for the reason to clarify the role of nurses in relation to pregnant women. For instance, it is possible that where there is no presence of GP, women might attend the practice for pregnancy confirmation or as health assessment part. The ANP may make a diagnosis of pregnancy. Therefore, local guidelines must be in place so that the ANP could make a primary referral to services of local maternity. ANPs may also find themselves an individual asked to give care for non-pregnancy connected conditions, which may have an impact on pregnancy or be called on to give emergency care as well as accurate referral path ways should be in place for such scenarios (Howard and Barnes, 2012).
I have faced several issues also at the time of my nursing practice. First, was in relation to dissatisfaction among patients, as they generally expect for the doctor to treat them properly. But when I was tried to provide them health service, they were refused to follow my precautions and ask for the doctors. It was mainly faced by me while undertaking their physical examination. This type condition mostly prevails, as people are not comprehend with the profession and role of nurse practitioners and desires to become treated by some specialist, rather than any practicing staff (Vilma and Egle, 2007).
It is recommended by RCN that nurses aspire to become ANPs, must ideally conduct RCN accredited advance program for nursing practice. Such course should incorporate core areas that develop on skills of nursing already obtained as well as cover the subsequent subject spheres (Hallam, 2002). For instance, comprehensive physical assessment of every system of body across the life span, therapeutic nursing care; disease plus health comprising sociological, physical cultural and psychological aspects; clinical decisions-making and history taking skills; evidence-based prescribing plus applied pharmacology; health promotion and public health; management of practice. Further, it also involves interpersonal, communication and organizational skills; research; quality assurance; legal or ethical issues; economic, social plus political influences on health care as well as teaching and leadership skills. The consensus in the health departments of UK is that in future ANPs will have conducted master’s level educational preparation (Furåker and Agneta, 2013). Everyone along with RCN has been agreed that nurse should pursue master’s education for recognizing the emerging trends, foresee directions of health care and giving leadership in planning, adopting and evaluating practice of nursing.
In order to attain MSN (Master’s of Science in Nursing), a nurse should firstly have a bachelor’s degree in nursing or its related areas. Moreover, it can be perfectly said that to become an ANP, a master’s degree in nursing is significantly required. ANPS’s have more clinical autonomy and authority as well as typically earn higher than “regular” registered nurses. Some programs of master’s nursing have particular concentration or “track” for definite medicinal specialties or nursing types, such as a clinical nurse specialist track or focal point on forensic nursing. In addition to this, a specialized degree of master’s is also needed to become a mid-level contributor, such as CRNA (certified registered nurse anesthetist) or NP (nurse practitioner). Generally, masters degrees are 1-2 years of supplementary coursework, which can be attained during employed as a nurse (Riendeau, 2007).
All education of ANP’s should be standardized, as these are registered nurses who are skilled in performing huge range of primary or initial health services, particularly preventive services and screening, which if ignored can cause far more costly and serious health issues. APN’s also provide their service in very particular fields of health care. Thus, all ANP’s should meet exact certificates, education and continuing education requirements. Their practice standards are set and monitored by professional’s institutions. Moreover, these nurses work in collaboration with health professionals and physicians to coordinate in the services of health care, so for their ethical and effective cooperation standardization is required (Advanced Practice Registered Nursing Education, 2012). These professionals sometimes pay for the courses of that nurse who make long time contract to contribute their service with them. They also work as mentor for them and guide in their learning program. Further, they help doctors in their research work and provided with study leave at the time of examination.
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An individual required to have primary and secondary care skills for becoming an advance nurse practitioner. ANPs expertise in primary care lies in their capability to work as generalist (ADVANCED PRACTICE NURSING: A NEW AGE IN HEALTH CARE, 2011). The ANP can care for patients of any age as well as with a huge range and variety of presenting issues plus needs of health care. It covers the provision of evidence based excellent quality care for patients whose problems fall within: long term/chronic conditions, urgent/acute episodes, public health and health promotion (Neno and Price, 2008). Research into the effectiveness and safety of ANPs has given tremendously positive conclusions in relation to the value of role as well as patient satisfaction, which arises from ANP care (Kohn, Corrigan and Donaldson, 2000). ANPs working in primary care should have broad range of skills, a wide base of knowledge and the competence to deliver particular aspects of care. Sometimes these will require to be supplemented by the proficiencies of specialist health care professionals in both secondary and primary care, moreover involves utilization of range of screening plus diagnostic services. ANPs should also operate collaboratively with colleagues functioning in the same practice area, or refer to as well as share care with, colleagues in more dedicated practice areas (How Long Does IT Take to Become a Nurse Practitioner, 2013).
ANP’s who becomes the primary care giver may operate with the patient to identify a care plan and may offer a big percentage of that care themselves or in affiliation with medical colleges plus other members of social and health care team. Some ANPs may require necessary skills to make them able to work with those patients that require specialist care. For example, ANPs are able to offer services for patients with rheumatoid arthritis, depression, heart failure and many more. In this circumstance it is the capacity to apply the wide foundation of advanced level of skills and knowledge that makes them an ANP, rather than having proficiency in particular field of care provision (Nurse Practitioner Primary Care Competencies in Specialty Areas, 2002). Do ANP’s have the support to develop these skills? Do they have mentors? Is there any evidence to suggest that they do not get adequate support? Or that they do? Do they get study leave, research time etc? (Please refer the green highlighted paragraph for this question)The word ANP has more and more been used to differentiate where these emerging roles have a higher degree of independence as well as appliance of expertise. Although, the patients under the complete care of medical advisor, the ANP should offer the first point of contact in dealing with issues, which is bring by patient (MacDonald, Schreiber and Davis, 2005). The ANP must be capable to proactively address any problems that could negatively impact on the pathway and length patient’s stay. Local evaluations have highlighted the ANP value is increasing the efficiency and responsiveness of care provision along with overall patient care quality (Advanced nurse practitioners, 2012). In addition to above, there are some more key competencies that are required in nursing practice. All these proficiencies in the nurses are perfectly developed by the courses of RCN. The first is competencies related to scientific foundation that includes critical analysis of evidence and information for developing practices of nurse, integrating knowledge from humanities and science, translating research and other skills to enhance practice outcomes and processing or developing latest approach on the basis of research integration and theory knowledge (Dreher and Glasgow, 2010).
Second is a competency of leadership, which comprises presumption of advanced and critical roles of leadership to guide and implement change. They make use of reflective thinking to advocate increased access of cost effective and quality health care. Furthermore, such competency requires effective communication of knowledge both in written and oral form (Hepworth and et.al. 2012).
Third is a quality competency that allows using available evidence for constant development of clinical practice quality. It evaluates the relationship between access, cost, quality and safety as well as its impact on the health care. Moreover, it facilitates to anticipate deviations in practice and ensure about the excellent quality (Finkelman and Kenner, 2010).
Next is practice inquiry competency, which includes giving leadership in translation of knowledge into practice, production of expertise from clinical practice to improve practice and care for patient. Further, it allows implementation of clinical investigation proficiencies to attain good health results (Buppert, 2008). Fifth is an information and technology literacy competency that combines proper techniques for management of knowledge to improve health care. The skill exhibits proficiencies of information literacy in complex decision making. Through this competency, ANP is able to add in design of clinical information systems, which promote safety, quality and cost effective care of patient (Fitzpatrick, Glasgow and Young, 2003).
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Sixth is policy competency, which demonstrate knowledge about interdependence of practice and polices. It also analyzes legal, ethical and social factors that influence policy development. Moreover, this competency considers the health policy implication across all disciplines of nursing practice. One more competency is related to health delivery system that supports in understanding complex systems and organizational practices to enhance delivery of health care services. For this purpose, it also analyzes the organizational structure, function and resources for effective delivery of health services (NURSE PRACTITIONER CORE COMPETENCIES, 2011).
The last important competency for ANPs that is provided by RCN is ethics and independent practice skills. Ethical proficiencies means incorporating ethical practices in the decision making process. It also includes implementation of ethically sound solutions to critical problems of individual’s health care. Furthermore, independent practice competencies facilitate ANP’s to operate as licensed autonomous practitioner (AACN SCOPE AND STANDARDS FOR ACUTE CARE NRUSE PRACTITIONER PRACTICE, 2012)
Thus, with the compliance of all above legal and professional obligations, I have attained specialization in advance nursing practice. Through having competency in my subject and with the adequate support of my mentor, I was able to handle all issues related to dissatisfaction of patients and managing study and practice at the same time. By completing this course I have got a license to work independently in the examination of patient and providing them treatment. Now I have been able to receive salary in the hospital where I was just working as trainee along with several other benefits, such as paid vacation, sick leave, life insurance, 401k or 403b savings plans, malpractice insurance and also education reimbursement. Moreover, I have also received dental, mental and vision care benefits.
Hence, from the above essay this can be concluded that ANPs are very efficient in promotion of health and are capable to support patients with a range of chronic health issues, such as obesity, hypertension, diabetes, depression, Parkinson’s, asthma and diabetes. Several studies has illustrated that patients with issue of hypertension responded more better by ANPs, rather than physicians (Smolenski, 2005). Furthermore, if we talk about benefits to hospitals, it can be articulated that with the availability of ANPs, hospitals gain superiority in their regular services and can able to provide best care to their patients. It is also fact that ANPs have perfect know-how about utilization of technology and facilities and hence, makes adequate or effective use of it for improvement of patient health. For this reason, nowadays it is very important for any health care or hospitals to employ advance nurse practitioners and this field is gaining more preference day by day, due to the increase in complex disease in humans (Health Care System, 2007).
Further, the ANP’s are required to complete master degree in nursing education, which is essential to the innovations required in health care. Because of the complex and ever changing health environment the master prepared nurses would be more capable to lead change for getting quality care results, develop collaborative inter-professional care teams, advance a culture of superiority by lifelong learning, devise innovative nursing practices, integrate and navigate health services across the healthcare institution as well as translate evidence into actual work. Therefore, by attaining masters degree in nursing practice my knowledge and skills has enhanced to address the evolving needs of health care system. Moreover, with the help of authority that I have received by this degree, several chronic disease and aging patients were well treated by me. Also, they have accepted my recommendations and followed all precautions for their medical care.
Given the prominence on independent nature of advanced nursing practice as well as the benefits of providing patients direct access to advanced nurse practitioners and doctors, a number of options for employment are presented to ANPs. It ranges from self-employment to autonomously contracted nurse partnerships and nursing teams. These onetime radical ideas are now received ways of offering treatment and care, within which ANPs do extremely well (Vilma and Egle, 2007). No health care system area is closed to the ANP and several novel posts are currently offered in all settings of health care. A caution note must be resonance when looking for an adequate post. For reasons borne out of false economy or ignorance, some potential employers continue in providing so-called ANP posts for which no particular educational preparation is needed and for which the pay on offer is not proper for a nurse as highly qualified plus competent as an advanced nurse practitioner (Banham and Connelly, 2002).
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