Nursing Impairment

Due to the patient to nurse ratio on the floor, the floor RN would be more focused on the shift’s operations such as the administration of the medications, ensuring that the patient’s ADLs are taken care of, and collaborating with the inpatient care team when family had demands or questions. On the other hand, the APRN would look more closely on the bigger picture, the care provider would not only look into the patient’s daily needs but also the welfare of the family and the organization. The APRN may dig deeper into the signs and symptoms associated with the psychological or psychiatric aspects of the patient’s condition that can sometimes manifest as somatic or physical illness. For example, the patient might have been sleep deprived due to some emotional stress related to the upcoming court hearing. The APRN would explore on why the patient is having an issue with sleep deprivation, make the care plan, intervene appropriately, and then evaluate the outcome. The APRN could also refer the patient to a psychiatric or legal counseling and assist the patient and family members embrace wellness by establishing trusting care relationships, recognizing the clients’ needs but setting limitations, and reassuring them that the APRN would facilitate towards the resolution of their health care

The Arizona State Board of Nursing (AZBN) is an organization that protects the public by ensuring that all nurses holding a license or certificate are competent to practice safely. The board approves education programs and also regulates the practice of nursing (Arizona State Board of Nursing, 2012). The board holds a meeting almost every month to discuss issues and rule on present cases. The purpose of this paper is to identify and discuss agenda items of the attended Arizona State Board of Nursing’s monthly professional meeting.

At the time of the incident, I felt very inadequate. I felt that I was not a good advocate for Ms Lisa, nor did the AMU nurse fulfil the clause of the NMC (2015)’s Code of Conduct and act in patient’s best interests (NMC (2015)). For me, the hardest part was not able to help Ms Lisa. However, I felt that I did help Ms Lisa, only in a small way but could

Why it is important: According to Texas Nurse Association, “The Texas Peer Assistance Program for Nurses is a non-punitive, confidential, and voluntary alternative for RNs and LVNs with concerns related to substance use and mental health. TPAPN encourages nurses to seek help with psychiatric or substance use disorders. By recognizing and managing nurses with psychiatric and substance use disorders in the workplace, TPAPN advances patient safety. Guided by an Advisory Committee comprised of representatives from a number of important Texas nursing organizations and other stakeholders, TPAPN offers a minimum 1-to-5 year monitoring program (5-year for APN’s) that is voluntary and abstinence-based” (TNA, n.d.).

The North Carolina Board of Nursing has specific criteria for any nurse that is identified as being under the influence. They offer a voluntary program for nurses who have impaired judgement and competency as a result of chemical influence. The Alternative Program, or AP, focuses on ensuring public health and safety by monitoring impaired nurses, return the nurse to a safe state of practicing, achieve early intervention of chemical dependency, and give nurses the opportunity to seek recovery in a non-published, non-punitive and therapeutic environment (Alternative). To enter into the program, the nurse must apply directly to the NCBON and agree not to work until cleared by the board. Eligibility for re-entering into the work force is a minimum of three months after initial treatment

Advanced Practice Registered Nurse (APRN) has evolved tremendously since it was establish in 1965 to service vulnerable populations, however there are still barriers that must be addressed in order to free APRNs from limitation imposed by state scope of practice (SOP) laws and payers, which disrupts health care financing/costs, access, delivery, and quality patient care. Currently, only one third of the states in the U.S. permit APRNs to fully practice within their scope without limitations (Hain & Fleck, 2014; Yee, Boukus, Cross, and Samuel, 2013).

These impose severe constrictions on the ability of the nurse to move forward or advance into the areas of practice where traditional nursing practices were not allowed {Institute of Medicine, 2010}. However with the increase in the number of nurses graduating with advance degrees in nursing; the situation is changing. These well educated nurses are leading the charge to confront the complex issues that the rapidly changing health care situation presents. Regulatory barriers must be lifted so that nurses can practice within their scope in order to be reimbursed by private insurance for the services they provide. These changes can be done through the federal and state legislators as well as supervisory agencies and bodies such as congress and licensing regulatory boards. The IOM also recommends that nurses will expand their scope of practice and increase their responsibility through teaching and counseling of patients. {Institute of Medicine,2010}. The use of Advance Practice Registered Nurses and Physician Assistant in providing primary care services will decrease wait time and increase patient satisfaction. The high turnover of nurses transitioning from school to practice also affects the quality of care. These nurses do not have enough experience to make decisions in patient care.{Institute of Medicine,2010}.The IOM and JCAHO{2012} report supports the recommendations for the introduction of nursing residency

Substance abuse is a tragedy that touches many lives. Abuse begins with a single use event that, with continued use and overindulgence, transforms into a battle. The abuser most always loses that battle. Personal relationships, social ties, and employment suffers. Irresponsible and erratic behavior becomes the norm, and though the abuser is aware on some level of the reckless and thoughtless acts that they commit, they continue to use and abuse their drug of choice. What starts as experimentation often ends in addiction. The best hope for a person in the grips of substance abuse is immediate,

The Professional Recovery Network (PRN) meets expectations in accordance with the laws and medicinal; practical demonstrations of the State of Idaho to give a safe situation in a soothing setting. Ideally, the reason for this particular project is to aid experts and their families in recognizing liquor, drug, or behavioral issues that represent detrimental situations and/or circumstances that directly concern experts, families, or patients/customers.

According to the American Association of Nurse Practitioners (2013), the NPs scope of practice, which is similar to the remaining three APRN roles, revolves around their professional role, education, accountability, and responsibility. Their professional role as a licensed independent practitioner consists of diagnosing and managing acute and chronic illnesses, promoting and educating health and wellness, prescribing pharmacological and non-pharmacological agents as well as advocating for their patients, and coordinating care. Under the ACAs classification of an APRN, they are more than qualified to work as an independent provider who may offer nursing services such as primary care, transitional care, preventive care, chronic care management (Ward, 2015). Despite an APRNs qualifications, there are still statewide limitations as to what their roles and responsibilities entail. These limitations unnecessarily limit the industry’s capability to appropriately provide healthcare services to the

The first case scenario presented in this project reflect the significance of gaps between nursing programs and textbooks, organizations’ policies and procedures, published literature, and the actual practice. Some of the gaps refer to nursing programs and textbooks based on an ideal nursing profession, the autonomy of healthcare organizations to establish their specific policies and procedures, traditional policies and procedures unsupported by evidence-based practice (EBP), and the individual and organizational barriers that influence the breach between the published literature and the real-world. Literature review was used to demonstrate the negative personal and professional consequences triggered from these gaps when the nurse is employed in the healthcare system. In addition, the paper suggests how improving a “Culture of Safety”, preventing an unsafe environment, and promoting Continuous Quality Improvement activities enhance the overall health care quality and safety. The second case scenario provides guidelines to the ethical dilemma of the impaired nurse, signs and symptoms of impairment, ethical and legal obligations, common reasons for not reporting, and failing to report consequences.

First, the state licensure regulates NP practice and it has been a big issue since NPs are not able to practice to the fullest extent despite of their education and training. NPs practice is regulated by state licensure and only about one-third of the nation has adopted full practice authority licensure and practice laws for NPs (Hain & Fleck, 2014). The American Association of Nurse Practitioners (AANP) reports that, under a full practice authority model, NPs are still required to meet

Managers must always maintain an open door policy for staff, with no fear of reprisal, when voicing any concern. Patient safety should always be the top priority. When dealing with an impaired nurse, the first step in “the nurse manager’s role in the process is removing the nurse from patient care is essential, which will assist the nurse in focusing on the care and treatment of the disorder and the sooner patients are protected” ("A Nurse Manager’s Guide," 2014). In addition, the nurse manager should occasionally review and become familiar with any facility policies or procedures on this topic and ensure that confidentiality is always

It is very important for the NP to understand their scope of practice and the rules they must follow to legally furnish drugs and devices in California. Different states also have different rules for furnishing drugs and devices, a function of primary care that an NP needs to perform to be successful in the patient aspect of their work. NPs in California need to address not only the Board of Registered Nursing’s (BRN) requirements, in addition to the Drug Enforcement Agency’s (DEA) requirements for writing prescriptions. Over time new rules and regulations are being presented for legislative action, so it is important to stay up to date with information that may affect the NP profession.

This puts added responsibility and pressure on the care team to ‘do no harm’ and abide by the patient’s previously stated wishes if available. In an acute care setting, patients advancing diseases processes can require many unwanted (and sometimes unnecessary) medical interventions. With that said, I encourage care teams to put themselves in place of the patient’s family and not only be their provider, but their voice and protector. There was this 92 year old women with sepsis and dementia who we lost two peripheral IV’s on, therefore requiring two new IV’s and not a candidate for a central line. From the hallway, her distress was apparent from her screaming and crying, all the while trying to bite and punch the nurses and nurse aides as new lines were attempted. The care team was frustrated and their communication in the patient’s room aligned with the situation at hand but was inappropriate for a advanced dementia patient. Having taken care of this patient before, this RN entered the room, grabbed the patient’s free hand, and came eye to eye asking the patient what was wrong. With tears in her eyes she clearly and blatantly exclaimed, “I don’t want to do any of this anymore. Please no more.” At that moment, her behavior was understood leading to care that aligned with her