NR510 week 6 discussion 2

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NR510 week 6 discussion 2 NR510 week 6 discussion 2 Discussion Part Two (graded) Inconsistent regulation of APN role and scope prevent a seamless healthcare system in which APN can practice. Di... scussion Question: What evidence-based strategies should be implemented to achieve continuity between state regulatory boards? Provide evidence for your response. Topic responses  Discussion  Expand All More Sort By: Meghan Mills Part 2 What evidence-based strategies should be implemented to achieve continuity between state regulatory boards? Provide evidence for your response. The APRN Consensus Model as described in a 2008 report by the APRN Joint Dialogue Group, is a model for APRN regulation and is, “the product of substantial work conducted by the Advanced Practice Nursing Consensus Work Group and the National Council of State Boards of Nursing (NCSBN) APRN Committee” (p. 5). Under the APRN Consensus Model, also known as the APRN Model of Regulation or APRN Regulatory Model, the four roles of anAPRN include CRNA, CNM, CNS, or CNP and, “APRNs are educated in one of the four roles and in at least one of six population foci: family/individual across the lifespan, adult-gerontology, neonatal, pediatrics, women’s health/gender-related or psych/mental health” (APRN Joint Dialogue Group, 2008, p. 10). By implementing the APRN Consensus Model at perhaps the federal level, continuity between state regulatory boards may be achieved, “The APRN Regulatory Model applies to all elements of LACE. Each of these elements plays an essential part in the implementation of the model” (APRN Joint Dialogue Group, 2008, p. 7). According to the APRN Consensus Model report from the APRN Joint Dialogue Group (2008), some expectations for LACE include boards of nursing nationwide giving licensure to APRNs in the categories of CRNA, CNM, CNS, or CNP within a specific population foci; that the boards of nursing be solely responsible for the licensure of APRNs providing licenses to graduates of accredited graduate programs only, and requiring completion of a national certification examination prior to licensure. The report also states all boards of nursing will license APRNs as, “independent practitioners with no regulatory requirements for collaboration, direction, or supervision” (APRN Joint Dialogue Group, 2008, p. 14). Reference APRN Joint Dialogue Group. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_J uly_2008.pdf Show Less Instructor Duncanreply to Meghan Mills RE: Part 2 MeghanYes! Having identical licensure requirements and education standards would improve consistency between state boards. Hopefully, this ongoing effort will improve licensure from state to state. Dr. Duncan Show Less Jose DelAcruz 8/9/2016 12:37:24 PM Discussion Part Two Hello Dr Duncan and Class Evidence-based strategies to be implemented to achieve continuity between state regulatory boards DeNisco & Barker (2013) assert that, to achieve continuity between regulatory boards there are various strategies that have to be put in place for instance; communication is a very effective tool for boards to achieve the right outcome. Constructive communication should start with the board members when they raise any concern regarding the welfare of the health care system, patients or the nurses themselves. Any complains that may arise have to be taken positively and communicated as first as they are noted and acted upon with immediate effect. Corporation is another strategy that has to be adopted and implemented. To achieve a good health care system and patient safety, there has to be togetherness between the members of the board. The patients’ needs have to be put on the fore front and attended to accordingly. Yee et al, (2013) indicate that policy initiatives may be another strategy that may be used by regulatory boards so as to help minimize the physician supervision of nurses as it seems to hinder the NP’s ability to practice the fullest extent of the education and the training that they have undergone. The physicians and other health professionals should be full partners with the nurses and this will significantly help in redesigning the health care system. Reeves et al, (p.2, 2013) indicate that inter professional education where members of more than one health profession should learn interactively together so as to be able to improve inter professional collaboration or the well-being of all patients should also be implemented. This is because such interventions have shown various positive incomes like improved patient satisfaction, reducedsignificantly medical errors that occur and improved health outcome of people with specific chronic diseases (Tappen, 2015). Jose References DeNisco, S. & Barker, A. (2013). Advanced practice nursing: evolving roles for the transformation of the profession. Burlington, Mass: Jones & Bartlett Learning. Retrieved from https://books.google.com/books?id=YGSSHUlMTaEC&pg=PA249&dq=regulatory+boards+in+ health+care+systems&hl=en&SA=X&ved=0ahUKEwjmyKj8n7TOAhVRahoKHSCtBqUQ6AEI LDAE#v=onepage&q=regulatory%20boards%20in%20health%20care%20systems&f=false> Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database of Systematic Reviews, 3. doi: 10.1002/14651858.CD002213.pub3. Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers. Retrieved from https://books.google.com/books?hl=en&lr=&id=DnyUCgAAQBAJ&oi=fnd&pg=PR1&ots=NLq wVgktLt&sig=WU06DUVm6Q9PYwKxPyMtpaC8OfM&redir_esc=y#v=onepage&q&f=false> Yee, T., Boukus, E. L. L. Y. N., Cross, D., & Samuel, D. I. V. Y. A. (2013). Primary care workforce shortages: nurse practitioner scope-of-practice laws and payment policies. National Institute for Health Care Reform. Research Brief, 13. Retrieved from http://www.floridanurse.org/arnpcorner/ARNPDocs/NIHCR_Research_Brief_No._13.pdf> Show Less Mijanou Marretta-Lewis Discussion Part Two Dr. Duncan and Classmates, Varied stated regulations governing the nurse practitioner (NP) has created barriers to practice within the full capability of education and clinical training (American Association of Colleges of Nursing, 2011). As such groups as theAmerican Association of Nurse Practitioners (AANP) push on a national level through government lobbying for full practice authority for all 50 states there remains push back from the American Medical Association (American Association of Nurse Practitioner (AANP), 2014, p.1). Sadly there are only 21 states and the District of Columbia that allow for full practice status allowing them to diagnose, prescribe, evaluate patients, order, interpret diagnostic tests, initiate and manage care and treatments as primary care providers which include prescribing medication without the supervision of a physician (Rudner Lugo, 2016). The Unites States Institute of Medicine (IOM) in 2010 report, the Future of Nursing, recommended regulations and policies is designed so as to facilitate nursing practice to the full extent of their education and training in every state. It was recommended by the IOM to reform the scope-of-practice regulations for advanced practice nurses (APRNs) so that each state conforms to the regulation of the APRN to the National Council of State Boards of Nursing (NCSBN) Model Nursing Practice Act (IOM, 2010). The template by the NCSBN for combining regulations among the states wanted APRNs to be recognized licensed practitioners with full rights and privileges, which included prescribing and equal pay (NCSBN, 2012). Sadly this was not adopted nationally, the APRN regulations are governed at the state level and they make the rules for the practice of the APRNs. Therefore the United States has not instituted an evidence base to APRN regulation and so there is a hodgepodge of varied regulations and standards for nurse practitioners (Rudner Lugo, 2016). Even though the APRN role has been in existence for the last 50 years with nearly as much research to demonstrate safety and efficacy of the APRN, many states like Ohio remain limited by regulations (Newhouse et al., 2011). Nursing remains a predominately female role, however currently there are nine percent men in the profession across the US. This leads to the belief that the role of women in our society versus the state regulation governing the four APRN roles appears to not accept women’s equality which are directly associated with those states that restrict the updated status of the APRN (Bobbit-Zeher, 2011). Today gender gaps continue with women getting 21 cents less on the dollar than their male counter parts. In 2015,male NPs averaged a salary to $109,000, which women NPs made $100,000, a difference of $9,000 per year (Muench, Sindelar, Bush & Buerhaus, 2015). Due to the complexities of state regulations and the nursing practice, the procedure for assessing APRN regulatory environments continues to vary. The NCSBN maintains data that has been compiled from state boards of nursing to measure the progress towards full professional practice and authority for advanced nurses in each state and territory (NCSBN, 2015). Interestingly the states that supported the Equal Rights Amendment have more women in the legislator and supported the nurse model practice act and the IOM Future of Nursing (2010) recommendation. It is the belief of this nurse that the attitudes towards women reflect and directly influence the APRN regulations. Those states that supported the ERA have a higher rate of APRNs full practice authority and those who opposed the ERA have placed restrictions on the APRNs of their state. To enhance the image of APRNs as male and female professionals who have ethics and are strong and competent can be a positive stepping stone to partnerships and grass-root efforts to establish political support to institute the IOM recommendation of full authority for the APRN. Being a part of the AANP or ones local state Nurse Practitioner Association will help to support the work of those pushing for all of us to have full authority in our practices. Mijanou References American Association of Colleges of Nursing (AACN). (2011).Essentials of master’s education in nursing. Retrieved from http://www.aacn.nche.edu/educationresources/MastersEssentials11.pdf Association of American Medical Colleges Center for Workforce Studies. (2013). 2013 state physician workforce data book. Retrieved from https://www.aamc.org/download/362168/data/2013statephysicianwork forcedatabook.pdf Bobbitt-Zeher, D. (2011). Gender discrimination at work: Connecting gender stereotypes, institutional policies, and gender composition of workplace, gender & society. Gender & Society, 25(6), 764-786. doi:10.1177/0891243211424741Institute of Medicine. (2010). Future of nursing, leading change, advancing health. Washington, D.C.: National Academies Press. Muench, U., Sindelar, J., Busch, S.H., Buerhaus, B. (2015). Salary differences between male and female registered nurses in the United States. JAMA, 313(12), 1265-1267. doi:10.1001/jama.2015.1487. National Council of State Boards of Nursing. (2015). Implementation status map of NCSBN’s APRN campaign for consensus: State progress toward uniformity. Retrieved from https://www.ncsbn.org/5397.htm Newhouse, R., Stanik-Hutt, J., White, K., Johantgen, M., Bass, E., Zangaro, G. … Weiner, J. (2011). Advanced practice nursing outcomes 1990-2008, A systematic review. Nursing Economics, 29(5) http://www.nursingeconomics.net/ce/2013/article3001021.pdf Rudner Lugo, N., (May 4, 2016) "Full Practice Authority for Advanced Practice Registered Nurses is a Gender Issue" OJIN: The Online Journal of Issues in Nursing Vol. 21 No. 2. doi: 10.3912/OJIN.Vol21No02PPT54 Show Less Dana Harbuck Discussion part two Hello Dr. Duncan and class, Registered nurses (RN) living in a compact state, currently receive a license issued by their primary state of residency, which allows them to practice in other compact states, under one license. Compacts are formal agreements between states that bind them to the compact’s provisions. The use of compact licenses help reduce redundancy and ease the nursing shortage in underserved areas (Stempniak, 2016). The National Council of State Boards of Nursing (NCSBN), has recently adopted two new compact designs. One is the enhanced RN compact and the advanced practice registered nurse compact. The APRN compact is similar to the RN compact, as it allows the APRN to have one multistate license, with the ability to work in other compact states, both physically and through telemedicine. The APRN compact promotes cooperation between the states and reduces redundancy for those working in multiple states. One uniform license promotes public safety and benefits public health (National Council of State Boards of Nursing, 2015).I live in a community that is not far from the state boundaries. There are many rural communities that lie just on the other side of the state border that are in need of primary care practitioners. With an APRN compact, APRN’s would be able to travel to these communities without the need for another license. References: National Council of State Boards of Nursing. (2015). Advanced practice registered nurse compact. Retrieved from https://www.ncsbn.org/APRN_Compact_Final_050415.pdf Stempniak, M. (2016). Nurses without state borders. H&HN: Hospitals & Health Networks, 90(7), 59-60. Show Less Instructor Duncanreply to Dana Harbuck RE: Discussion part two Dana, The RN compact has been implemented in many states, but not in the majority. This is due to various requirements including education and background checks, the compact has not been very successful... yet. How could this improve so it could include APNs and additional states? Dr. Duncan Show Less Dana Harbuckreply to Instructor DuncanRE: Discussion part two Hello Dr. Duncan, The National Council of State Boards of Nursing (NCSBN) has proposed the advance practice registered nurse (APRN) compact model rules. One of the rules is regarding the APRN compact is the uniform license requirements (ULR). The NCSBN suggests APRN’s who wish to obtain a new compact license or renew a compact license, must meet the ULR’s requirements, along with their home state licensing laws and qualifications. Having multiple laws and licensing regulations for APRN’s, can be very confusing, not only for the APRN, but also for those that inforce the laws (National Council for State Boards of Nursing, 2014). If were to improve this process I would first make one set of regulations for APRN’s. Unfortunate this may eliminate some from being qualified for a compact license, most likely due to their education level. I my opinion this should only encourage those APRN to advance their education. Having one set of laws also helps eliminate confusion. References: National Council for State Boards of Nursing. (2014). Proposed advanced practice registered nurse compact. Retrieved from: https://www.ncsbn.org/APRN_Compact_Rules Show Less Amber Kelly Discussion Part One Professor and class As nurses one of the most important thing we could do is join a professional nurses organization such as the American Nurses Association, this will help to achieve continuity of care between state lines. Professional nursing organizations help advocate for the nursing profession and for all nurses (Matthews, 2012). The American Nurses Association and the American Association of Nurse Practitioners has been working diligently to achieve this continuity (Matthews, 2012). When trying to enforce a change in policies oneperson’s voice can only go so far, a greater impact can be seen when a large group of people get together to fight for the same cause. Matthews, J. (2012). Role of professional organizations in advocating for the nursing profession. The Online Journal of Issues in Nursing, 17(2). Retrieved from http://nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17- 2012/No1-Jan-2012/Professional-Organizations-and-Advocating.html Show Less Marsha Wiersteinerreply to Amber Kelly RE: Discussion Part One Amber, I completely agree with you that belonging to and participating with an organization such as the American Nurses Association is a great way to improve continuity of care nationally among APRNs. Associations like the ANA take on serious issues regarding the nursing profession, our patients and communities (ANA Annual Report, 2015). They provide encouragement to members to become involved in the issues that surround nursing and can empower each of us to make better choices and advocate for ourselves. Reference Leading the Way (2015). American Nurse 47(3) 7-10. Show Less Urvashi Shahreply to Amber Kelly RE: Discussion Part OneHey Amber, I agree with you that one person's voice can only go so far, it is key point to keep membership with organization and also socially active with similar profession to achieve continuity of care between states. Many times, it become difficult to keep up with everything but today social media keep you up to date with current situation and future scope whether it is healthcare or other field. I have learned through LinkedIn organization such as ANA and CDC regarding current disease process, treatment plan, incubation plan, future plan and cautions. I believe in "More the Merrier". Show Less Michelle Incereply to Amber Kelly RE: Discussion Part One Amber, I definitely agree with you that it is very important for nurses to be a part of a professional nursing organization and to take an active part in creating change. Nurses not only have the ability to make changes on the national level, but on the global level as well. Premji and Hatfield (2016) state that nurses "are uniquely positioned to facilitate shared learning globally and engage in reverse innovation and reverse capacity development" (p, 3). This is a great reminder that we as nurses are not only responsible to make changes for our country, but for our world as well. Quality healthcare is a should be a fundamental right of every single person, regardless of their country of residence (Premji & Hatfield, 2015). The participation of nurses in policy development is essential in making changes that will not only benefit healthcare in our nation, but also worldwide (Premji and Hatfield, 2015). Reference Premji, S. S., & Hatfield, J. (2016). Call to action for nurses/nursing. Biomed Research International, 1-5. doi:10.1155/2016/3127543Show Less Marsha Wiersteiner Discussion part 2 Strategies that could help states continuity of nursing practice among state regulatory boards include contacting state lawmakers and joining in a grass roots campaign aimed at change ("APRN Standards," 2011). Educating lawmakers of the benefits of national regulations is a way of providing incentive to speed the process of law changes. APRN’s provide safe cost-effective care that has been shown in evidence-based research for several decades("APRN Standards," 2011). Promoting uniformity of care would increase access to healthcare that is cost-effective in these times of healthcare reform. There are multiple ways of contacting lawmakers to the multiple states that are resistant to change, such as letter writing campaigns. Use of a template letter to encourage nurses who are unsure of what to say is a way of encouraging APRN’s to participate ("Methods," 2016). However, letter writing that includes personal experiences are much more compelling and affective in promoting change ("Methods," 2016). Sending email can be affective as well, and can be a quick an effective method for contacting key members legislative staff and legislators themselves ("Methods," 2016). Personal communication is active method for contacting lawmakers as well. Personal phone calls, personal appointments and making visits to the office can effective in persuading lawmakers to listen to the information being presented("Methods," 2016). Providing them quality reasoning and pertinent details as to why the issue is important to you as well as the entire APRNcommunity can lend support for making the necessary changes to create a more continuous system of APRN regulations. Methods for communicating with your Legislator/Campaign for APRN Consensus. (2016). Retrieved from https://www.ncsbn.org/6183.htm Nursing groups work for national APRN standards. (2011). Connecticut Nursing News, 19. Retrieved from http://www.ctnurses.org/Homepage-Category/Publications/CTNursing-News-Flash-Archive Show Less Molly McIntyre Part 2 Having inconsistent regulatory boards from state to state restricts the authority of the Advanced Practice Nurse (APN) and undermines the high quality, cost effective care that can be provided (Hain & Fleck, 2014). Hain and Fleck (2014) consider this the most serious barrier to acceptable care in our nation because it has an indirect impact on patient care, practice opportunities, and payer polices. It appears that the biggest opposition that APNs are facing while trying to achieve uniformity across state lines is physician opposition (Hain & Fleck, 2014). It is recommended that nurses become members of local, state, and national level organizations who are backing this movement (Hain & Fleck, 2014). A large financial support is needed to achieve significant policy and legislative changes and can be received through major organizations like the American Association of Nurse Practitioners, American Nurses Association, and American Association of Retired Persons (Hain & Fleck, 2014). The other recommendation from Hain and Fleck (2014) is the implementation of a single APN license resulting in standardization across the country. This standardization will span across education, licensure, and practice to achieve consistency and quality nation wide (Hain & Fleck, 2014).Hain, D., & Fleck, L.M. (2014). Barriers to NP practice that impact healthcare redesign. The Online Journal of Issues in Nursing, 19(2), 1. doi: 10.3912/OJIN.Vol19No02Man02 Show Less Mijanou Marretta-Lewisreply to Molly McIntyre RE: Part 2 Molly, There is agreement with Hain & Fleck (2014) that a single APN license should become a stand of practice in the United States. However the problem continues to be that individual states determine the scope of practice for the APN and not all decided to follow the recommendation of the Institute of Medicine’s recommendation in 2010’s report on the Future of Nursing. The IOM’s recommendation was to make the scope-of-practice be regulated by the National Council of State Boards of Nursing Model Nursing Practice Act (IOM, 2010). Sadly not all states decided to comply with the IOM recommendations. In many states the laws governing the APN scope of practice varies greatly from prescriptive usage to supervision, signing death certificates and require writing contracts for standard agreements which include the amount of pay physicians will receive even when not actively working on site. This incongruence from state to state undermines the education and training of the APN and causes questionable professionalism within the APN practice. Mijanou Reference Hain, D., & Fleck, L.M. (2014). Barriers to NP practice that impact healthcare redesign. The Online Journal of Issues in Nursing, 19(2), 1. doi:10.3912/OJIN.Vol19No02Man02Institute of Medicine. (2010). Future of nursing, leading change, advancing health. Washington, D.C.: National Academies Press. Show Less Hannah Miller Regulation Dr. Duncan and class, Currently, there are diverse requirements among states for advanced practicing nurses in relation to scope of practice, privileges, and licensing. It is important for all state regulatory boards to not dictate an advanced practicing nurses' capabilities and competencies based on the geographical location, but within the criteria of certification, scope of practice and state/national licensing boards. State regulatory boards can achieve continuity by mandatory licensing advanced practicing nurses as independent practitioners who are expected to practice within the standards established or recognized by a licensing body. It is important that licensing is required as APN will be practicing in a role beyond that of a Registered Nurse (AACN, 2016). Advanced Practicing Nurses currently are required to seek licensure that is both established and recognized nationally by a licensing boards. In order to maintain seamless healthcare that is both of quality and safety, the different state regulatory boards need to require all APNs to register and renew their license in compliance with the board. Not only will this allow for the states to report all practicing clinicians nationally, but also maintain a record of the various scopes of practice that they hold. American Association of Critical-Care Nurses. (2016). The new APRN regulatory model: Defining the future of Advanced PracticingNursing. Retrieved from http://www.aacn.org/wd/certifications/content/newaprnregulatorymod el.pcms?menu=certification Hannah Miller Show Less Jenica Hughesreply to Hannah Miller RE: Regulation Hi Hannah, Each state has different requirements for licensure, accreditation, certification, and education for the advanced practice nurse. This makes it difficult for smooth healthcare delivery in the United States. I know it may take several years, but with the implementation of the Licensure, Accreditation, Certification, and Education (LACE) Consensus Model, nurse practitioners will be able to practice independently in every state in America. Reports have projected that by 2020, the United States will need 40% more primary care providers to manage the healthcare needs of our population (Stanley, 2012). One way to bridge this gap is for State Boards to achieve continuity with mandatory licensing nurse practitioners as independent providers as you have mentioned in your post. Does your State regulations mandate supervision by a physician for nurse practitioners? Jenica Reference Stanley, J. (2012). Impact of new regulatory standards on advanced practice registered nursing: The APRN consensus model and LACE. Nursing Clinics of North America, 47, 241-250. doi:10.1016/j.cnur.2012.02.001Show Less Katherine De Los Trinos-Ocampo Week 6 Discussion Part 2 One way to achieve continuity between state regulatory boards is to follow the Institute of Medicine’s (IOM) proposal of standardizing an expanded scope of practice for advanced practice nurses (APNs) (Fairman, Rowe, Hassmiller, & Shalala, 2011). By standardizing an expanded scope of practice for APNs and removing state-based regulatory barriers APN’s will be able to efficiently deliver primary care to a larger amount of people. There is a lack of data stating that greater restrictions on APN practice will result in safer and better care; but there is a large amount of data that indicates nurse practitioners are able to deliver care that is comparable if not better than physicians (Fairman et al., 2011). Adoption of the APRN consensus model will streamline licensure, accreditation, certification, and education processes for APRN’s and will allow NPs to practice with more autonomy without question due to the standardization of APRN practice. Besides the IOM both the Macy Foundation and the American Association of Retired Persons (AARP) are in full support of all states adopting the APRN consensus model created by the National Council of State Boards of Nursing in order to help reform healthcare and better serve the growing number of insured patients as a result of the Affordable Care Act (Fairman et al., 2011). The benefits of implementing the APRN consensus model far outweigh any potential risks; therefore it is up to all APRNs and potential APRNs to become actively involved in supporting the implementation of the APRN consensus model nationwide. Reference Fairman, J., Rowe, J., Hassmiller, S., & Shalala, D. (2011). Broadening the scope of nursing practice. The New England Journal of Medicine, 364, 193-196. doi: 10.1056/NEJMp1012121 Show LessMolly McIntyrereply to Katherine De Los Trinos-Ocampo RE: Week 6 Discussion Part 2 Hi Katherine, According to the National Council of State Boards of Nursing (NCSBN) (n.d.) the Concensus Model would have profound positive effects if adapted throughout the United States, however states have only adopted portions of the model and there is still extreme variation between states. Having these variations between state lines results in obstacles for Advanced Practice Nurses (APN) but also inhibits access of patients to care (NCSBN, n.d.). Adopting the Concensus Model in full could decrease stress to APNs over wondering if their certification and licensure will be accepted because there would be uniformity across the country regarding licensure, accreditation, certification, and education (NCSBN, n.d.). I hope that in the next couple of years this gets established for our sake and for the people needing care. Thank you for your post. Molly Show Less Kirsten Englishreply to Katherine De Los Trinos-Ocampo RE: Week 6 Discussion Part 2 Hi Katherine, The APRN Consensus Model was developed to address the evolving changes in APRN practice and expansion. Nursing leaders recognized that the lack of standardization of APRN practice from state to state was limiting the portability of APRNs across state lines (Walker,2015). The model promotes patient safety and improves access to APRNs through the creation of uniform regulatory standards (Walker, 2015). Streamlining licensure, accreditation, certification, and education (LACE) would help in so many ways, to allow APRNs to travel from state to state without restrictions and to better serve the growing need for healthcare providers wherever they are needed. I also found that there was inadequate data to support that more restriction resulted for APRNs resulted in safer care. So many important groups support the APRN Consensus Model and it will be interesting to see how long it will take to fully implement across the entire United States. Thank you for your informative post, Kirsten References Walker, S. (2015). Consensus Model Delineates and Guides APRN Practice. ONS Connect, 30(1), 51. Show Less Joshua Richardson Part 2 Professor and classmates, I fear that this issue will be a difficult one to overcome. With each states currently having the power to regulate and license nurses and Advanced Practice Nurses (APN’s) in their individual state, the intervention would have to come at a national level. Approximately one-third of the nation has adopted full practice authority for APN’s (Hain & Fleck, 2014). The rest of the nation has either reduced or restricted practice. This inconsistency of regulation can lead to difficulties and errors when patients or APN’s transfer from one state to another. The Consensus Model for APRN Regulation recommends having a single advanced practice RN license across the nation with no regulatory mandates for physician supervision or collaborative agreements (Hain & Fleck, 2014). “Standardizing APRN regulation maypromote nationwide consistency and quality of NP educational programs so that there is uniformity among the graduates” (Round, Zych, & Mallary, 2012). Creating a single national certification and regulation that is accepted across all states with improve continuity and quality of care and reduce confusion and errors. Josh Hain, D., & Fleck, L. (2014). Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign. OJIN: The Online Journal of Issues in Nursing, 19(2), Manuscript 2. Round, L., Zych, J., & Mallary, L. (2012). The consensus model for regulation of APRNs: Implications for nurse practitioners. Journal of the American Academy of Nurse Practitioners, doi: 10.111/j.1745- 7599.2013.00812.x. Show Less Amber Kellyreply to Joshua Richardson RE: Part 2 Joshua Thank you for your post, I completely agree with you on the difficulty of changing things in regards to licensure. The more I learn about the different states policies regarding the APRN the more of a headache it is. Honestly I feel the entire licensure system needs an overhaul. If a profession impacts the consumer so much to warrant licensing, shouldn't it be uniform across the United States. It is a matter of public safety that there is not uniformity in regards to regulations on what the APRN can and cannot do (Gutchell, Idzik, & Lazear, 2014). Gutchell, V., Idzik, S., & Lazear, J. (2014). An Evidence-based Path to Removing APRN Practice Barriers. The Journal for Nurse Practitioners, 10(4), 255-261. doi:10.1016/j.nurpra.2014.02.005Show Less Jill Coles Discussion Part Two Dr. Duncan and Class, Thanks to the passages and implementation of the Patient Protection and Affordable Care Act (P PACA) and the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health, national attention has been brought to the restrictio ns that advanced practice nurses (APNs) face (Rigolosi & Salmond, 2014). Standarization of education for APNs is happening throughout the U.S., but ea ch state still has different laws that govern how APNs practice (Rigolosi & Salmond, 2014). The only real way to achieve continuity between state regulatory b oards is to adopt the Consensus Model for APRN Regulation. The Consensus Model recommends having a single advanced practice RN license which would allow APNs to practice with no regulatory restrictions (Hain & Fleck, 2014). Once standardization occurs, there will be nationwide consistency and qu ality of educstional programs wich will promote uniformity among all APNs (Hain & Feck, 2014). References Hain, D. & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesi gn. OJIN: The Online Journal of Issues in Nursing, 19(2), Manuscript 2. Rigolosi, R. & Salmond, S. (2014). The journey to independent nurse practitioner practice. Jour nal of the American Association of Nurse Practitioners, 26(12), 649-657.Show Less Kirsten English WK6DT2 Hello Dr. Duncan and Classmates, Nurse Practitioners (NPs) have become a common and vital asset to the medical field and in the delivery of patient care. An issue that lies within the profession is that from state to state there are many inconsistencies in the standards of practice. A strategy that could help to eliminate this issue and to achieve continuity would be to standardize the national legislation allowing for full scope of practice. By doing this, there would be an elimination of variances in state licensures (Hain and Fleck, 2014). A standard license across the United States (U.S.) for the NP would yield consistent practices and standards. Only approximately one third of the nation has adopted full practice authority licensure and practice laws for NPs, the rest have some restriction or another (Hain and Fleck, 2014). If there were to be uniformity of licensure throughout the U.S., the education of NPs would have an overall improvement. Educational institutions and programs could focus on the same educational objectives assuring that the NP would have consistent expectations within any state. Thank you for your time, Kirsten References Hain, D. & Fleck, L. (2014). Barriers to NP practice that impact healthcare redesign. Online Journal of Issues in Nursing, 19(2), 5. doi:10.3912/OJIN.Vol19No02Man02 Show LessJenica Hughes Discussion Part 2 Dr. Duncan and class, When it comes to the role of APRN, there are different requirements and regulations that vary from state to state. This prevents a seamless healthcare system, which is one of the key points in this week's lesson. Education requirements for minimum level of entry, accreditation standards, and certification requirements are just a few of the reasons why these inconsistencies exist (Chamberlain College of Nursing [CCN], 2015). The Advanced Practice Nursing Consensus Work Group and the National Council of the State Boards of Nursing collaborated to create the Licensure, Accreditation, Certification, and Education (LACE) Consensus Model to redesign healthcare in the United States (Stanley, 2012). The LACE Consensus Model would allow for better healthcare delivery across the United States. There are several strategies that could be implemented to achieve continuity between state regulatory boards of nursing; One of which being, common education requirements for minimum level of entry. Historically, an APN may have graduated from a diploma program in nursing who later, obtained a specialized education often within the hospital setting (CCN, 2015). Over the course of my 23 year nursing career, I have witnessed an increasing requirement for education for general nursing practice. In years past, a licensed practical nurse (LPN) could work in a hospital setting whereas now, a nurse who has earned an Associate's Degree will be hired, but only if there is a commitment to obtain a Bachelor's Degree within the next three years of practice in the hospital system where I amemployed. I started out as an LPN and have earned an Associate's degree (ADN), a Bachelor's degree (BSN), and am obviously pursuing my Master's degree to remain current with nursing standards of practice. My ADN provided me with the technical education to perform as a nurse. My BSN provided me with more of a theory based way of thinking. Nurses gain insight to ask appropriate questions in order to determine the nature of a patient's complaint using theory and principles learned with advanced education (McHugh & Lake, 2011). If every State had the same education requirements , this would be a step in the right direction to more smoothly regulate the role of the APN. Jenica References Chamberlain College of Nursing. (2015). NR510 Leadership and Role of the APN: Week 6 lesson.[PowerPoint slides]. St. Louis, MO: Online Publication. McHugh, M. & Lake, E. (2011). Understanding clinical expertise: Nurse education, experience, and the hospital context. Research in Nursing and Health, 33(4), 276- 287. doi:10.1002/nur.20388 Stanley, J. (2012). Impact of new regulatory standards on advanced practice registered nursing: The APRN consensus model and LACE. Nursing Clinics of North America, 47, 241- 250. doi:10/1016/j.cnur.2012.02.001 Show LessKasey Shipp Week 6, Part 2 Dr. Duncan and Class, According to Hain & Fleck, (2014), NP practice is influenced by four policy and regulation initiatives: The Consensus Model, the Doctor of Nursing Practice Movement, the IOM report, and the Patient Protection and Affordable Care Act. The main goal is to have Full Practice Authority, meaning the ability to evaluate patients, diagnose, order, and interpret diagnostic tests, initiate and manage treatments (such as prescribing medication). Additionally, it is expected that NPs will meet his or her licensing state's educational and practice requirements or certification. Some states fail to have full practice authority. Also, restrictive payer policies restrict some NPs from practicing independently. Finally, another barrier is the restriction to prescribe controlled substances. To better achieve better quality of care, it is essential that NPs deliver quality, efficient primary care in which NPs establish relationships with physicians and take an active role in care of patients. Hain, D & Fleck, L.. (2014). Barriers to NP Practice that Impact Healthcare Redesign. The Online Journal of Issues in Nursing; 19: 2. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAP eriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NPPractice.html Show Less Nicole CassedyPart Two There is an extreme shortage of primary care providers in the United States, with a projected deficit of about 40,000 primary care doctors over the next ten years (Flaskerud, 2010, p. 816). Advanced practice nurses (APNs) have the ability to improve access to primary care in our country, and research has shown that primary care provided by an nurse practitioner (NP) produces comparable outcomes to primary care provided by a physician (Flaskerud, 2010, p. 817). In order to improve access to care across the country, a streamlined system for nurse practitioner licensure, accreditation, certification and education (LACE) is essential. At this time, each state has its own regulatory agency for APN practice, prescribing authority and licensure (Watson & Hillman, 2010, p. 25). These various regulations make it difficult for APNs to move across state boarders in order to take another position or move to another area. The convoluted process of obtaining licensure in various states can prevent APNs from bringing much needed primary care services to populations in need. The National Council of State Boards of Nursing (NCSBN) helped to develop the Nursing Licensure Compact (NLC) which allows nurses to be licensed in their home state with the ability to practice in all other states who participate in the NLC. If all 50 states, the District of Columbia and United States territories adopt the NLC legislation, patient access to healthcare will improve substantially. This system does exist for APNs in some states, and can improve access to primary care by allowing NPs to more easily practice across state lines. It would also be beneficial for state boards of nursing to collaboratively agree upon which nursing program accreditation(s) and which national APN specialty certification(s) will be accepted for licensure. References: Flaskerud, J. (2010). Health care reform and meeting the needs for primary care. Issues in Mental Health Nursing, 31(12), 818-818. doi:10.3109/01612840.2010.496139 Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education, scope of practice, and liability issues. Journal of Legal Nurse Consulting, 21(3), 25-29. Show LessLeslie Garnerreply to Nicole Cassedy RE: Part Two Nicole, Fortunately I live in one of the states that are part of the Nursing Licensure Compact, which makes it easier if I want to move around, whether it be for my own career or just to move. Workforce studies predict a predict severe physician shortages within the next few years particularly in primary care. Approximately 70-80% of all Advanced Practice Registered Nurses (APRNs) provide primary care. Numerous studies in the last decade have been published documenting the critical role APRNs play in providing costeffective and high quality care. There is also an increased satisfaction with APRN care and lower costs associated with educating APRNs. With that being said, why is it so difficult to get licensure across the nation? On average, NPs who receive their master’s degree have spent 4-5 years in clinical training by the time they are awarded their degree. NPs who are enrolled in a Doctor of Nursing Practice (DNP) program often have 6-7 years of clinical training by the time they finish their education. If all states could agree on licensure requirements, I feel there would be more APRN practices across the nation and easier access to healthcare (South Carolina APRN Fact Sheet, 2014). South Carolina APRN Fact Sheet. (2014, March). Retrieved August 14, 2016, from https://www.sc.edu/study/colleges_schools/nursing/centers_institutes/center_nursing_leadership/ sc_onevoice_oneplan/aprn_bullet_points_2015.pdf Show LessUrvashi Shah Part Two Healthcare professionals will be challenged to meet needs of an aging and diverse population within an emerging primary care workforce shortage. Through education and training, NPs are prepared to serve in roles of primary care providers with the potential to make a substantial impact to improve clinical outcomes. The same trend and feeling would translate to the customers. Therefore, to protect the customers, the market has to be involved in the setting of the policies (Porter-O'Grady, 2015). Corporation is another strategy. To achieve marker protectionism and consumer protection, there has to be togetherness between the regulatory boards. The needs of the customers have to be put in the forefront and attended to accordingly (Yoder-Wise, 2013). When the needs are attended to as required, business would flourish and led concerns would be experienced (Yoder-Wise, 2013). Communication is an effective tool between boards to achieve the right outcome. The communication should start with the board members, where they raise the concerns regarding customer complaints, products being sold, and what can be done to increase sales. Complaints have to be taken positively, and communicated as first as they are noted. This boosts the growth of the boards if they are handled well (Yoder-Wise, 2013). The boards should also be aware of the product that is being sold. Not at any time should a consumer buy a product that is not up to date, or contaminated. A healthy relationship is kept to keep teamwork, which in return increases the number of sales (Yoder-Wise, 2013). To achieve continuity between regulatory boards, there are strategies that have to be put in place. The product being sold should have been well scrutinized regarding its safety before it enters the market. The representatives from the board that handle distributing the products need to keep communicationwith the rest of the board, especially regarding any feedback from the market. Porter-O’Grady, T., & Malloch, K. (2015). Quantum Leadership: Building Partnerships for Sustainable Health. Scott, E. S., & Yoder-Wise, P. S. (2013). Increasing the intensity of nursing leadership: graduate preparation for nurse leaders. Journal of Nursing Administration, 43(1), 1-3. Show Less Tammy Kill Part Two The role of the Advanced Practice Nurse (APN) varies greatly from state to state. This can affect the quality of education and the requirements for education that should be a standard practice for all APNs. Standardization of the role of the APN will have many benefits for both the practitioner and the quality of patient care. Standardization would allow for the NP to work at the full extent of his or her skill set utilizing all areas of their education and expertise (The National Academy of Sciences, 2011) The State Board of Nursing for each state should have representatives that collaborate with each other to develop a plan to standardize the requirements for the APN and the certification and continuing education required. Across the board this will help to define the roles and scope of practice of all areas of specialty of the APN (O’Grady, n.d.). Standardization in the APNs role should include all areas of the APN and specifically; the Certified Nurse Practitioner, the Certified Nurse Midwife, and the Certified Nurse Anesthetist (CRNA). In 45 states CNPs are able to prescribe medications, 16 of those states without collaboration of a physician. Standardization of the role and requirements of the APN will bring a continuity to the education requirements for the CNP. This standardizationwould help the nurse and the patient to assure the level of education and care will be equivalent across the board. The complexity of the delivery of care for the patient should be built on a standard of care that the patient can recognize and trust. References O’Grady, E. (n.d.). Advance practice registered nurses: The impact on patient safety and quality. The American Journal for Nurse Practitioners. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2641/ The National Academy of Sciences (2011). The future of nursing: Leading change, advancing health. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK209871/ Show Less Michelle Ince Discussion Part Two Advanced Practice Nurse (APN) practice varies from state to state due to the fact that states are granted the authority to guide practice (Rigolosi & Salmond, 2014). Because of this, the scope and practice of APNs within each state varies widely. At this present time, in order for better continuity between state regulatory boards to happen, changes must be made at the state and national level. One strategy to get these changes made is by utilizing the Kingdom model of policy analysis. The Kingdom model “serves as a framework for analyzing and discussing state practices taken to achieve policy change supporting independent practice for NPs” (Rigolosi & Salmond, 2014, p. 650). The Kingdom model states that there are three “streams” of activity through which action is taken. All three streams happen simultaneously and independently, and when the three streams converge, this is when change can happen (Rigolosi & Salmond, 2014). The three streams are called the problem, political, and policy streams (Rigolosi &Salmond, 2014). The problem stream can be defined as issues that are going on that have risen to the level where policy makers are taking notice (Rigolosi & Salmond, 2014). This problem stream for the purpose of our discussion can be the differences between states regarding APN scope and practice. The policy stream consists of possible solutions to the problems as discussed in the problem stream (Rigolosi & Salmond, 2014). Solutions are brain stormed until one is seriously considered and is considered to be possibly feasible. The political stream is independent of the other two streams. This stream consists of elements such as public mood and interests groups. According to the Kingdom model, where these three streams intersect, a solution can be found (Rigolosi & Salmond, 2014). Using this model, nurses must become active and present their cases to both the policy makers and the public. Enough interest must be raised in each of these realms in order for change to be achieved. When this happens, change might be made to make APN role and scope more standardized on a national level. By using the Kingdom model, the problem of variances of scope and practice will be made visible on the public and political levels. Possible solutions must coincide with public interest. When these things happen at the same time, change is possible. Reference Rigolosi, R., & Salmond, S. (2014). The journey to independent nurse practitioner practice. Journal Of The American Association Of Nurse Practitioners, 26(12), 649-657. doi:10.1002/2327-6924.12130 Show Less Leslie Garner Continuity Between States According to Yonder-Wise (2010), consistent regulation of the advanced practice registered nurse (APRN) role and scope should be seamless across the health care system. Licensure, accreditation, certification and education (LACE) for the APRN creates a framework for the future of the practice. To achieve the expectations of the consensus model, every state must agree to the same terms, definitions, and conditions set forth in the document (Yonder-Wise, 2010). One way to achieve this would be to have a licensure system controlled by thegovernment. By having one organization control the licensing regulation for professions, there would be no questions on a state to state basis as to what an APN could or could not do. Insurances would be able to bill easier and there would be no differences state to state when it comes to practicing. It would also be easier for APNs who move between states or practice in multiple states. Instead of having a license that is only good in the state of South [Show More]

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