usiness Influences and Advanced Practice Nursing Case Study

You are a family nurse practitioner (FNP) employed as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in 3 months. You are highly satisfied with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend.

Discussion Question:

What negotiation strategies should you use to propose a contract renewal? How does your role as a 1099 contractor benefit the practice over the W2 employees? What evidence will you present to the practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may be willing to provide under your contract. Use logical reasoning, and provide evidence-based rationales for your decisions.

NR510 Leadership and Role of the Advanced Practice Nurse

NR510 All Weeks Discussions Week 4 Discussion

Organizational Change and Ethical-Legal Influences in Advanced Practice Nursing Case Study

You are a family nurse practitioner employed in a busy primary care office. The providers in the group include one physician and three nurse practitioners. The back office staff includes eight medical assistants who assist with patient care as well as filing, answering calls from patients, processing laboratory results and taking prescription renewal requests from patients and pharmacies. Stephanie, a medical assistant, has worked in the practice for 10 years and is very proficient at her job. She knows almost every patient in the practice, and has an excellent rapport with all of the providers.

Mrs. Smith was seen today in the office for an annual physical. Her last appointment was a year ago for the same reason. During this visit, Mrs. Smith brought an empty bottle of amoxicillin with her and asked if she could have a refill. You noted the patient’s name on the label, and the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber. The patient admitted that she called last week concerned about her cough and spoke to Stephanie. You do not recall having discussed this patient with Stephanie nor do the other providers in the practice.

Discussion Question:

What are the potential ethical and legal implications for each of the following practice members?:

Medical assistant

Nurse Practitioner

Medical Director

Practice

What strategies would you implement to prevent further episodes of potentially illegal behavior?

What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice.

NR510 Leadership and Role of the Advanced Practice Nurse

Week 5 Discussion – Conflict at the Office Discussion

You are a family nurse practitioner working in an outpatient primary care office of a large hospital system. The practice has been operating for over 15 years, and many of the administrative and clinical staff were hired when the practice opened. You have been in the practice for less than 3 months. In that short amount of time, you have witnessed several of the clinical staff engaging in heated arguments with each other, sometimes in patient areas. You overhear an argument occurring today between two staff. You pick up a patient’s chart and notice a very low blood pressure that the medical assistant failed to notify you about. When you confront the MA, she states that she was going to report the vital signs to you when she became engaged in the heated argument you overheard and forgot to notify you.

Unfortunately, this pattern of behavior is not unusual in this practice. Working with staff who cannot cooperate effectively can negatively influence your ability to spend time with patients, can impede the flow of patients through the office, and could impact patient safety.

Discussion Question:

What are the potential ethical and legal implications for each of the following practice members?:

Medical assistants

Nurse Practitioner

Medical Director

Practice

What strategies would you implement to prevent further episodes of potentially dangerous patient outcomes?

What leadership qualities would you apply to effect a positive change in the practice? Be thinking about the culture of the practice.

Provide rationales and evidence to support your decisions

NR510 Leadership and Role of the Advanced Practice Nurse

NR510 All Weeks Discussions Week 8 Discussion

Reflection on Achievement of Outcomes

Reflect back over the past eight weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #4, the MSN Essential II, and the NP Core Competencies #2.

Program Outcome #4

Integrate professional values through scholarship and service in health care. (Professional identity)

MSN Essential II: Organizational and Systems Leadership

Recognizes that organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making, effective working relationships, and a systems perspective.

NP Core Competencies

# 2 Leadership Competencies

Assumes complex and advanced leadership roles to initiate and guide change.

Provides leadership to foster collaboration with multiple stakeholders (e.g. patients, community, integrated health care teams, and policy makers) to improve health care.

Demonstrates leadership that uses critical and reflective thinking.

Advocates for improved access, quality and cost effective health care.

Advances practice through the development and implementation of innovations incorporating principles of change.

Communicates practice knowledge effectively both orally and in writing.

Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus. NR510 All Weeks Discussions

 

 

MORE INFO 

The four APN roles

Introduction

The Advanced Practice Registered Nurses (APRN) role is a combination of many different specialties, including but not limited to: CNS, CNM, CRNA and CNP.

Clinical Nurse Specialist (CNS)

As the name suggests, CNSs are advanced practice nurses who provide direct patient care in a variety of settings. They can be found in hospitals and clinics as well as home health agencies and nursing homes.

CNSs often have additional responsibilities beyond their primary role as an APN. For example, they may assist physicians with managing patients who are on chronic medication regimens or in need of specialized care (e.g., those with Alzheimer’s disease). In addition to providing direct patient care during office hours or after hours when needed by a doctor’s order, CNSs also work on committees that make decisions about changes regarding medications and procedures within their respective organizations—such as whether new drugs should be used instead of old ones because there might not be enough evidence supporting its safety yet; whether it would be better if more patients were treated at home instead because research has shown this can reduce costs while improving quality outcomes like faster recovery times from surgery).

Certified Nurse Midwife (CNM)

CNMs are the primary care provider for women throughout their childbearing years. CNMs provide prenatal, intrapartum and postpartum care. They also provide gynecologic care for women of all ages. CNMs are midwives who have completed additional training as a Nurse Midwife (NM) or Certified Nurse Midwife (CNM).

The American College of Nurse-Midwives (ACNM) is an organization dedicated to protecting and promoting professional nursing practice through education, research, advocacy and support services; they also offer continuing education courses that can help you advance your career in this field!

Certified Registered Nurse Anesthetist (CRNA)

CRNAs are experts in anesthesia and pain management. They’re registered nurses with advanced training in the field of anesthesia, and they work in hospitals, ambulatory surgical centers, rural health clinics or other health care settings.

CRNAs are skilled at managing patients during major surgeries such as heart surgery or neurosurgery. The role requires a high level of skill as well as knowledge about medications used during surgery that can affect anesthetized patients’ ability to breathe normally (such as morphine).

In order to become certified as an CRNA you’ll need:

• A bachelor’s degree from an accredited college or university with 60 credit hours including courses related to anesthesia/pain management (i.e., pharmacology) plus 12 credits in nursing-related coursework such as mental health counseling skills training or social work practice techniques; OR

• At least three years working experience under direct supervision either within a hospital setting or elsewhere where you provided direct patient care including administration of intravenous fluids/medications via syringe pumps; OR

• Three years post-high school education leading up to completion of coursework leading toward certification from one of several organizations offering this credentialing program

Certified Nurse Practitioner (CNP)

A Certified Nurse Practitioner (CNP) is a registered nurse who has completed a college-level degree in nursing and has passed the National Council for Continuing Education and Training (NCCET) exam. They provide care to patients with complex medical conditions or injuries, including those who have been injured on the job or due to an accident, such as car accidents.

CNP’s work with patients in hospitals, outpatient clinics and other health care facilities. They may also work in long-term care facilities or private practice offices where they see patients one-on-one rather than through groups of other nurses who are caring for similar types of patients at once.

In addition to treating common illnesses like colds and flu viruses or managing chronic conditions like diabetes mellitus type 2 diabetes mellitus type 2), CNP’s may also treat pain management issues such as back pain arthritis osteoarthritis neuromuscular diseases such as Parkinson’s disease Multiple Sclerosis

CNP’s are required by law within their state(s) where they practice medicine before practicing independently without supervision from another physician (i

Each APN role has a specialized area of focus.

Each APN role has a specialized area of focus. While each role may have the same responsibilities, they are different in how they approach those responsibilities and what type of person it takes to fill them.

APNs work in many different settings and have diverse backgrounds, making them well-suited for any type of health care setting. They’re trained to be problem solvers who can bridge gaps between systems or even manage their own departments if necessary (such as when an APN moves from one facility to another). APNs also need leadership skills so they can lead by example while demonstrating best practices through examples rather than preaching about them constantly like doctors do when talking about treatment plans with patients who know nothing about medicine!

Conclusion

We hope this post has given you an overview of the APN roles and how they differ. Each role has a specific area of focus, which is why it’s important to talk with your doctor about your needs as well as how they can best serve them.