Advanced Practice Nursing. Shawn Wells September 30, 2016

Transcription

1 Advanced Practice Nursing Shawn Wells September 30, 2016

2 Definition: Advanced Practice Nursing Registered Nurse Graduated from accredited NP program Passed National Certification Obtained License to Practice Diagnose Manage acute and chronic illness Advanced clinical training (Advanced Practice Registered Nurses Joint Dialogue Group Report,2008)

3 Primary Types of Nurse Practitioners Nurse Practitioner - NP Clinical Nurse Specialist - CNS Certified Registered Nurse Anesthetist -CRNA Certified Nurse Midwife - CNM (Advanced Practice Registered Nurses Joint Dialogue Group Report,2008)

4 History of Nurse Practitioners CNS Certified Nurse Specialist 1880 Psychiatric Nursing Program at McLean Hospital 1954 Rutger University first Masters program 1970 American Nurses Association recognized CNS 1995 Direct Medicare Reimbursement (Zaccagnini, 2017)

5 NP Nurse Practitioners 18, 105 total active Advanced Practice Nurses 1965 University of Colorado first NP program (Short, 2017, pp. 334) 1971 First independent nurse practice (Banigan, 1998) 1975 Nursing Training Act (Banigan, 1998)

6 CRNA Certified Registered Nurse Anesthetists First clinical nursing specialty late 1880 s 1877 first documented anesthesia case first school of anesthesia at St Vincent s Hospital in Portland, Oregon 1931 first professional organization: American Association of Nurse Anesthetists Primary anesthesia for military since WWI (Peterson, pp )

7 CNM Certified Nurse Midwife Primarily immigrants in Mary Breckinridge introduced midwifery model of care 1930 obstetrics became a medical specialty 1931 First nurse midwifery education program opened 1970 midwifery transitioned to middle class (Ringdahl & Saftner, 2017, pp )

8 Specialty areas include: Acute Care Adult Health Family Health Gerontology Health Neonatal Health Oncology Pediatric/Child Health Psychiatric/Mental Health Women's Health (American Association of Nurse Practitioners, 2013)

9 Sub-specialty areas include: Allergy & Immunology Cardiovascular Dermatology Emergency Endocrinology Gastroenterology Hematology & Oncology Neurology Occupational Health Orthopedics Pulmonology & Respiratory Sports Medicine Urology (American Association of Nurse Practitioners, 2013)

10 Comparison Nurse Practitioner Nursing model Masters or Doctoral degree Patient-centered Practice independently in 21 states and DC Physician Assistant Physician model Masters degree Disease-centered Licensed to practice medicine with physician supervision on site supervision not required (Practicing Clinician Exchange, 2016)

11 Role of Nurse Practitioner Evaluate Diagnose Manage Collaborate Ordering tests Prescribing medications Referrals (Nurse Practitioners in Womens s Health, n.d.)

12 Focus on Prevention Health promotion Education (American Association of Nurse Practitioners, 2013)

13 Education Admission Criteria: Must be an RN GPA year nursing experience (Frontier Nursing University, n.d.a.) Curriculum: 2 years / full time (includes summers) 46 credits 520 clinical hours (Frontier Nursing University, n.d.b.)

14 Program Basics First step Foundation Pathophysiology Health Assessment (Frontier Nursing University, n.d.c.) Third step Clinical 675 clinical hours (Frontier Nursing University, n.d.b.) Second step - Specialty Courses Pharmacology Primary Care (Frontier Nursing University, n.d.c.)

15 Nurse Practitioner Outcomes: Systematic Review 107 studies were included 56 Randomized Controlled Trials Patient outcomes compared to physician Emergency Department Hospitalization Length of Stay Patient satisfaction Patient perceived health Glucose control Lipid control Blood Pressure (Newhouse et al., 2011)

16 Outcomes Nurse Practitioners High Grade of Evidence Blood glucose levels comparable or better Lipid levels better Patient Satisfaction equivalent Patient rates of hospitalization/rehospitalization equivalent Mortality equivalent Blood Pressure levels equivalent (Newhouse et al., 2011)

17 Nurse Midwives High grade of Evidence Episiotomy rates are lower Lower to comparable vaginal vs operative deliveries Less analgesia Rates of third and forth degree perineal lacerations were lower (Newhouse et al., 2011)

18 Evidence Shows Patient Satisfaction: Emergency room nurse practitioners positively impact patient satisfaction (Jennings, Clifford, Fox, O Connell, & Gardner, 2015) A collaborative effort between NP s and physicians will lead to a higher quality health care systems. (Newhouse et al., 2011) Patient satisfaction is equivalent between nurse practitioner and physician (Newhouse et al., 2011) Care Outcomes: Patient outcomes are better with care provided by NP s and CNM s than care by physicians alone. (Newhouse et al., 2011) ARNP s provide effective and safe care. (Newhouse et al., 2011) Emergency room nurse practitioners improve patient quality of care. (Jennings et al.,2015)

19 Scope of Practice Boundaries nurse practitioners are legally allowed to practice within Each specialty has its own boundaries Each state has different laws regarding scope of practice (Short, 2017)

20 Florida Regulations: Nurse Practitioners can: Diagnose Treat Preform minor operations Prescribe drug therapies Order diagnostic tests under a board approved protocol between certified nurse practitioner and Florida licensed physician (Florida Board of Nursing, 2007)

21 Pearson Report Summary State of Florida received a Grade of F rank for patient access Mandated physician involvement Ranked A DC Alaska Maine Montana New Hampshire North Dakota Orgeon

22 Nurse Practitioners are not Authorized In State of Florida Sign a Death Certificate Sign a DNR Prescribe schedule I Narcotics

23 New Florida Regulations: Effective July 1, 2016 Order controlled substances Pharmacist available to dispense antagonist (Florida Board of Nursing, 2016b) Effective January 1, 2017 Prescribe controlled substances Schedule II, III, or IV (Florida Board of Nursing, 2016a)

24 References: Advanced Practice Registered Nurse Joint Dialogue Group Report. (2008). Consensus model for Advanced Practice Registered Nurse regulation: Licensure, accreditiation, certification & education. Retrieved from ConsensusModelforAPRNRegulation.pdf American Association of Nurse Practitioners. (2013). Your Partner in Health the Nurse Practitioner. Retrieved from Banigan, C. (1998). A Nursing History. [NP700; Module 2]. Frontier Nursing University, Hyden, KY. Florida Board of Nursing. (2007). Nurse Practice Act, F.S.A Retrieved from program/files/nurse-practice-act.pdf Florida Board of Nursing. (2016a) Access to Health Care Services, HB Retrieved from Florida Board of Nursing. (2016b). Ordering of Medication, HB Retrieved from Frontier Nursing University. (n.d.a.). Admissions Criteria: Master of Science in Nursing + Companion DNP. Retrieved from Frontier Nursing University. (n.d.b.). Family Nurse Practitioner. Retrieved from Frontier Nursing University. (n.d.c.). Family Nurse Practitioner Curriculum. Retrieved from http ://

25 Continued... Jennings, N., Clifford, S., Fox, A. R., O'Connell, J., & Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review. International Journal Of Nursing Studies, 52(1), doi: /j.ijnurstu Newhouse, R. P., Stanik-Hutt, J., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G.,... & Weiner, J. P. (2011). Advanced practice nurse outcomes : a systematic review. Nursing Economics, 29(5), Retrieved from Nurse Practitioners in Women s Health. (n.d.). Nurse Practitioner & Women s Helath Nurse Practitioner Practice Facts. Retrieved from Peterson, G. J. (2017). Traditional advanced practice roles for the DNP: Certified Registered Nurse Anesthetist. In M. E. Zaccagnini & K. Waud White (Eds.). The doctor of nursing practice essentials (3rd ed.) (pp ). Burlington, MA: Jones & Bartlett Learning. Practicing Clinicians Exchange. (2016). Do you know the difference between NPs and PAs. Retrieved from Ringdahl, D. & Saftner, M. (2017). Traditional advanced practice roles for the DNP: Nurse Midwife. In M. E. Zaccagnini & K. Waud White (Eds.). The doctor of nursing practice essentials (3rd ed.) (pp ). Burlington, MA: Jones & Bartlett Learning. Short, G. (2017). Traditional advanced practice roles for the DNP: Nurse practitioner. In M. E. Zaccagnini & K. Waud White (Eds.). The doctor of nursing practice essentials (3rd ed.) (pp ). Burlington, MA: Jones & Bartlett Learning. Zaccagnini, M. E. (2017). Traditional advanced practice roles for the DNP: Clinical Nurse Specialist. In M. E. Zaccagnini & K. Waud White (Eds.). The doctor of nursing practice essentials (3rd ed.) (pp ). Burlington, MA: Jones & Bartlett Learning.

26 Contact Information Shawn Wells, BS, BSN, RN, CCRN Any Questions?