Family Nurse Practioner
Family Nurse Practitioner (FNP) in family surburban clinic
The paper provides information on an advanced nursing role (Family Nurse Practitioner). It consists of the requirements of the nursing role in terms of certification, education qualifications, and also the persons responsible for certifying nurses for this role. The paper discusses the job duties associated with the practice. It creates the understanding of collaborative associations that promote success of the nursing role. The paper identifies various issues (environmental) which influence nursing practice.
FNP’s are not just primary care givers as it was in previous years but their roles have evolved to include the treatment of both physical and psychological situations, which is done through conducting: physical exams, ordering and interpreting diagnostic tests and comprehensive history taking. It is worth noting that the FNP’s are educated, certified and accredited nationally in areas of: Pediatrics- under pediatrics they can serve in pediatric critical health care, acute care, pediatric oncology and general pediatrics (PNP), gerontology (GNP), acute care (ACNP), adult health (ANP), neonatology (NNP) (Codina, 2007).
The scope of practice for FNPs; vary widely, from state to state as well as internationally. However the core principles that define the characteristics of APNs as a professional nurse whom; integrates research and research tools in the discharge of their responsibilities all the while maintaining a high degree of professional autonomy and independent practice. An APN is also characterized as an individual who has advanced health assessment expertise, which incorporate skills in diagnostics (Hamric, Spross & Hanson, 2008).
Small-scale clinics may benefit immensely from the services a FNP renders; considering the expertise, they offer on many levels. Considering an FNP who discharges the role of a certified nurse anesthetist (CRNA), shows that by the time the patient is at the operating table, he would have been prepared for surgery adequately mentally to know what exactly to expect during the surgery and the care to get after surgery. If the health center has the expertise and tools for the surgical procedures; then it can be much easier, efficient and very effective for the clinic to offer surgical service.
FNP’s that offer pediatric care are very vital especially in small communities that may lack the services of a fully fledged pediatrician, but also when the child needs constant advanced care, the nurse can actually provide the necessary care full time when employed directly by the family. Practicing nurses who are not APNs may not cater to the needs of the child at full capacity. In their training; the APNs are imparted diagnostic tools so that they can actually help a small suburban clinic that lack the services of a full time pediatrician, the APN can competently carry out this role and if there is any specialist follow up then the protocols to resolve the diagnosis is engaged. These protocols and delegation of roles vary from state to state (Codina, 2007).
Minor surgery like the one the removal of an appendix can be done in a clinic within a community without necessary traveling far especially for emergencies, the nurse can competently handle the cases saving time and money as well as bringing convenience to the residence of the area. Consequently, the FNP conducts the follow up procedures at the environment the patient finds himself or herself in. For instance, Texas state College caters largely to a student population. One of the many programs offered is the sports department where students play basketball, football, soccer or any other sporting discipline. During the course of the sporting activity, players might sustain injury that may need surgical interventions. In relation to this factor is the fact that the population housed in the college is significant to warrant the college to have a fully equipped theatre stocked with the tools needed to alleviate the injuries surgically if possible and also to conduct simple minor surgeries (Cody & Kenney, 2006). The nurse would be invaluable since she can perform dual responsibility of providing primary care at the same time discharging her expertise service as a nurse anesthesiologist. When translated to the role of a FNP, then the nurse can follow up on the improvement of the victim post admission from the facility.
This role requires the nurse to have completed a Bachelor’s of Science degree in nursing. Principally one must first be a qualified and registered nurse before proceeding to be a nurse anesthesiologist. By law before one is approved to be in this line of specialization; they must have a minimum of one year full time experience serving in an high dependency setting like the. ICU. After complying with the fore mentioned requirements, the next step is applying to the Council on Accreditation (COA) a program that relates to nurse-anesthesia Hamric et al., 2008).
In Texas, the scope of practice APNs is defined as activities that a healthcare provider performs in the delivery of patient care services. The type of patient the Practioner tends to define the scope further. Under section 301.002 sub-sections 2 defines professional nursing as: “The show of an act that needs significant particular judgment and skill, the appropriate conduct associated with knowledge of biological, physical, and social science as acquired by a fulfilled course in an accepted school of professional nursing” (Brixey, 2008).
Since a family practice nurse is an example of an advanced practice nurse, then they are subject to sub-section 301.152, which describes who an ANP is. It states that an ANP is a registered nurse approved by the state board of nurses (BON) to discharge the duties as an ANP. The law stipulates that they practice based on completion of an advanced educational training program. It includes a nurse practitioner, nurse mid wife, nurse anesthetist and clinical nurse specialist.
Legislation gives the board the mandate to regulate and issue pertinent licenses to all the FNPs. Such licenses include the statute that requires the nurses to renew their advanced practice nurse’s drug prescription privileges (Cody & Kenney, 2006). The state of Texas also describes that for one to be recognized by the state as a trained nurse then one must first complete the needs of the given course of study. The course entails clinical practice of a school or education program; which is accredited by a national nursing accreditation council or is approved by another state and the board subject to subsection (d4) of the TX BOD act; or finally is approved by the board.(Certified Registered Nurse Anesthetist playing their functions as APNs under the FPN role) . CRNAs therefore must first start on the level of registered licensed nurses as per the Texas law. The law goes a step further and distinguishes the administration of anesthesia in three categories. The stipulation holds that if a CRNA administers anesthesia then it becomes a nursing function and therefore she is in charge of the patient and needs no direct supervision and therefore she is not culpable if the result is fatal and is ascertained that her competency is not in doubt.
The law further states that if an anesthesiologist administers anesthesia, then it becomes a medicine function. This means that the nurse is not therefore qualified to interfere in the delivery of the anesthetic but her function is subject to the guidelines issued by the doctor or anesthesiologist. Finally, if dentistry administers the same then it is considered a dentistry function. However, there is provision for delegation of this role provided the parties to the delegation of roles are; sane, competent and qualified subject to supervision of the lead delegating entity such as dentists or surgeons.
Presently the Public Health code allows health professionals in the medical field who hold licenses to delegate certain acts, to licensed or unlicensed individuals to carry out certain tasks. However, there are stringent guidelines that inform the procedure on how this can be accomplished. Specific to the administration of anesthesia, the law states that the delegating physician MUST be available in the health facility as at the time the procedure was done. If it was during the course of surgery then the delegating physician must be performing the material surgery.
Suits filed in a court of law challenging the legitimacy of nurses administering anesthesia are: Frank v.South of 1917, Holgdins and Crile in 1919 and Chalmers-Francis v. Nelson of 1936. All were found in support of the nursing profession.
The JCAHO’s impact to this relevant but not mandatory; accreditation of CRAN’s is already competently dealt with by the national agencies and state boards. What the JCAHO’s accreditation delivers is the raising the profile of the Practitioner. Overall the fact that the commission cites areas of improvement helps the entire practice to attain high standards thus, providing a competitive environment.
Abuse of various anesthetics whether for recreational purposes or using banned medicine to perform anesthesia is monitored by the DEA and the National Pharmacy Board. The NPB issues a list of all banned substances as well as give approval to new medicine allowed in the market. These agencies help in enforcing the law that governs the use of various general anesthesia medications. These agencies impact this role positively if properly followed since their work complete the ethics and rules that inform the procedure.
CRAN’s role in the medical field is aided by the fact that there are now many institutions that offer the course. FNPs; gain from the fact that they can access school materials online or on part-time basis. This has the dual effect of giving the nurse both clinical experiences while learning. Accreditation agencies are coming up whose existence is aided with the support of both the state and federal governments. This ensures the nurses offering this expertise role; are qualified and competent persons.
According to a research conducted in 2010; showed that CRNA’s who worked independently without supervision were as effective as full fledge anesthesiologist and that having the former was more cost effective than just the latter. Justifications to this research can be deduced as follows: CRNA’s perform dual roles; the nursing role of providing primary health care while filling the position an anesthesiologist plays. The American Association of Nurse Anesthetists commissioned this study. This is an illustration of how FNPs who majored in nurse anesthetists benefit the community they operate in.
CRNA program in the end brings about a convergence of responsibilities to one individual who can sort out a problem on the spot without having to involve many people an exercise that wastes time and money. Pre-surgery and post surgery functions care to patients is easy and convenient. Hospitals with a large staff can actually trim down the redundant workers whose roles are duplicated elsewhere and so this will lead to having a lean mean team, which is effective and does not take up a large chunk of the hospitals budgetary allocations in remuneration and therefore the extra funds go into equipping the hospitals. For small community health centers, this advantage will save lives of many people who require minor life saving surgery.
Bearing in mind the tough financial climate the country is in, CRNAs give a solution to the many health centers that have limited budgets. Experienced practitioners can offer supervisory roles to their in-experienced counterparts. Consequently, the hospital saves a substantial amount since the CRNAs earn a fraction less than anesthesiologists (Cody & Kenney, 2006).
Institutions that work collaboratively with this role include; Anesthesiologist Association of America, Medical Boards of the individual states where this role is practiced, American Association of nurse Anesthesiologists, Department of health, Accreditation agencies. These institutions play complementary roles to the effect that they offer assessment of the nurse’s competency in discharging their duties as anesthesiologist as well as providing supervisory protocols between the CRNAs and the anesthesiologist (Horton, 2010). Accreditation agencies certify that indeed the persons practical knowledge of the field is not just reserved to theory but practically the nurse is well versed (Watson, 2008). The state medical board works to issue supervisory role in the practice of medicine providing the link between the law and the nurses. In addition, the board ensures that all players in the sector play fairly and describes punitive measures if the law is broken.
National pharmaceutical agencies provide a list of all controlled drugs while giving specific instructions on how certain medication maybe administered. Any deviation or abuse then leads to the DEA’s involvement in investing any impropriety and actually arresting the suspect; since the medical boards have limited powers when it comes to conducting arrests.
As established in subsequent sections of this paper, the CRNA’s are under the hospitals chain of command and authority. However, there is distinction between regular nurses and the ANP’s, hospitals should have their chief matron as an APN, since this position requires the head to be firstly a general practice nurse (Masters, 2009). The office can therefore handle both sides without bringing about divisions in the hospital workforce. Sustaining this effort is the use of peer publications on ethical and unethical practices such that the community of nurses involved in this specific role hold the errant nurse culpable.
Political goodwill to maintain this role can be achieved through appealing to the boards of the hospitals and the state’s health department heads. This is achieved especially in the case of veterans who undergo pain therapy. Political goodwill is actively presented to the program since veteran care programs inform the electorate on how they may vote. Veterans embody patriotism and selflessness if a politician seeking office neglects a policy that addresses the veterans’ medical needs then it would work to his/her detriment. Funding is then secured by the presentation of a strong proposal in support of such roles accompanied by figures to further augment the argument.
In every assessment of how productive an undertaking is; success or failure is translated through numbers. This implies that the parameter used to gauge the success or failure of this role is by comparing mortality numbers of the patients who died as a result of wrong dosage of anesthetic, administered by an NA with those from an anesthetist, and finally with those at hand; finally consider figures from the two parties working together. That way the final figure reaches true objectivity without bias.
Conducting patient satisfaction surveys on the individuals who were served by NA’s would lead to specific responses of before surgery and after surgery care, and would give an indication on the NA’s client service, and not just the medical perspective of administering the drugs.
In conclusion, the role of NA has its standing validated by historical facts as well as legitimate accreditation by agencies that give credence to the theory leant in school combined with clinical experience (Duncan & DePew, 2011). FNP’s need to branch into different specifications to provide extra expertise to small community hospitals enriching the services rendered to the community. There has been no substantial numbers and figures to prove that the NA role has not had any figures to prove that the role has not caused any deaths directly due to incompetence or neglect.
Substantive agencies have also worked together to ensure the role is successful. Outpatient services such as pain management for veterans and the elderly has seen the role get more funding and increased scope of operations. Legal statutes have also given credence to this role with the law providing guidelines and defining the scope in which the role performs as well as the delegation of tasks procedures (Masters, 2006)
Understanding that anesthetics scope of work is not just limited to administering anesthesia, but also preparing the patient for surgery and giving after care services. The core mandate of any nurse whether a general practicing nurse or an APN, is giving primary care to the patient in all capacities and so the practice of nursing must be upheld and continued diligently to serve the community in general. Scientific methods of obtaining statistics and research must be employed to give the true picture of success of this role in all spheres of the vast health sector.
References
Codina, L.M.T. (2007). Family nurse practitioner certification: Intensive review. New York:
Springer.
Horton, B. (2007). “Upgrading Nurse Anesthesia Education Curriculum, Faculty and Students.”
retrieved from http://www.aana.com/newsandjournal/Documents/educnews167-170.pdf.
Masters, K. (2009). Role development in professional nursing practice. Sudbury, Mass: Jones
and Bartlett Pub.
Watson J, (2008). Assessing and measuring Caring in nursing, New York: Springer Pub. Co. Cody, W.K., & Kenney, J.W. (2006). Philosophical and theoretical perspectives for advanced nursing practice. Sudbury, Mass: Jones and Bartlett Publishers.
Hamric, A.B., Spross, J.A., & Hanson, C.M. (2008). Advanced Practice Nursing: An Integrative
Approach. New Delhi: Elsevier Health Sciences
Duncan, G., & DePew, R. (2011). Transitioning from LPN/VN to RN: Moving ahead in your career. Australia: Delmar Cengage Learning.
Brixey, J.J. (2008). Understanding Interruptions in Healthcare: Developing a Model. Texas:
ProQuest
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