A minimum of 2 paragraphs

Discussion

Advanced registered nurse practitioners (ARNPs) have to consider a broad range of factors when prescribing medicines. For instance, professionals in this area have to consider federal and state laws that regulate their practices. The focus on controlled substances is particularly important because registered nurses have a responsibility to prevent fraud and diversion (Klein, 2016). ARNPs have the authority to prescribe Schedule II, Schedule III, and Schedule IV drugs if they pass certification (Florida Board of Nursing, 2016). It is imperative to prevent tampering to prevent abuse and negative health effects when prescribing such substances. Similarly, nurses have to identify behavioral red flags and demonstrate outstanding communication skills when dealing with scammers (Klein, 2016).

Advanced practice nurses have to deal with a set of barriers that limit their ability to prescribe medicines. First of all, ARNPs have to consider such factors as state licensure and regulations. The situation has improved over the years, and such organizations as the American Association of Nurse Practitioners (AANP) seek to improve the prescriptive authority of nurse practitioners. Nevertheless, nurse practitioners have to deal with such issues as supervision and delegation. It is also noted that physician professional organizations believe that it is necessary to limit the scope of nursing practice because of such factors as the overall quality and safety of care (Hain & Fleck, 2014). Available research indicates that most of the concerns voiced by the opponents of unrestricted prescriptive authority are unreasonable. It is also suggested that payer policies affect the ability of registered nurses to prescribe medicines because of low reimbursement rates (Hain & Fleck, 2014). The situation is challenging because both public and private payers often prevent nurse practitioners from practicing independently. It may be beneficial to cooperate with policymakers to address the problem and eliminate the barriers that have an adverse effect on advanced practice nurse prescribers.

References

Florida Board of Nursing. (2016). Important legislative update regarding HB 423. Retrieved from https://floridasnursing.gov/new-legislation-impacting-your-profession/

Hain, D., & Fleck, L. M. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2). DOI: 10.3912/OJIN.Vol19No02Man02

Klein, T. (2016). Legal and professional issues in prescribing. In T. M. Woo, & M. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.) (37-50). Philadelphia, PA: F. A. Davis Company.

Advanced Practice Nurses (APRNs) as health professionals, are tasked with the responsibility to care for and safeguard the health and safety of patients. One duty of care owed by APRNs is on ethical and legal prescribing of medication. APRNs are expected to adhere to strict standards of prescribing, which serve the needs of the patient, minimize medical errors as well as maintain high levels of professionalism and accountability (Mitchell & Oliphant, 2016). In 2007, the World health Organization (WHO), outlined 7 guidelines which were meant to serve as a universal regulatory framework for ethical prescribing for all health practitioners, including APRNs. They are as follows: (1)Evaluate and define the patient’s problem; (2) Determine the therapeutic objective of the drug therapy; (3) Select an appropriate medication; (4) Provide patients with information, warnings and instructions; (5) Monitor the patient regularly; (6) Consider drug costs when prescribing and (7) Use appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors.

While the role of APRNs has been extended to include drug prescription, the independence to do so is not absolute. The primary barrier to APRN prescribing involves state practice and licensure (Hain & Fleck, 2014). Only 22 states so far have given full independence to APRNS to prescribe to patients. In the majority of states, including Florida, APRNs can only prescribe with the supervision or collaboration of a qualified physician. Another major barrier lies in the lack of physician cooperation and goodwill. The American Medical Association for instance, is yet to accept and support APRNs as capable of handling independent practice (Hain & Fleck, 2014). Thirdly, APRNs grapple with a physician-biased insurance system that discriminates against nurse practice. Several payer policies and reimbursement models in various states fail to recognize nurse practitioners as primary care providers, thereby affecting the extent of APRN practice including prescription (Altman et al.,2016).

References

Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report the Future of Nursing. National Academies Press (US).

Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2).

Mitchell, A., & Oliphant, C. M. (2016). Responsibility for Ethical Prescribing. The Journal for Nurse Practitioners, 12(3), A20.

n this assignment, you will be writing a 1,000-1,250 word paper describing the differing approaches of nursing leaders and managers to issues in practice. To complete this assignment, do the following:

1. Select an issue from the following list: bullying, unit closers and restructuring, floating, nurse turnover, nurse staffing ratios, use of contract employees (i.e., registry and travel nurses), or magnet designation.
2. Describe the selected issue. Discuss how it impacts quality of care and patient safety in the setting in which it occurs.
3. Discuss how professional standards of practice should be demonstrated in this situation to help rectify the issue or maintain professional conduct.
4. Explain the differing roles of nursing leaders and nursing managers in this instance and discuss the different approaches they take to address the selected issue and promote patient safety and quality care. Support your rationale by using the theories, principles, skills, and roles of the leader versus manager described in your readings.
5. Discuss what additional aspects mangers and leaders would need to initiate in order to ensure professionalism throughout diverse health care settings while addressing the selected issue.
6. Describe a leadership style that would best address the chosen issue. Explain why this style could be successful in this setting.

Use at least three peer-reviewed journal articles other than those presented in your text or provided in the course.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

NO PLAGIARISM

MUST INCLUDE PLAGIARISM CHECK

PLEASE FOLLOW ATTACHED RUBRIC AND MUST ADHERE TO WORD COUNT

Signature Assignment Description/Directions:

Beginning in Module 1 of this course you have been researching a healthcare informatics topic of your choice.  Now you will present your findings in a 7 to 12 minute recorded presentation complete with PowerPoint slides (no length requirement).

• Discuss your topic and its relationship to your current (or future) practice. Discuss why the topic is important in healthcare informatics.
• What research have you have found on the topic. Describe how each scholarly article relates to the topic and your current (or future) practice. Describe what conclusions you have drawn based on your research of the topic.
• What ethical or legal issues does this topic present?
• Create a plan for implementing a change (or justify the need for no change). Who needs to be involved? What training programs are needed? Is there a need for on-going training? Discuss how you would evaluate the success of the change (or the continued success of what you are currently doing). What is the cost to implement or maintain this change? Who will be financially responsible? How feasible is this change?
• Finally, identify how changes in public policy and technological advances in the future could impact this topic. What would those changes mean to the healthcare industry?

My topic is health care cost.

Case Study 1

Case Study 1

Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.