SCOPE OF PRACTICE AND ROLE OF THE NURSE PRACTITIONER

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Definition of NP: The nurse practitioner is a registered nurse….
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who has specialized advanced education and clinical competency to provide health and medical care for diverse populations in a variety of primary, acute, and long term care settings. A Master’s degree is required for entry-level practice and a DNP was proposed by 2015 Nurse practitioners provide nursing and medical services to individuals, families and groups. Emphasis is placed on health promotion and disease prevention as well as the diagnosis and management of acute and chronic illnesses. Teaching and counseling are major parts of the NP’s activities. Another term that is used to refer to nurse practitioners is Advanced Practice Registered Nurse or APRN or APN.
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What is the legal authority to practice as a nurse practitioner?
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The legal authority to practice as a NP is tied to the individual state statutes, which all are generally referred to as nurse practice acts. The basic statute governing NP practice is the Nurse Practice Act in each state. Currently, Michigan does not have Nurse Practice Acts but legislation is pending to change this The legal statement in Michigan that allows all nursing practice is in the Occupational Regulation Section of the Michigan Public Health Code Act 368 of 1978 http://www.michigan.gov/lara/0,4601,7-154-35299_63294_27529_27542-295888–,00.html Check your own state for regulationshttp://www.aanp.org/legislation-regulation/state-legislation-regulation/state-practice-environment
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Regulations
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Practice acts vary from state to state. Decision making process for practice acts can potentially be influenced by campaign contributions, lobbying, and political power struggles, and not on evidence regarding quality of care and potential impact on health care costs and access. As long ago as the PEW report of 1998 there was a recommendation for the creation of a national advisory board to develop standard for uniform practice acts for all health professions. These would be based on a wide range of evidence regarding the competency of a profession to provide safe and effective care. Each state could then enact and implement scopes of practice that are nationally uniform and based on the national advisory body.
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MI regulation
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The state of Michigan has “title protection” for nurse practitioners. Prior to obtaining a Michigan Board of Nursing Specialty Certification as a nurse practitioner the registered nurse may not “hold him or herself out” to the public as a nurse practitioner or use nurse practitioner credentials Check your state to see if title protection for NPs is in place.
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Scope of Practice
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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
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MI Regulation
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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.
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What are some of the activities and roles that NPs perform?
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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.
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What do NPs do that is different from other health professionals?
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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
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What are some of the roles that NP’s perform?
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Provider Educator Counselor Advocate Consult Manager Researcher Theorist Mentor
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Standards of Care
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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.
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What are current restrictions to NP Practice?
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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
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What are current restrictions to NP Practice?
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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
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What are current restrictions to NP Practice?
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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.
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What are current restrictions to NP Practice?
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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.
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What areas will impact the future of NP Practice?
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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.
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Evaluate research on nurse practitioner cost effectiveness and acceptability to patients
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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
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NP Practice Resources
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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!

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