The role of a nurse primarily focuses on providing hands-on care to all patients, in a variety of health settings. Nurses are responsible for addressing the physical and mental needs of the patients that range from complete care, to implementing interventions for prevention and management of illness. Nurses are also responsible for maintaining the dignity of their clients, while providing skilled, knowledgeable care (Esther Sangster-Gormley, 2013). The main purpose of hospital policies are required based on their characteristic of setting a general plan of action that guides the desired outcome of the health organization. This report will illustrate a professional activity that encompassed meetings for discussion on the hospital policy.
Participants and environmental context
I belong to an advanced practice registered nurse group (APRN) at the Kaiser Permanente, an integrated managed care consortium at California. My job requires me to conduct psychiatric consultation in the organisation. Our group comprises of 9 nurse practitioners (NPs) who are trained and educated to promote patient health and maintain it through appropriate diagnosis and treatment of the acute and chronic disorders. Our group is composed of FNP, PMHNP, nurse anethesists, nurse educators and midwife. Our professional activity includes holding meetings once in a month, where we discuss about the policies of the hospital and devise ways to enhance our independence, which does not require calling or consulting the MD at all times.
The regulatory requirements and licensure for NPs differ by state and the major issue discussed in the meetings pertained to independent NP practice. Independent practice by the NPs is a major step towards addressing and reducing the shortage of primary healthcare. Furthermore, at present the District of Columbia and 21 states have provided the approval of full practice for NPs that allows the professionals to diagnose, assess, interpret, and prescribe medications to their clients (Poghosyan t al., 2013). New Hampshire, Alaska, Washington and Oregon were the first states that adopted the expansion of the NP scope of practice during the 1980s (Kuo et al., 2013). The Kaiser Family Foundation states that an estimated 58 million Americans reside in areas, which has short supply of primary care providers that fails to meet the federal standards (Bay Area Council Economic Institute, 2018).
With the increase in the number of patients who are gaining access to medical care services, with the help of Affordable Care Act, and imminent retirement of one-third primary physicians over the next decade, NPs in several states have gained their independence and successfully established their autonomy in providing medical care without management of an MD (Yee et al., 2013). Thus, the primary objective of our meetings was to address lack of NP independent practice facilities in our organization. We aimed to formulate plans that would bring about amendments in the health policy, to allow us NPs to practice independently, without the consultation of MDs. We aimed to design strategies that would help the hospital enforce health policy that takes regulatory or legislative action, favourable to NPs, and empowers us to practice independently.
Impact of professional organization, advocacy and nurse leaders
Although nursing professionals have great potential in contributing to health policy development, through political action, nurses engaging in policy making often participate in policy committees of their employers and support certain professional organizations. Such organization will provide unparalleled networking opportunities, will allow interaction with mentors and seniors, provide access to continuing education, and influence excellence in practice (Wong, Cummings & Ducharme, 2013). Most organisations have been found to possess comprehensive advocacy efforts where collective power lies in the hands of the members. Belonging to the profession acts as a direct benefit and helps in influencing policy making at federal and state levels. Advocacy also helps NPs to act as liaison between the physicians and patients and allows the NPs to assist cleitns in understanding the diagnosis of the health condition. This facilitates the decision making process and improves health outcomes (Hanks, 2013). Nurse leaders also provide the skills, tools requires by NPs that allows the latter to accomplish the intended goals (Iglehart, 2013). Leaders have the responsibility and are accountable for the quality of care delivery, staff and patient satisfaction and the outcomes of the organisation. Thus, all of them play a crucial role in bringing about changes in the health policies.
Upon holding the meetings, we learnt that full practice or independent practice of NPs have been recommended by several states, medicine institutes and health and policy makers. We found that health outcomes of patients subjected to independent NP practice have proved as good as or better than that of other health providers (Bay Area Council Economic Institute, 2018). Furthermore, owing to the huge shortage of primary care providers, patients require better care services ([email protected], 2018). This has been identified relevant especially in the rural communities. Moreover, our discussion also helped us conclude that independent practice of NPs would not cost the taxpayers any huge sum (Spetz et al., 2013). Continuing NP education would also play an essential role in enhancing the quality of patient care and would help us to pursue advanced career options. We realized that in most instances, the MDs do not give new recommendations, upon consultation (Blais, Hayes, Kozier & Erb, 2015). Thus, independently diagnosing and prescribing medications to the patients, without the oversight of the MDs would save time. NPs were also found to practice at lower rates, when compared to primary care physicians in California.
I intend to attend conferences held at California for NPs, which will act as a forum and unify the voice for independent practice of NPs. The knowledge that I have acquired by participation in these meetings on health policy enforcement will help me adorn the role of a successful doctoral nursing leader in future. I would display a commitment towards my passion and purpose for caring for the patients, and would act as patient advocates, regardless of the crisis. I would try to measure patient satisfaction and become familiar with the core measure that are imperative for integration into independent NP practice. I would also try to develop realistic action plans that would built satisfaction among the employees.
To conclude, recommending changes in the legislation and health policies would successfully address the increasing healthcare demands, subsequently resulting in more utilization of health services by the patients. In accordance with the legislation of other states, full practice authority must be given to the NPs, since they are indispensable primary care providers. However, there is a need to continue education for rendering safe and effective care practices, independently to all patients.
Bay Area Council Economic Institute. (2018). Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost. Retrieved from https://canpweb.org/canp/assets/File/Bay%20Area%20Council%20Report%204-30-14/BAC%20NP%20Full%20Report%204-30-14.pdf
Blais, K., Hayes, J. S., Kozier, B., & Erb, G. L. (2015). Professional nursing practice: Concepts and perspectives (p. 530). NJ: Prentice Hall.
Esther Sangster-Gormley PhD, R. N. (2013). How case-study research can help to explain implementation of the nurse practitioner role. Nurse Researcher (through 2013), 20(4), 6.
Hanks, R. G. (2013). Social advocacy: A call for nursing action. Pastoral Psychology, 62(2), 163-173.
Iglehart, J. K. (2013). Expanding the role of advanced nurse practitioners—risks and rewards.
Kuo, Y. F., Loresto Jr, F. L., Rounds, L. R., & Goodwin, J. S. (2013). States with the least restrictive regulations experienced the largest increase in patients seen by nurse practitioners. Health Affairs, 32(7), 1236-1243.
[email protected] (2018). Where Can Nurse Practitioners Work Without Physician Supervision? Retrieved from https://onlinenursing.simmons.edu/nursing-blog/nurse-practitioners-scope-of-practice-map/
Poghosyan, L., Nannini, A., Stone, P. W., & Smaldone, A. (2013). Nurse practitioner organizational climate in primary care settings: Implications for professional practice. Journal of Professional Nursing, 29(6), 338-349.
Spetz, J., Parente, S. T., Town, R. J., & Bazarko, D. (2013). Scope-of-practice laws for nurse practitioners limit cost savings that can be achieved in retail clinics. Health Affairs, 32(11), 1977-1984.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of nursing management, 21(5), 709-724.
Yee, T., Boukus, E., Cross, D., & Samuel, D. (2013). Primary care workforce shortages: Nurse practitioner scope-of-practice laws and payment policies. National Institute for Health Care Reform Research Brief, 13, 1-7.