Future Advanced Practice Nurse
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Future Advanced Practice Nurse
As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal.
In preparation for this course’s practicum experience, address the following in your Practicum Journal:
· Select one nursing theory and one counseling theory to best guide your practice in psychotherapy.
Explain why you selected these theories. Support your approach with evidence-based literature.
· Develop at least three goals and at least three objectives for the practicum experience in this course.
· Create a timeline of practicum activities based on your practicum requirements.
The Institute of Medicine (IOM) proposed in 2010 that states reform their advanced practice registered nurse (APRN) scope-of-practice rules to allow for prescriptive authority and independent practice.
APRNs, notably family nurse practitioners (FNPs), are now acknowledged by a rising number of jurisdictions as trained licensed professionals with the capacity to affect the U.S. healthcare issue.
In 2017, more than 20 states enacted laws expanding the scope of practice and independent prescribing authority of the APRN, increasing the total number of states and the District of Columbia that enable full and autonomous practice to 25.
APRNs work in partnership with or under the supervision of physicians in other states.
APRNs are recognized in healthcare by more than 40 professional medical organizations, including the American Nurses Association (ANA) and the American Association of Nurse Practitioners (AANP).
They also support the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education, which encourages APRNs to take on more responsibilities in the healthcare system.
APRNs, especially FNPs, are a “major part of the solution” to the primary healthcare provider shortfall, according to the Robert Wood Johnson Foundation.
APRNs seek opportunities to practice to the maximum extent of their skills and knowledge, according to the organization, but they frequently confront obstacles.
“A large portion of the public is unaware of or misinformed about the work of APRNs.
According to the group, “a lack of information can cloud regulatory policy decision-making.”
“While APRNs’ area of practice may overlap with that of physicians, they are not physicians; they are nurses.”
The need for APRNs who can perform positions across the United States will continue to grow as the healthcare system in the United States develops.
The online Post-Certificate Master’s in Family (Individual Across the Lifespan) Nurse Practitioner program at Duquesne University prepares nurses to serve as Certified Registered Nurse Practitioners and Family Nurse Practitioners (FNPs).
APRNs can provide primary medical care to people who need it most through the FNP post-online master’s certificate program.
Overcoming Obstacles to Prescription Drugs
Prescriptive authority for advanced practice nurses is not a new concept.
APRNs, including FNPs, have had the education, training, and know-how to prescribe drugs for decades, according to healthcare professionals.
However, as the population ages, primary-care doctors retire, and healthcare access expands, the issue has risen to the fore in the last 20 years or so.
In all 50 states and the District of Columbia, nurse practitioners have some form of prescribing authority.
Nurse Practitioners in full-time practice currently write an average of 23 prescriptions every day.
Prescriptive authority for advanced practice nurses is classified as either independent or limited practice, depending on state regulations:
APRNs with independent or full prescriptive authority can prescribe drugs, devices, health and medical services, durable medical goods, and other equipment and supplies without the involvement or supervision of a physician.
APRNs with limited or limited power must practice and prescribe under the supervision of a physician.
APRNs must work in close physical proximity to a supervising doctor or can create an independent practice that is monitored remotely by a physician, depending on state law.
States with APRN prescribing privileges have their own set of rules.
Applicants for prescriptive authority must, in general, meet the following criteria:
Have a current RN license: RNs that have a current license must have completed the needed continuing education units (CEUs), refresher courses, and practical hours.
RN licenses must be renewed every two years on average.
Graduate from an accredited APRN program: Registered nurses must complete a nationally accredited MSN program, such as Duquesne University’s FNP program.
Coursework in the “three Ps”—advanced physical assessment, advanced pathophysiology, and advanced pharmacology—as well as prescription practice hours, which can be done concurrently with supervised practice hours, are required for academic preparation.
For prescriptive power, many FNP students must also take courses in sickness diagnosis and management.
Obtain national accreditation:
Graduates of Duquesne University’s online APRN program are prepared to take the American Academy of Nurse Practitioners Certification Board (AANPCB) or the American Nurses Credentialing Center (ANCC) Family Nurse Practitioner certification exam.
To apply for the proper state prescriptive authority license, follow these steps:
Prescriptive authority licensure is governed by different rules and regulations in each state.
NPs may be required to work under the supervision of a licensed physician for the duration of their career or for a specific amount of time.
Other states allow NPs to prescribe drugs once they have obtained license.
Obtain a registration number from the Drug Enforcement Administration (DEA) in the United States:
Personal information, proof of schooling, and a background check are all required when applying for a DEA registration number, commonly known as a DEA license.
APRNs Respond to the Opioid Epidemic
Despite the numerous safeguards in place to ensure that APRNs have a clear path to prescribing medications, some concerns remain.
As a result, a slew of new laws and restrictions governing opioid prescriptions have been implemented in a number of states.
California and Oregon are two of them, having approved regulations in 2017 clarifying the role of APRNs in prescribing buprenorphine, an opioid used to treat opiate addiction.
APRNs’ prescribing of medicines with misuse potential, such as opioids and benzodiazepines, has also been studied in various research.
There was no link between APRN prescriptions and increased drug misuse in these investigations.
In fact, one study revealed that states with APRNs with autonomous prescribing power write “much fewer opioid and benzodiazepine prescriptions.”
Possible explanations for the significant decrease in opioid and benzodiazepine prescriptions by independent APRNs could be due to education and training, according to the study, “State Variation in Opioid and Benzodiazepine Prescriptions Between Independent and Non-Independent APRN Prescribing States.”
“It’s been argued that APRN training is more holistic, wellness-focused, and less disease-oriented and cure-focused,” according to the study. “As a result, nurses may be more inclined to use non-opioid pharmacologic and non-pharmacologic therapy methods to address pain.”
When it comes to prescription mental health medicines, NPs with full prescribing authority have similar prescribing habits to physicians, according to a separate study published in 2016.
“This shows that nurse practitioners with unlimited prescribing authority do not prescribe controlled medications in bigger quantities or in different ways than their peers,” researchers told Medscape.
Aside from prescriptive authority, APRN advancements include state law uniformity that allows for a broader scope of practice.
Lifting Practice Restrictions for APRNs In 2016, the United States Department of Veterans Affairs (VA) made history by providing APRNs full practice rights.
APRNs can now deliver a full spectrum of medical services across the United States, easing the strain on the VA’s already overburdened healthcare system.
Similar practice uniformity should be written out in state legislation across the country, according to organizations like the Robert Wood Johnson Foundation and the National Academy of Medicine.
Allowing APRNs complete practice power does not imply that they are attempting to fill physicians’ shoes, according to the organization.
According to the organization, APRNs are working to remove regulatory, institutional, and legal hurdles that prevent them from practicing within their scope of practice.
APRNs do not commonly perform surgery, diagnose uncommon diseases, treat high-risk pregnancies, or engage in a range of other complicated medical operations, according to the foundation.
APRNs, on the other hand, refer patients to specialists and other doctors when necessary.
According to the foundation and other professional APRN organizations, such practice restrictions undermine healthcare in the following ways:
Reduced access to care: APRN-physician supervisory sessions divert attention away from required patient appointments and medical procedures.
In most circumstances, medical supervision does not occur in real time, and physicians and APRNs do not share a facility.
That means both the physician and the APRN must set aside time in their schedules to meet in person.
Patients under the care of an APRN may be denied critical medical interventions if their supervising physician is unable to give them.
For example, when a psychiatrist was fired from a behavioral health facility in Massachusetts in 2013, state regulations prohibiting APRN practice precluded ten APRNs from providing care.
Patients were compelled to seek medical help at hospital emergency rooms.
Increased healthcare expenditures: Even though states require APRNs to work under physician supervision, the costs are still borne by the APRNs.
Payment for collaboration is uncontrolled in general, and it can cost APRNs thousands of dollars per year.
In 2009 and 2014, testimony before the Nebraska legislature revealed a wide range of reimbursement costs: one NP compensated her physician supervisor by covering his weekend emergency room shifts, while another NP paid her supervising physician $15,000 per year.
Future Advanced Practice Nurse
APRNs are prepared to serve millions of individuals who need access to great healthcare, but state and federal regulations are standing in their way.
Despite the constraints, experts are optimistic that politicians will pave the way for new legislation that expands the scope of APRN practice.
APRNs in the Future
Susanne Phillips, FNP, author of The Nurse Practitioner’s “30th Annual APRN Legislative Update: Improving access to healthcare one state at a time,” stated the future years would bring even more good changes to prescriptive authority, albeit more slowly than some would prefer.
“Incremental developments provide the possibility to expand access over time as state APRN and nursing organizations and (boards of nursing) strive toward (full practice authority),” she added.
In the United States now, there are over 234,000 NPs practicing, with the majority of them being FNPs.
Since 2007, the number of NPs has more than doubled, according to the AANP.
The figures are predicted to increase by another 35% by 2024.
APRNs who expand their scope of practice are leading the charge to improve healthcare access.
FNPs are the most common type of NP, and they give treatment to patients from birth to old age, including pregnancy.
FNPs have the knowledge and training needed to offer primary care, perform medical exams, and diagnose ailments.
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