The Impact of Policy on APRN Practice Paper

The Impact of Policy on APRN Practice Paper

The Impact of Policy on APRN Practice Paper

Based on the readings for this week, please answer the following question

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  1. Select a state that has full practice authority and compare it with a state that does not have full practice authority for APRNs, and compare the state’s health outcomes on at least 5 different metrics (e.g., cancer incidence, maternal mortality rate, infant mortality rate, diabetes, heart disease, suicide rate, etc.). Reflect on the differences and similarities you find. How do you think full practice authority for APRNs could help improve outcomes? include 3 nursing articles less than 3 years old APA STYLE.

Advanced Practice Nursing Essentials for Role Development Fourth Edition 6044_Fm_i-xvi.indd 1 9/11/17 8:51 PM 6044_Fm_i-xvi.indd 2 9/11/17 8:51 PM Advanced Practice Nursing Essentials for Role Development Fourth Edition Lucille A. Joel, EdD, APN, FAAN Distinguished Professor Rutgers, The State University of New Jersey School of Nursing, New Brunswick–Newark, New Jersey 6044_Fm_i-xvi.indd 3 9/11/17 8:52 PM F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2018 by F.A. Davis Company Copyright © 2018 by F.A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Sponsoring Editor: Jacalyn Sharp Content Project Manager II: Amy M. Romano Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The Impact of Policy on APRN Practice Paper

The author(s) and publisher have done everything possible to make this book accurate, up-to-date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Joel, Lucille A., editor. Title: Advanced practice nursing : essentials for role development / [edited by] Lucille A. Joel, EdD, APN, FAAN, Distinguished Professor, Rutgers, The State University of New Jersey, School of Nursing, New Brunswick-Newark, New Jersey. Description: Fourth edition. | Philadelphia, PA : F.A. Davis Company, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2017023590 | ISBN 9780803660441 Classification: LCC RT82.8 .J64 2018 | DDC 610.7306/92–dc23 LC record available at https://lccn.loc. gov/2017023590 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-6044-1/17 + $.25. 6044_Fm_i-xvi.indd 4 9/11/17 8:52 PM Preface The content of this text was identified only after a careful review of the documents that shape both the advanced practice nursing role and the educational programs that prepare these individuals for practice. The Impact of Policy on APRN Practice Paper

That review allowed some decisions about topics that were essential to all advanced practice nurses (APNs)*, whereas others were excluded because they are traditionally introduced during baccalaureate studies. This text is written for the graduate-level student in advanced practice and is intended to address the nonclinical aspects of the role. Unit 1 explores The Evolution of Advanced Practice from the historical perspective of each of the specialties: the clinical nurse-midwife (CNM), nurse anesthetist (NA), clinical nurse specialist (CNS), and nurse practitioner (NP). This historical background moves to a contemporary focus with the introduction of the many and varied hybrids of these roles that have appeared over time. These dramatic changes in practice have been a response to societal need. Adjustment to these changes is possible only from the kaleidoscopic view that theory allows. Skill acquisition, socialization, and adjustment to stress and strain are theoretical constructs and processes that will challenge the occupants of these roles many times over the course of a career, but coping can be taught and learned. Our accommodation to change is further challenged as we realize that advanced practice is neither unique to North America nor new on the global stage. Advanced practice roles, although accompanied by varied educational requirements and practice opportunities, are well embedded and highly respected in international culture. In the United States, education for advanced practice had become well *Please note that the terms advanced practice nurse (APN) and advanced practice registered nurse (APRN) are used interchangeably in this text ­according to the author’s choice. stabilized at the master’s degree level. This is no longer true. The story of our recent transition to doctoral preparation is laid before us with the subsequent issues this creates. The Practice Environment, the topic of Unit 2, dramatically affects the care we give. With the addition of medical diagnosis and prescribing to the advanced practice repertoire, we became competitive with other disciplines, deserving the rights of reimbursement, prescriptive authority, clinical privileges, and participation as members on health plan panels. There is the further responsibility to understand budgeting and material resource management, as well as the nature of different collaborative, responding, and reporting relationships. The APN often provides care within a mediated role, working through other professionals, including nurses, to improve the human condition. Competency in Advanced Practice, the topic of Unit 3, demands an incisive mind capable of the highest order of critical thinking. This cognitive skill becomes refined as the subroles for practice emerge. The Impact of Policy on APRN Practice Paper

The APN is ultimately a direct caregiver, client advocate, teacher, consultant, researcher, and case manager. The APN’s forte is to coach individuals and populations so that they may take control of their own health in their own way, ideally even seeing chronic disease as a new trajectory of wellness. The APN’s clients are as diverse as the many ethnicities of the U.S. public, and the challenge is often to learn from them, taking care to do no harm. The APN’s therapeutic modalities go beyond traditional Western medicine, reaching into the realm of complementary therapies and integrative health-care practices that have become expected by many consumers. Any or all of these role competencies are potential areas for conflict, needing to be understood, managed, and resolved in the best interests of the client. Some of the most pressing issues confronting APNs today are how to mobilize informational technology in the service of the client, securing visibility for their work, and thinking v 6044_Fm_i-xvi.indd 5 9/11/17 8:52 PM vi Preface through publication. The chapters in this section aim to introduce these competencies, not to provide closure on any one topic; the art of direct care in specialty practice is not broached. When you have completed your course of studies, you will have many choices to make. There are opportunities to pursue your practice as an employee, an employer, or an independent contractor. Each holds different rights and responsibilities. Each demands Ethical, Legal, and Business Acumen, which is covered in Unit 4. Each requires you to prove the value you hold for your clients and for the systems in which you work. Cost efficiency and therapeutic effectiveness cannot be dismissed lightly today. The nuts and 6044_Fm_i-xvi.indd 6 bolts of establishing a practice are detailed, and although these particulars apply directly to independent practice, they can be easily extrapolated to employee status. Finally, experts in the field discuss the legal and ethical dimensions of practice and how they uniquely apply to the role of the APN to ensure protection for ourselves and our clients. This text has been carefully crafted based on over 40 years of experience in practice and teaching APNs. It substantially includes the nonclinical knowledge necessary to perform successfully in the APN role and raises the issues that still have to be resolved to leave this practice area better than we found it. Lucille A. Joel 9/11/17 8:52 PM Contributors Cindy Aiena, MBA Executive Director of Finance Partners HealthCare/MGH Boston, Massachusetts Patricia DiFusco, MS, NP-C, FNP-BC, AAHIVS Nurse Practitioner SUNY Downstate Medical Center Brooklyn, The Impact of Policy on APRN Practice Paper

New York Judith Barberio, PhD, APNC Associate Clinical Professor Rutgers-The State University of New Jersey School of Nursing New Brunswick-Newark, New Jersey Caroline Doherty, AGACNP, AACC Advanced Senior Lecturer University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Deborah Becker, PhD, ACNP, BC, CCNS Director, Adult Gerontology Acute Care Program University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Carole Ann Drick, PhD, RN, AHN-BC President American Holistic Nurses Association Topeka, Kansas Andrea Brassard, PhD, FNP-BC, FAANP Senior Strategic Policy Advisor Center to Champion Nursing in America at AARP Washington, District of Columbia Edna Cadmus, RN, PhD, NEA-BC Clinical Professor and Speciality Director-Nursing Leadership Program Executive Director NJCCN Rutgers-The State University of New Jersey School of Nursing New Brunswick-Newark, New Jersey Ann H. Cary, PhD, MPH, FN, FNAP, FAAN Dean and Professor University of Missouri Kansas City, School of Nursing and Health Studies Kansas City, Missouri Lynne M. Dunphy, PhD, APRN, FNP-BC, FAAN, FAANP Professor and Associate Dean for Practice and Community Engagement Florida Atlantic University Christine E. Lynn College of Nursing Boca Raton, Florida Denise Fessler, RN, MSN, CMAC Principal/CEO Fessler and Associates Healthcare Management Consulting, LLC Lancaster, Pennsylvania Eileen Flaherty, RN, MBA, MPH Staff Specialist Massachusetts General Hospital Boston, Massachusetts vii 6044_Fm_i-xvi.indd 7 9/11/17 8:52 PM viii Contributors Jane M. Flanagan, PhD, ANP-BC Associate Professor and Program Director Adult Gerontology Boston College Connell School of Nursing Chestnut Hill, The Impact of Policy on APRN Practice Paper

Massachusetts Rita Munley Gallagher, RN, PhD Nursing and Healthcare Consultant Washington, District of Columbia Mary Masterson Germain, EdD, ANP-BC, FNAP, D.S. (Hon) Professor Emeritus State University of New York–Downstate Medical Center College of Nursing Brooklyn, New York Kathleen M. Gialanella, JD, LLM, RN Law Offices Westfield, New Jersey Associate Adjunct Professor Teachers College, Columbia University New York, New York Shirley Girouard, RN, PhD, FAAN Professor and Associate Dean State University of New York-Downstate Medical Center College of Nursing Brooklyn, New York Antigone Grasso, MBA Director Patient Care Services Management Systems and Financial Performance Massachusetts General Hospital Boston, Massachusetts Anna Green, RN, Crit Care Cert, MNP Project Manager Australian Red Cross Blood Service Melbourne, Australia 6044_Fm_i-xvi.indd 8 Phyllis Shanley Hansell, EdD, RN, FNAP, FAAN Professor Seton Hall University College of Nursing South Orange, New Jersey Allyssa Harris, RN, PhD, WHNP-BC Assistant Professor William F. Connell School of Nursing Boston College Boston, Massachusetts Gladys L. Husted, RN, PhD Professor Emeritus Duquesne University Pittsburgh, Pennsylvania James H. Husted Independent Scholar Pittsburgh, Pennsylvania Joseph Jennas, CRNA, MS Program Director Clinical Assistant Professor SUNY Downstate Medical Center Brooklyn, New York Lucille A. Joel, EdD, APN, FAAN Distinguished Professor Rutgers-The State University of New Jersey School of Nursing New Brunswick-Newark New Jersey Dorothy A. Jones, EdD, RNC-ANP, FAAN Professor, Boston College Connell School of Nursing Senior Nurse, Massachusetts General Hospital Boston, Massachusetts David M. Keepnews, PhD, JD, RN, NEA-BC, FAAN Dean and Professor Long Island University (LIU) Brooklyn Harriet Rothkopf Heilbrunn School of Nursing Brooklyn, New York 9/11/17 8:52 PM Contributors Alice F. Kuehn, RN, PhD, BC-FNP/GNP Associate Professor Emeritus University of Missouri-Columbia School of Nursing Columbia, Missouri Parish Nurse St. Peter Catholic Church Jefferson City, Missouri Irene McEachen, RN, MSN, EdD Associate Professor Saint Peter’s University Division of Nursing Jersey City, New Jersey Deborah C. Messecar, PhD, MPH, AGCNS-BC, RN Associate Professor Oregon Health and Science University School of Nursing Portland, Oregon Patricia A. Murphy, PhD, APRN, FAAN Associate Professor Rutgers-The State University of New Jersey New Jersey Medical School Newark, New Jersey Marilyn H. Oermann, RN, PhD, FAAN, ANEF Thelma Ingles Professor of Nursing Director of Evaluation and Educational Research Duke University School of Nursing Durham, North Carolina Marie-Eileen Onieal, PhD, MMHS, RN, CPNP, FAANP Faculty, Doctor of Nursing Practice Rocky Mountain University of Health Professions Provo, Utah David M. Price, MD, PhD Founding Faculty Center for Personalized Education of Physicians (CDEP) Denver, The Impact of Policy on APRN Practice Paper


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