All Discussions NR510 2018 June

NR510 Week 1 Discussion 1 & 2 Latest 2018 June

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Week 1: Barriers to Practice Discussion

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Read the assigned Hain & Fleck article, and discuss the following:

• What are the barriers to APN practice identified in the article? Describe these barriers in your own words.
• What are your impression of the barriers to APN Practice? (Are you surprised by these barriers? Is this new information to you? Have you ever been involved at the legislative level in nursing? Do these barriers concern you or motivate you toward becoming an APN?)
• Do these barriers represent Restraint of Trade? Why, or why not?
• Your thoughts on how nurses can influence these barriers.

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Week 1: Historical Development of Advanced Practice Nursing and Evidence-Based Practice Discussion

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Jessica, a baccalaureate prepared registered nurse, has been practicing for 8 years. Throughout her nursing career, she has worked in pediatric, surgical, and emergency departments. She worked as a floor nurse, a charge nurse, and she was recently offered a position in Nursing Administration. A stipulation for becoming a nurse administrator is that Jessica must attain a Master of Science in Nursing degree within 2 years of accepting the position. The offer prompted Jessica to contemplate her career. She is interested in returning to college, and wants to have greater impact on patient care but isn't sure she will find that in an Administrative role, nor is she sure is ready for the responsibility of becoming a Nurse Practitioner. Jessica has decided to explore the advance practice roles available in nursing in order to determine the best MSN track for her. Jessica must choose one role (CNP, CRNA, CNS, CNM) and apply to a program, but she is unsure about the different roles and their individual scopes of practice. One colleague states, "You know, Jessica, working as an NP is great because you can diagnose and write prescriptions, and the accountability will fall on the physician you are working with."

Discussion questions:

• Is Jessica's colleague right? Why or why not?
• Explore the four APN roles, and compare and contrast the pros and cons of each role against each other in order to determine the best choice for Jessica. Consider issues such as work environment, level of accountability, patient population, salary, and scope of practice. Include each role of the APN on the list, and be certain to provide appropriate rationales and citations.

NR510 Week 2 Discussion 1 & 2 Latest 2018 June

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5858 unread replies.7777 replies.

Karen, a registered nurse, decided that she wants to become a CNP. She applied and was accepted to the Family Nurse Practitioner program at Chamberlain College of Nursing. She received a course curriculum that outlined the courses necessary to complete her degree. One of the early courses in the program curriculum is NR501 Theoretical Basis for Advanced Nursing Practice.

You are a student colleague of Karen's enrolled in the same class. On the course Q & A Forum, Karen posted, "Nursing theory is outdated and is too broad and isn't useful for Advance Practice Nurses."

Discussion Question:

Is Karen right? Is theory important to APN practice? Why, or why not?

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Karen is still not convinced that Theory has any place in APN practice. Provide a specific example of how theory is relevant to APN practice in one of the four specialties (CNM, CNP, CRNA or CNS). Provide evidence to support your arguments.

NR510 Week 3 Discussion 1 & 2 Latest 2018 June

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You are a family nurse practitioner (FNP) employed as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in 3 months. You are highly satisfied with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend.

Discussion Question:

What negotiation strategies should you use to propose a contract renewal? How does your role as a 1099 contractor benefit the practice over the W2 employees? What evidence will you present to the practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may be willing to provide under your contract. Use logical reasoning, and provide evidence based rationales for your decisions.Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.

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As revenue generators, NPs must be aware of how their work contributes to the overall revenue of the clinical practice. You see 20 patients per day on average and take call every third weekend. According to Buppert (2011), an NP who sees 15 patients per day at $56 per patient visit, on average, brings in $840 per day. Allowing 1 week off for continuing education, 1 week off for illness, and 4 weeks off for vacation, this NP will bring in $193,200 a year, potentially. However, not all bills are paid. With a 90% collection rate—a reasonable collection rate for an efficient practice—this NP actually will bring in $173,880 per year. An NP who sees 24 patients per day will bring in $1344 per day, or $309,120 per year in accounts receivable. With a 90% collection rate, this NP will bring $278,208 to the practice (Buppert, 2011).

Establishing a salary can be a challenge for NPs. Deducting 40% of the NP's gross generated income for overhead expenses (rent, benefits, continuing education, supplies, malpractice, lab expenses, and depreciation of equipment) leaves $104,280 for the 15-patient-per-day NP and $166,925 for the 24-patient-per-day NP. Further deducting 15% of that figure to pay a physician for consultation services leaves $88,638 in salary for the 15-patient-per-day NP and $141,887 in salary for the 24-patient-per-day NP. Deducting 10% for employer profit leaves $79,775 in salary for the 15-patient-per-day NP and $127,699 for the 24-patient-per-day NP (Buppert, 2011).

What salary would you propose for the contract renewal? How does your salary proposal fit in with the community standard for an NP in a similar practice? Use logical reasoning, and provide evidence based rationales for your decisions. Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.

NR510 Week 4 Discussion 1 & 2 Latest 2018 June

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You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers.

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient's name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice.

Discussion Question:

What is your next logically sound course of action? Provide evidence to support your response.

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Upon further investigation, you learn that Stephanie spoke with the patient and called the medication into the patient's pharmacy without consulting with a provider. Stephanie claimed that the patient was insistent about needing a prescription. Because Mrs. Smith was coming into the office the following week for an appointment, she didn't think you would mind if the patient received the prescription early.

Discussion Question:

What are the ethical-legal concerns associated with this situation? What is your liability in this situation, if any? What is the practice's liability in this situation? What quality improvement strategies might you implement as an APN in this practice to safeguard your role and assure patient safety? Provide evidence to support your response.

NR510 Week 5 Discussion 1 & 2 Latest 2018 June

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You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient's chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you.

Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety.

Discussion Question:

What is your response to the medical assistant? What actions do you take to redirect the flow away from arguments and back to patient care?

Provide rationales and evidence to support your decisions.

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Leadership is not random. It is multifaceted and must be communicated as a stated plan to effect a change. Organizational leaders provide a vision and move others toward a common goal. This vision also reinforces the importance of teamwork in the workplace.

According to Buppert (2015), quality improvement and patient safety are inextricably intertwined. A work environment that supports teamwork and respect for other people is essential to promote patient safety and quality of care. Unprofessional behavior is disruptive and adversely impacts patient and staff satisfaction, the recruitment and retention of healthcare professionals, communication, teamwork and undermines a culture of safety. Unprofessional behavior is therefore unacceptable.

Discussion Question:

In this scenario, what evidence-based organizational strategies and management skills might you employ to resolve co-worker conflict? Reflect on conflict resolution strategies specifically for healthcare. How does teamwork increase patient safety? Provide evidence and rationales to support your decisions. Provide evidence and rationale to support your decisions.

NR510 Week 8 Reflection Latest 2018 June

Week 8: Reflection on Achievement of Outcomes

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Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential II, and the NP Core Competencies #2.

Program Outcome #4

Integrate professional values through scholarship and service in health care. (Professional identity)

MSN Essential II: Organizational and Systems Leadership

Recognizes that organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making, effective working relationships, and a systems perspective.

NP Core Competencies

# 2 Leadership Competencies

1. Assumes complex and advanced leadership roles to initiate and guide change.
2. Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care.
3. Demonstrates leadership that uses critical and reflective thinking.
4. Advocates for improved access, quality and cost effective health care.
5. Advances practice through the development and implementation of innovations incorporating principles of change.
6. Communicates practice knowledge effectively both orally and in writing.
7. Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus.