Abstract
The above paper seeks to outline the role of Advanced Practice Registered Nurse (APRN) with a comparison of practices in two main states (Louisiana and Arkansas). The paper starts with a review of the prescriptive authority of APRN's in Louisiana, with an emphasis that the area faces a shortage of health professionals. According to the regulations of the state, it is a requirement that NP should offer prescription with an oversight of a physician. The collaborative practice agreement helps guide the two practitioners to work in close collaboration with one another in providing quality health care to the residents. However, a common practice in the two states is that NP's could offer prescription in the absence of the physician who should be within reach for consultation purposes. Like in Louisiana, Arkansas state laws restrict the APRN practices in the country for purposes of maintaining quality health care in the country. The state requires that the physician and NP ought to restrict themselves within their areas of specializations whatsoever. In the second section, the study appreciates the need for credentialing and delineating privileges in medical institutions for purposes of provision of quality health care. The paper further outlines the nature of collaboration that exists in health facilities, indicating that physicians and NP's should work in close collaboration to get a shared understanding of quality health care practices. The hospital management ought to oversee that the physicians and the nurses work closely with each other to avoid any risks to patient health whatsoever.
Part 1
Examination of the Prescriptive Authority of APRN's
Louisiana is one of the states that adhere to strict restrictions when it comes to nurse practitioner practice. However, most of the population in the country lives in areas that have a shortage of health professional which is a matter of concern. The house bill 951 that intended to allow nurse practitioners to offer prescription without the oversight of the physician in the region was highly rejected. In Louisiana, it is a requirement that nurse practitioners (NP) work closely through the collaborative practice agreement with a physician (Bryant-Lukosius et al., 2016). However, the collaborative practice agreement specifies the prescriptive authority of the nurses, a plan on how patients are admitted and how to conduct diagnosis among other key features. However, the copy of the agreement should be signed by both the nurse and the physician at least once a year.
Nonetheless, it is imperative to understand that in Louisiana, the physician is not limited to be on site or within a specified area as long he/she can be consulted through phone or other means when need arises. The document (collaborative practice agreement) defines how the two parties can communicate for consultation purposes. However, in case, the NP is not able to reach the consultant (physician) he/she is not allowed conducting any form of prescription whatsoever (The Courtroom: legal Spotlight, 2014).
Arkansas is not different from other cities in the US as it restricts on the extent to which the APRN is practiced in the country. The collaborating physician needs to be in the same line and specialty with the nurses and should abide by the quality assurance plan and respective protocols. Approval requires a lot of experience at least five years and the APRN is only allowed to prescribe within the scope of practice based on their individual certification.
Credentialing and Clinical Privileges
It remains the role of the board of an organization in appointing of medical staffs to ensure that quality services are offered at an institution. Staff credentialing is a task performed to guarantee quality in medical facilities. The work enables the management to see to it that only the qualified doctors are employed and that the practice is within their scope of competence whatsoever. Therefore, it is a requirement that the oversight team establishes the requirement and evaluates the individual qualification of the staff members. The issue can be divided further into two with the first option being an evaluation of the professional qualification of the doctors, their respective experiences and another requirement as may be mandatory (Cashin et al., 2016). In the second option, it entails obtaining evidence that the people under evaluation are qualified and requires that the applicant's identity is correct, they have been licensed, insured and meets the minimum requirement set by the institution. To ensure the achievement of quality patient care, the credentialing verification requires primary source verification to avoid any problem with the legal system whatsoever.
Privileging is another facet in credentialing process, and it entails quality patient care is met at the health care facilities. The task requires that hospitals have efficient diagnostic and treatment procedures, well equipped, and they have competent staff personnel to offer medical services among others. Another specification of the task is that clinicians meet the minimum requirements and experience necessary as far as competency issues are concerned. Therefore, the privileging specifies the specific procedures or conditions under which a practitioner can offer treatment to a patient. It is imperative to note however that use of wrong information in the credentialing process can put the life of the patients at risks. The medical institution, therefore, should make sure that the medical institutions should employ competent staff with the highest level of qualification to avoid compromising the life of the patients. The above task can be achieved by outsourcing the credentialing and privileging team in case of internal weaknesses in an organization (Brown & Kaplan, 2011).
Discussion on the Collaborative Nature of Practice
Health professionals often work together in groups while providing care and they are trained to work as a team as one approach through which they can minimize risks. The training is based on evidence, and there is a contention that working as a team significantly reduces errors due to standardization and efficient planning (Brooten et al., 2012). The collaboration to allow nurses to work in close collaboration with the physicians is one approach through which the medical facilities can be equipped well with adequate personnel fit for the task. It is a requirement therefore that the board of nursing, together with medicine board, should jointly collaborate to oversee the collaborative amid the physician and the NP arrangements. The monitoring process by the board is to ensure that nurse practices and those of the physicians are within their scope of operation, meets legal requirements and the interest of the medical field. The guideline used in establishing cordial relations among the collaborative parties requires the definition of the nature and scope of the practice accomplished by the NP. In a situation where the NP is authorized to prescribe, the two (NP and physician) have to work closely with a specific guideline to direct them.
Although the physician does not have to be present during prescription, it is worth noting that the two should have a shared understanding. This requires working as a team with shared decision making, consistent chart review and regular discussion on the patient management practices. Close communication is a must and immediate availability to indicate the strength of a collaborative physician. However, the NP is always held responsible for his/her action under legal enforcement in case they compromise the health of a patient.
Part 2
Evaluation of Participation in Quality Initiatives and Managed Care
Managed care plans have in the recent past received increased implementation due to their significance in meeting quality care. The concept is enforced by the Managed Care Organizations (MCOs), which ensure that people enrolled in their plan receive quality health care. The MCO's, as the oversight institutions of the project, are funded by the Medicare and Medicaid programs, which are in return funded by the state. MCO's have a mandate to ensure the provision of evidence-based clinical information and other relevant measures to evaluate the providers and identify areas that require improvement. The health providers ought to understand the feedback from their consumers as well provide adequate information to end users concerning their most recent preventive care recommendations.
The MCO's contract with different health care providers and therefore offers participants with various financial incentives to use the various plans set in place. Managed care plans help monitor the various health care providers under their contractual agreements to ensure that quality health care is provided to end users. The organization helps eliminate any unnecessary services in the health care plan to minimize any form of risk whatsoever. In the recent past, the managed care have revolutionized the health care system in the US and provided prospective payment plans to different employers. This has led to increased number of users, and MCO covers the various provisions. The approach has been found to be cost-effective as compared to other health programs offered by Medicare and Medicaid programs (Prevost & Dennison, 2012).
Examining reporting relationships and working through other people
Reporting is an important task in any organizational management, and it requires that the health practitioners keep their patients informed on their progress. Efficient management of information supports effective communication in an organization, an aspect that enables people to work closely with one another to establish the organizational goals. In the health care facilities, the reporting function is often considered as an evaluation strategy through which the management can compare past performance with existing situation, so as to advise on areas of improvement (Holley, 2016). Moreover, the concept of holding staff accountability of in their operations is one of approach through which quality care is achieved. The reporting aspect is also important to a health facility, as it allows for the management to summarize its various operations among other concerns.
Global Perspective of APRN and Authority
It is imperative to understand that APRN practices have gained popularity globally due to the need to meet the increased need of healthcare. However, different countries have varying regulations on the diverse practices accomplished by the APRN practitioners and include diagnosis, medication prescription, and treatment among other roles (Duffield et al., 2009). There are concerns on enhancing education and training among the NPs to promote full practice among the practitioners as one strategy through which to achieve improved health care. However, although the number of APRNs has increased globally, many challenges are faced in the worldwide perspective. Some of the problems include poor role clarification among the practitioners, varied competence requirement, conflict concerning the scope of practice and diversity in standard regulation, and quality of the education offered. Moreover, specific regulations to a great extent influence the practice in different countries, a feature that hinders achievement of quality health care in the particular countries. However, the NPs play a significant role in health care facilities and through education and training; they help accomplish different functions in primary care hence impacting well on improved health care in the hospitals (Kooienga & Carryer, 2015). The NPs have a mandate to accomplish better health care, and lower cost in the different medical facilities.
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The Courtroom: legal Spotlight, 2014. Nurse Practitioner Scope of Practice: Louisiana retrieved on 26th May 26, 2016 from http://www.midlevelu.com/blog/nurse-practitioner-scope-practice-louisiana