Nurse Practitioner: A Case Study

The remaining LPNs worked in community care facilities for elderly patients or in home health care services.

As a new student, Mary must determine the direction of her nursing career. According to DeNisco and Barker (2013), there are four roles of an advanced nurse practitioner entail certified nurse midwife (CNM), clinical nurse specialist (CNS), certified registered nurse anesthetist (CRNA), and nurse practitioner (NP). Each role has different duties, responsibilities, and focus. The A CNM provides health care services for office visits, family planning, prenatal care, delivery, and postpartum care. CNSs are trained in a specific area of health care to include pediatrics, geriatrics,critical care, and the emergency department. CRNAs work in the operating room with the ability to care for surgical patients using pharmacological interventions. NPs diagnosis and treat, prescribe, and conduct exams. In order to decide which role is best for Mary, there is a need to examine the lists of pros and cons to delineate a method of comparison. This will help her make the right decision.

The American Association of Colleges for Nurses [AACN], (2006) in 'The Essentials of Doctoral Education for Advanced Nursing Practice ' Essential II: Organizational and Systems Leadership for Quality Improvement and Systems Thinking, affirms "advanced nursing practice (APN) includes an organizational and systems leadership component that emphasizes practice, ongoing improvement of health outcomes, and ensuring patient safety. APNs should be prepared with sophisticated expertise in assessing organizations, identifying systems’ issues, and facilitating organization-wide changes in practice delivery". (p.10) Hameric, Hanson, and Tracy ( 2014) indicates that APN must assess the clinical microsystems in which they perform nursing practices, have knowledge of the medical organizations that impact their specialties, assist with establishing patient centered care reforms to enhance quality of nursing care, improve patient safety, and provide nursing indicators that evaluates nursing performance. (p.266) APNs perform leadership capabilities in four chief areas including clinical practice settings, in the nursing career, within organizations, and in healthcare politics at regional and national levels. (Hameric et al, 2014, p. 266)

This mean depending in what state the advance practice nurse is working in they may be under supervision of a physician or in collaboration with them. “Some states allow nurse practitioners to practice without physician oversight, or 'independently'” (). “Other states require physician oversight for nurse practitioner practice, prescribing, or both. States differ in the language they use to describe oversight” (). “The American Nurses Association defines collaboration as physicians and nurses or NPs working together as colleagues, working interdependently within the boundaries of their scope of practice"

Although all advanced practice nurses (APN) require leadership skills, master level preparation and clinical competence, they also incorporate various levels of research into core competencies. The Nurse Practitioner (family, acute and gerontology), the Nurse Educator, Nurse Informaticist, and Nurse Executive are advanced practice nurses that interact in the inpatient and outpatient settings and collaborate to contribute and enhance quality in healthcare. The APN roles continue to evolve as autonomy, healthcare transformation and affordable care impact our healthcare today (Turner & Burman, n.d.).

Indeed, a comprehensive assessment should be throughout a patient’s course of treatment in order for Nurse Practitioners to identify health information which is very important in order to provide optimal care for their patients. In regards of females age 13 -15 years old, a comprehensive assessment help Nurse Practitioners to use their assessment as a format to organize their histories which are relevant to the patients present, past and family health. By using this approach for this age group will help Nurse Practitioners to establish and strengthen rapport with the patients. Also with this process, patients who are non-adherence will be able to safely make clinical decision due to clinician –patient relationship.

For my Clinical experience, I was referred to one of community clinics run by nurse practitioners - yes, NPs- in Suffolk County in Long Island by my coworker. It is called “Nightingale Preventative Care.” I am working in the ER and at first, I thought this clinic would be a type of urgent care office which is a similar setting to the ER. I was totally wrong. For the past two weeks, this place has surprised me many ways and I learned about what the community clinic is alike to its neighbors. Patients can be seen by NPs by the appointment. However, it is located inside of K-mart and has many walk-in patients as well. Many patients who come to visit for their check-up have no medical insurance. Every Wednesday, a representative from Fidelis Care insurance company comes and provides information about Medicaid and Medicare service the company has. I really like to sit down with patients and assess about their medical histories and family histories which I cannot do often in the ER. I had a patient who was Hepatitis A Ab, Total positive Abnormal first day I work at the clinic. He didn’t understand what the test result meant and neither did I. I printed out an article from National Library of Medicine and went over with him. Patient’s education in the ER rarely happens from nurses. I felt great to listen what patients tried to lose their weight or quit smoking. I like to continue on developing skills on patient’s education and preventative care measure for patients.

There are many changes in the practice of advanced practice nurses (APNs) in the health care environment. These changes are brought by the Institute of Medicine (IOM), The Future of Nursing (2010), the Patient Protection and Affordable Care act (PPACA; U.S. Department of Health and Human Services [HHS], 2011). This affects the APNs marketing and negotiating contracts. Marketing is one of the ways for the APNs to accomplish importance. For successful marketing, the APNs should show clinical expertise, leadership, collaboration, and business skills with the understanding of reimbursement, regulatory and credentialing requirements.

Donna is a registered nurse in the emergency room at Clinton Hospital. She actually went to West Boylston for high school and so did her kids. When she was fifteen she worked as a candy striper at Memorial where she wore a pink dress and pushed a cart with magazines and other stuff on it through the hospital and into the patients’ rooms for them. They don’t do that anymore due to HIPPA but my mom said she used to do it too. Donna then went on to become a CNA (certified nurses aid) at Oakdale for three years. She told me the woman who worked there was very caring and good at what she did. She would make all the meals homemade and gave the place a “homey” feel. The woman had liked Donna a lot and ended up giving her a small scholarship for college. This boosted her confidence since someone believed in her. Donna told me she didn't have a very good

According to the Texas Board of Nursing, in this particular scenario the Registered Nurse (RN) would be covered in delegating the task of discontinuing the intravenous for the patients that were waiting to be discharged. Revised rules for delegation as stated by the Texas Board of Nursing (2003), included delegation of tasks to unlicensed personnel in an acute care, a stable patient having a predictable condition is permitted. The RN is aware of the Nursing Assistants’ (NA) past knowledge and experience in performing this task. In addition, one could say that the RN had enough information using the Five Rights of Delegation and in her opinion, the NA could perform the task properly and safely (Texas Board of Nursing, 2003). The right task which

As a family nurse practitioner (FNP) I expect to work in the same organization that I am working now. I am a case manager nurse, and as a FNP I expect to put my knowledge into practice at Simply Healthcare Plans (HMO health plan) located in Miami-Florida. SHP offers an appropriate and accessible range of preventive, primary care, and specialty services to meet the needs of its Medicaid/Medicare enrollees, and maintains a sufficient number, mix and geographic distribution of providers. It is a prepaid, comprehensive system of health care deliver. Patients with heart failure are heavy users of the health care system and therefore require close clinical management and encouragement to manage and identify their symptoms. The FNP is in an ideal

Armstrong (2006) explains that paraphrasing transpires when the counsellor (or a health practitioner, as in the above case study) reflects back to the client what they have just said, without parroting or changing the meaning of their words. This skill, continues Armstrong (2006), is a feeding back of the essence of what the client has said, in an attempt to gain greater accuracy in discernment. Referring to the aforementioned case study, the Health Practitioner utilised this micro skill following Ally’s opening sentence:

Registered Nurse (RN): two year nursing course is $1,400. clinical fees per semester is $4,000. Bachelor’s course is $7,000-$8,000 in clinical fees while tuition is still lower at just $2,000 to $3,000 per semester. Cost of training at a hospital affiliated nursing schools can be higher at $55,000 for resident student and over $100,000 for non resident students.

Currently hospitals are faced with the challenge of providing safe, high quality patient care, while protecting the well-being and integrity of their nursing staff. As the baby boomer, generation continues to age, and patient’s medical complexity increases, the ongoing nursing shortage and high nursing turnover rates will continue to test hospital administration. CITE 7&6

Registered Nurses (RN’s) are the single largest group of healthcare professionals in the United States (Cortes and Pan, 2014). As nurses and future advanced practice nurses, we are faced daily with patient suffering and their needs. I agree with your statement that as nurses and indeed as a people, we must open our eyes to the poverty in our own backyard, and search for ways to improve living conditions within our communities. We as nurses have been so myopic, unable to see farther than our lives and environment. A way to resolve poverty in our communities is to become involved in different projected geared toward the homeless. Another method is to cook a meal for someone less fortunate in our churches or classes and give without boasting