Healthcare sector is a very delicate institution that requires due diligence, adherence to the codes of ethics as well as vast knowledge to discharge the duties at hand. Nurse practitioners are health practitioner with a thorough training in matter health, however, their scope of practice is limited with the realms set up their bodies, organs and laws and regulations. A nurse is a person who has undergone full training as per the course requirement, graduated, registered by the relevant authority and is licensed to practice. The delivery of services by the nurse practitioners has been impacted a great deal by the issues of health policies, such limitations have made it very difficult for the nurses to advance their practice. The regulations set for adherence by the nurse practitioner have served to thwart the nurses’ ambitions to improve their service delivery or gather sufficient experience to discharge more duties.
Proposal for Health policy Initiative on improving service delivery
As it stands, the nurse practitioners have the limits of their delivery of service fixed with certain levels of treatment and only acts on other situations only authorized by law such cases where and when there is risk of death or serious harm that arise unexpectedly and require urgent action or in the circumstances when the assignment is formally delegated to them, however, the process is so tedious and requires approval. The increasing workload caused by the demand for health care has led to the nurse practitioners exhibiting their limits, at times going beyond the requirement of law. The situation in the health care, therefore, necessitates the need for health policy initiatives that will give more latitude to the nurse practitioners to deliver quality services efficiently. One essential health initiative policy that would best address the issue at hand and also health the nurse practitioners to improve the capacity to handle serious cases is professional development and training plans that include capacity building.
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Further training and capacity building to deal with the increased condition will help the nurse gain competence and improve their service delivery. Today, patients are more likely to be cared for by non-medically qualified staff, “many of whom have not been formally trained in important subjects like pharmacology, or in consultation skills, most often it will be nurses and nurse practitioners taking on these roles with a smattering of pharmacists as well” (Ted Willis, 2016). The fact that nurse practitioners spend most of their times with the patients improve their relationship making it easy for the patient to express themselves better on their condition. The professional development programmes should be rolled into the sector, as a policy it neutralizes all the barriers that made it so difficult for the nurse practitioners to advance or effectively deal with the issue at hand.
Business Plan- importance of Nurse Scope of practice
The role of nurse practitioners is undeniably critical in the entire health sector, they deal with patients on a day to day basis and the limitation levied on the nurse results to direct consequences and suffering by the patients. The nurse scope of practice entails performing activities which they are trained in and authorized to do. The establishment of the scope of practice helps in reducing the trial and errors that one can attempt with a patient life, it also allows for one to perform what they are only skilled at and legally secured to perform. Establishing the scope of practice enables the institutions to divide separate roles among various employee with different skills thus promoting specialization and proper service delivery. It would be good that physicians who are better able to “manage complicated diagnostic problems, patients with multiple chronic conditions, and unstable patients. Physicians and nurse practitioners receive very different training, and it would be surprising if their competencies were identical” (McCleery, 2017). While the scope of practice simply demarcated the realm of operation for the nurse practitioners, consideration for professional development for the nurse would help in an efficient delivery of service.
At the center of the effect of the scope of practice are the patients, the regulations impact them in two dimensions. First, the regulations allow the patients to enjoy the service from experts with vast skills and knowledge concerning their health problems, “Noctors (nurse practitioners, practice pharmacists, physician associates, emergency care practitioners etc.) have a very much shorter period of training, for which there is no standard system of regulation, and no agreed curriculum” (Willis, 2016). The result of such limited knowledge could misdiagnosis or other errors that threaten the health of the patient. However, on the hand, the patients stand a great chance of suffering when other practitioners such as the physicians are held up or serve a larger population. If the nurse practitioners are not efficiently taken through proper skills they may not be better placed to help even the critical situations allowed to them by law.
Implementation plan – solutions
Improving the competency of the nurse practitioners is essential in the improvement of quality service delivery to the patients. Establishing a well-choreographed professional development would prepare the nurse practitioners to deliver in wide areas of medication. One of these programs includes the establishing an advanced practice Registered nurse fellowship in which the already registered nurse practitioners will be required to undertake refreshing course and also learn of the new approaches to the changes in taking in the healthcare realm. Maryanne Windey and Kaleen Cullen (2018) note that nurse fellowships and residency programs have been to shown to improve retention, confidence, nurse satisfaction and overall competence.” Such course will go hand in hand with improved service delivery within their scope of practice. To ensure the nurse practitioners are well equipped the fellowship can be regulated by accreditation bodies to check on quality and standards are met in accordance with the regulation.
The health institutions are today overstretched and crowded with patients such that the physicians alone cannot handle the entire patients. The nurse practitioners prove to invaluable assets in the hospital enhancing their skills would be of great relief to limited physicians in the hospitals, this can be through systematic delegation of some treatment aspects under the supervision of the doctors. Hand –on experience is a sure way of attaining knowledge and skills and if the nurses are allowed to work side by side with the doctors, then there is a guarantee that they will be aide the troubled healthcare institutions.
Evaluation plan
Establishing the system for professional development for the nursing practitioners calls changes in the policies and the usual norm, however, establishing an advanced practice for registered nurse fellowship demands financial resources to facilitate continuous training and fund the accreditation processes and payment of instructors. Therefore, the funding of the programme should be a mutual programme between the government and the nurses. The government needs to bear the highest cost of the programme as they stand to claim the glory arising from the improved service delivery.
The environment in which the advanced registered nurse practitioners operate is riddled with legal and political issues that greatly influence their delivery of service. The political and legal issues arise from different levels of governments, as result implementing any health policy initiative calls for persuasion of the political wing. The states are givers of law and enforcers of the same law; Gadbois et al (2015) assert that “although NPs and PAs are certified nationally, state scope-of-practice laws determine the extent to which they may practice independently.” The law set by the state, usually limit the scope of the nurse practitioners, the law uses critical factors such as educations levels create barriers for advancing the goals. Similarly, the variation of nurse practitioners requirement per state makes it difficult for nurses to exercise the freedom enjoyed by vertical or horizontal labor mobility.
The politics of the country usually influence the course and action of the nurse practitioners, usually; every regime comes with its health reforms agenda. The health insurance schemes that are formulated by every regime influences the service delivery of the nurse practitioners, It is important to note that the extent to which NPs and PAs provide patient care depends, in part, on factors other than scope-of-practice, including, for example, the impact of insurance reimbursement practices on provider income (Gadbois et al 2015).
Generally the state of the economy also does affect the operations and service delivery of the advanced practice registered nurses; this is because, other than better remuneration, they find themselves working in institutions that are understaffed, poor infrastructure and lack essential items necessary to practice while the at the same time the hospitals are overcrowded by patients. “Given the current economic and political climate in the United States, shrinking number of nurse educators carry an increasingly large responsibility for educating a declining number of APRNs” (Fitzgerald et al, 2012).
Critical Questions
How do we empower the ARNP as a technique of improving service delivery?
What are the roles served by the ARNP and how best can sector maximize their service and presence?
What are the best of integrating the ARNP into working in collegiality with physicians and doctors without compromising the life and health situation of the patient?
References
Willis, T. (2016). Nurse Practitioners are Taking on an Increasing Role in General Practice. Is this a Good Idea. Journal of General Practice, 04 (01). doi:10.4172/2329-9126.1000227
McCleery E, Christensen V, Peterson K, et al. Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses. 2014 Sep. In: VA Evidence-based Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384613/
Cullen, K. (2018). Advanced practise registered nurse fellowship (M. Windey, Ed.). Journal for Nurses in Professional Development, 34 (1), 41-42. Retrieved February 14, 2018.
Gadbois, E. A., Miller, E. A., Tyler, D., & Intrator, O. (2015). Trends in State Regulation of Nurse Practitioners and Physician Assistants, 2001 to 2010. Medical Care Research and Review : MCRR , 72 (2), 200–219. http://doi.org/10.1177/1077558714563763
Cynthia Fitzgerald, Ira Kantrowitz-Gordon, Janet Katz, and Anne Hirsch, “Advanced Practice Nursing Education: Challenges and Strategies,” Nursing Research and Practice, vol. 2012, Article ID 854918, 8 pages, 2012. doi:10.1155/2012/854918
