Np's Scope Of Practice
Jessica, I agree with you 100%. The differences and variation in the ANP scope of practice among the nation, does not allow for others especially legislators, to have a clear view of the ANP nurse and what it can be accomplish it all the restrictions and barriers were eliminated. It will also change the public perception and attitudes towards nurse practitioners. I firmly believe that NPs have not only the power, but the ability to improve and make sustaintials changes to our health care system, Excellent
It is the most influential source of insight for PA’s practicing in MI. Its purpose is to “encourage its members to abide by the AAPA code of ethical conduct”, “serve as a public information center with respect to its members, health professions, governments agencies, and the general public”, and “ represent its members in matters of legislation in order to maintain and further develop the practice of the profession” 2. Since the mid 1970s, MAPA has been an important advocator for its members and has not only worked on the improvement of working environments for physician assistants but is also involved in politicizing for enhancements in the scope of practice as well as raising a voice on actions that may impose a threat on the Physician Assistant occupation. At the turn of the century, the ‘Barriers to PA Practice’ list was created by MAPA in order to “overturn all of the antiquated laws disallowing PAs to practice in aspects of care or allowing negative interpretation by administrators of health plans and State agencies” 3. Since this list was created, many new public acts have been passed allowing physician assistants in Michigan to gain more independence. Some important advancements that occurred during this time included MAPA’s involvement in overturning office supervision guidelines insurances such as Blue Cross Blue Shield of Michigan imposed on physician assistants as well as overturning the insurances refusal to pay surgical PAs, Public Act 281 which allowed referrals from physician assistant to a physical therapist, and Public Acts 124-126 which approved Physician Assistants to be added to a “list of professionals able to form professional corporations (PC) and professional limited liability corporations (PLLC) and clarifies that physicians and
These studies illustrates that NPs can play a key role in providing services to health care market. NPs provide a full range of high quality care to patients of all ages. These services include primary care, acute care, special health care services such as oncology, gerontology health, or women’s health to name a few (American Association of Nurse Practitioners (AANP), 2015). NPs practice in many health settings, including private physician office, hospital, urgent care site, emergency room, community health center, school, and others. Family Nurse Practitioners (FNPs) are NPs are primary care providers who focus on
Lindeke, Fagerlund, Avery, and Zwygart-Stauffacher (2010) noted that such APNs deliver anesthesia and anesthesia-related service in collaboration with other healthcare professionals. Lastly, APNs would be a great addition to New Mexico Essential Healthcare because they not only assume active leadership roles, but also serve as educators, patient advocates, and consultants (Zwygart-Stauffacher,
“Advanced Practice Professionals” means those health care professionals who are not physicians and dentists and who will function within a scope of practice but may practice independently on defined clinical privileges as defined in these bylaws. These professionals include physician assistants (PAs), advanced practice registered nurses (APRNs), certified registered nurse anesthetists (CRNAs), certified registered nurse practitioners (CRNPs), and clinical pharmacist specialists/clinical pharmacist practitioners (CPS/CPPs). Advanced Practice Professionals may have prescriptive authority as allowed by federal regulation, and/or state of licensure statutes and regulations, under the supervision of a credentialed and privileged Licensed Independent Practitioner when required. Unless privileged to do so, Advanced Practice Professionals do not have admitting authority. Advanced Practice Professionals may initiate prescriptions for non-formulary drugs or prescribe controlled substances in accordance with state of licensure statutes and regulations.
While licensed NDs can still work in non-licensure states, NDs are not allowed to work to the fullest extent of their training. Due to the restrictions on how much they can do for their patients, Naturopathic Physicians are not able to help their patients as much as possible. These restrictions hurt the patients in the long-run, because the Physicians cannot use every tool in their arsenal to help heal their patients. The number of states that have licensure laws has increased from 14 to 20, including the District of Columbia and two US territories, within the past 10 years (AANP). That means only 34% of the states have Naturopathic licensure.
Even nurse practitioners themselves can be perplexed about what they are legally allowed to do in their state. Much of the confusion revolves around the differences between physicians, physician assistants and nurse practitioners. In order to start to diffuse the confusion regarding the role of the NP, Buppert (2015) offers many definitions but one that is succinct and understandable is the one offered by a national NP organization relaying “Nurse practitioners are registered nurses who are prepared, through advanced education and clinical training, to provide a wide range of preventive and acute healthcare services to individuals of all ages”
In many states, physicians determine their scope of work, including their range of medical tasks and their method of supervision. However, some states have more explicit rules and regulations in place regarding both supervisory and practice requirements.” (Physician Assistant Career
Due to this group-mentality, they are typically once piece of a larger effort toward improving a patient’s outcome. It is in this ideology that physician assistants and nurse practitioners may seem most similar at their core. Furthering their similar qualities is their shared scope of practice. Both are able to take histories, complete physical exams and procedures, prescribe medication, order labs, diagnose and treat diseases, give referrals to out-of-office specialties, and educate patients when necessary. Although
According to Garment (2013), “The American Association of Medical Colleges (AAMC) estimates that the U.S. will face a physician shortage of over 90,000 physicians by 2020; a figure that’s expected to reach over 130,000 by 2025” (p.4). The increasing amount of money required for health care services from a physician is a driving force to pursue alternative ways of receiving primary care. According to The American Association of Nurse Practitioners (2013), “NPs in a physician practice potentially decreased the cost of patient visits by as much as one third, particularly when seeing patients in an independent, rather than complementary, manner” (p. 2). NPs are maintaining the standard of care and for a lesser amount for patients to pay. Mid-level practitioners are completing the same amount of work and improving the quality of care.
Students in high school and college endure the same questioning almost everyday: “What are you going to be?” For many students, their career choice flip-flops multiple times and will most likely change at least once before graduating college. For those wishing to go into the healthcare field, but not desiring to become a doctor, there is another path median of the more extreme courses of nurse and physician. The glorious light shining in the middle is a nurse practitioner. Because of its ambiguous nature, many people are not aware of the differences between a nurse and a nurse practitioner.
Each morning patients came in for assessment and the treatment team developed or altered existing treatment protocols. I longed to be part of this team, working to stabilize each patient so they could return home to pursue their goals. The nurses stood out to me as the team members at ground zero in the unit, working directly with patients, and advocating for them in meetings. As a Nurse Practitioner, I will provide this same standard of holistic care to my patients, taking into consideration their biological, social, psychological and cultural needs while developing and implementing treatment decisions.
Reimbursement Reimbursement for services may differ for NPs depending on the restriction of services they can provide as outlined by their state’s practice laws (Kaiser Family Foundation, 2011). Credentialing and payment that is managed by many health plans provide payment according to the services that an NP can provide in each state, or from a federal perspective, Medicare will only pay 85% of the full physician rate to a billing NP or Physicians’ Assistant (PA). This is because the laws are not unified throughout all 50 states (Cassidy, 2012). Many NPs do not feel that this payment model it fair for several reasons (S. S. Gordner, personal communication, July 13, 2016).
While the main focus of APNs is clinical practice and direct patient care,
The guidelines set by the NP’s Core competencies involves educational programs for nurse practitioner and are referred to as essentials behaviors for all NPs (The National Organization of Nurse Practitioner, ([NONPF],2017). As a future NP, this course has echoed the importance to critically examine information given by finding evidence to support and manage care for the individual or the population, which I will apply to my practice. This, in turn, will offer better treatment plan and optimize better patient outcome. Using the differential diagnosis to pinpoint the best possible diagnosis for individuals has helped me to use critical thinking about my patient and to find the appropriate plan of care.
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