SCOPE OF PRACTICE AND ROLE OF THE NURSE PRACTITIONER – Flashcards

Scope of practice identifies who the nurse practitioner is, what the nurse practitioner does and where and how the nurse practitioner provides care. It is based on a set of philosophic beliefs and is clarified by a set of definitions. Beliefs and definitions may change as social trends emerge and professions change. The scope of practice is determined by the profession, with considerations of legal, ethical, political, economic, and educational variables. Visit the ANA for APRN scope of practice at: http://www.nursingworld.org/EspeciallyForYou/AdvancedPracticeNurses/Scope-of-Practice-2

The sole authority in Michigan, in defining the scope of practice resides with the State Board of Nursing (SBN). There are no statutory or regulatory requirements for physician collaboration, direction or supervision. In many states the SBN has authority for scope of practice but has a requirement for physician collaboration or physician supervision. In a few states the SBN and the State Board of Medicine have joint authority over scope of practice and in 2 states there is no title protection and NP's function under broad nurse practice acts. If you are not from MI, check your state for scope of practice for NP's and prescriptive authority.

Comprehensive histories and physical exam Diagnose and treat acute health problems Diagnose, treat and monitor chronic illness Order, perform and interpret diagnostic tests Prescribe medications and other treatments Provide prenatal care and family planning services Provide well child care including screening and immunizations Provide health maintenance care Promote positive health behaviors and self care skills and education Health counseling and guidance Collaborate with physicians and other health professionals as needed. Assessment of clients that included analysis, synthesis, and application of nursing theories and, modalities Admission of clients to hospitals and nursing homes and management referral to other providers and resources Prescription of medications and therapeutic agents.

Reduce repeat illness episodes and disabilities Prevent illness Optimize health in patients and their families Empower patients and families Coordinate community resource use Promote wellness-oriented self care Provide comprehensive health education Teach prevention/health promotion Coordinate care for optima utilization Negotiate the health care system as a patient advocate

Provider Educator Counselor Advocate Consult Manager Researcher Theorist Mentor

Standards of care are based on the scope of practice, and are a means to describe, measure, and guide the achievement of excellent NP care. Often you will see practice standards for a particular disease process or diagnosis and these serve as a measure of what would be considered competent care.

Prescriptive Authority Prescriptive authority in MI is based on 4 things: The 1980 Attorney Generals opinion (his interpretation of the language in the practice act) that allows physicians to delegate prescriptive authority to RN's (excluding controlled substances). The Occupational Regulations section of the Michigan Public health Code The Board of Medicine administrative rules that allow delegation of prescriptive authority to nurses The Board of Osteopathic Medicine Administrative rule rules that allow delegation of prescriptive authority to nurses

Thus in MI, NPs do not have independent prescriptive authority. It is delegated to us by physicians. In many states CNS and NPs have independent prescriptive authority that is granted by statutory authority (a bill or amendment to a practice act that has passed the legislature-it usually allows for the most autonomy in prescribing for NPs), and rarely in some states the Board of Pharmacy can have a waiver that allows NPs to prescribe. Check your state for prescriptive authority regulations

Relationship with Physicians Public visibility and professional recognition for NP's are at their highest levels. Yet there is still some animosity from the medical community when NP's seek to be identified as primary care providers. The American Medical Association (AMA) actively lobbies to prevent further inclusion of non-physicians into physician territory. They state that physicians are responsible for the quality of all patient care and support physicians as the only one to make independent pharmacological judgments for patients. They oppose any attempts to empower non-physicians to become unsupervised medical care providers. Over 100 research studies have shown that NPs provide high-quality, cost effective care with patient outcomes equivalent or higher than physician care.

The growing NP favorable reimbursement policies have allowed some NPs to compete economically with physicians. The AMA seeks to limit this competition. The majority of physicians who work with NPs are supportive of nurse practitioner practice and see benefits to having a nurse practitioner work with them in a collaborative relationship.

Improving the relationship between physicians and NP's. Education of patients, physicians, legislators, and the media to gather support for NP's. NP's need to be able to explain how they differ from physicians in philosophy, scope of practice, and authority to practice. They need to be knowledgeable of the current barriers to practice. They need to know that they are: Well educated Know their practice limits Consult with and work closely with other health care providers Have years of experience as nurses Are well accepted by patients Continued quality assurance of NP's professional skills will need to be demonstrated via continued competence. The creation and use of one national advisory board to standardize practice acts nation wide would strengthen the nurse practitioner's ability to practice.

American Academy of Nurse Practitioners. Nurse Practitioners. Documentation of quality and cost effectiveness. Briefly review the documents on this site. http://www.aanp.org/component/content/article/28-press-room/2012-press-releases/1000-nps-the-key-to-accessible-and-cost-effective-primary-health-care

The National Council of State Boards of Nursing, (NCSBN) www.ncsbn.org The American Academy of Nurse Practitioners, www.aanp.org, Capital Station, LBJ Building, P.O. Box 12846, Austin TX 78711, 512-442-4262 The Michigan Council of Nurse Practitioners, www.micnp.org American Nurses Association, Web address: www.nursingworld.org Michigan Nurse Association, 2310 Jolly Oak Road, Okemos, MI 48864-4599, 517-349-5640, MNA web address: www.minurses.org JOIN your professional organizations today. There are student rates. The profession cannot advance without you!