Discussion: Clinical Challenges for the NP

Each state has laws that differ in regard to the role of the Nurse Practitioner. They also may significantly impact the NP’s practice. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes may significantly impact your scope of practice as a Nurse Practitioner. Remaining current with the laws in your state is essential. For example, the recent change at the federal level changing hydrocodone-containing drugs from a Schedule III drug to a Schedule II drug has impacted NPs in some states. For states that allow for Nurse Practitioners to write Schedule III-V drugs, these NPs are now unable to write for hydrocodone- containing medications, which significantly impacts their ability to provide care for their patients. The Pearson Report, which is updated almost annually, provides a national overview of each state’s current legislature. As a future NP, you should become familiar with The Pearson Report and stay abreast of state and federal legislation.

For this Discussion, you will post an explanation that defines the legal implications for standard of care, the key components of a malpractice policy in regard to a case study. Additionally you will explain the collaborative agreements and rules for your state in regard to your NP practice and the case study you select.

To prepare:

Review the following case studies and select one to research in depth:

Case Study One: Dismissing the non-compliant patient.

Gwen, a 52 year old Caucasian LPN, recently joined your practice as a new patient. She currently has a BMI of 32, B/P of 142/88. Pulse is 89, Respiratory rate is 22, Pulse Ox is 96% on Room Air. She is taking Lisinopril 10mg po daily (when she can remember), Metformin 1000mg po BID and refuses lab work. Her physical exam is unremarkable and foot exam is normal. She refuses all vaccinations including Prevnar and Influenza. Gwen’s last mammogram and pap smear were “years ago.”

Case Study Two: Preventive care, why is it so important to document? 

John, a 62 year old attorney, who has been a long-term patient of yours, comes to you to discuss his erectile dysfunction. You note that he has refused lab work for the past two years. He is a 30 pack/year smoker, and has not had a chest x-ray or ECG in three years. He does take his HCTZ 25 mg po daily. His BMI is 29 and all vital signs are within normal limits. He does agree to his Prevnar Vaccine today.

Case Study Three: Patient and professional relationships.

Jennifer, a 45 year old Caucasian returns to your clinic for a refill of her hydrocodone. She was diagnosed with Ovarian Cancer last year, followed by successful removal and treatment. All vital signs are stable and preventive care is up to date. She wants to discuss filing a lawsuit against the surgeon that initially turned her away and told her she had gastritis and needed to eat healthier.

Review the following articles found in this week’s Learning Resources:

Miller, K. P. (2013). The National Practitioner Data Bank: An Annual Update. The Journal for Nurse Practitioners, (9)9, 576-580.

Stelmach, E. I. (2015). Dismissal of the Noncompliant Patient: Is this What We Have Come to? The Journal for Nurse Practitioners, 11(7), 723-725.

Review endocrine disorders and erectile dysfunction in your Primary Care Medicine text (Gorrol, Ah. & Mulley, A.G., 2009).

Consider strategies and treatment options that would be most effective for these patient scenarios to improve compliance and health outcomes.

Reflect on how to approach the non-compliant patient and the importance of a separate preventive care visit.

By Day 5

Post an explanation that addresses the following for the Case study you selected:

Identify and briefly summarize the case study you selected

Explain any legal implications for standard of care related to the case study you selected

Identify and explain the key components of a malpractice policy related to the case study you selected

Explain the collaborative agreements and knowledge the rules for your state in regards to NP practice the case study you selected

Theoretical Foundations of Transcultural Nursing

Read chapter 1 of the class textbook and review the attached PowerPoint presentation.  Once done answer the following questions.

1.  Discuss the historical and theoretical foundations of transcultural nursing.

2.  Mention and discuss Leininger’s contributions to the creation and development of transcultural nursing as a theory.

3.  Discuss the relevance of transcultural nursing in addressing contemporary issues and trends in nursing.

4.  Discuss the key components of the Andrews/Boyle Transcultural Interprofessional Practice (TIP) model.

As stated in the syllabus please present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion board title  “Week 1 discussion questions”.  A minimum of 2 evidence-based references is required (not counting the class textbook) no older than 5 years.

• Please cite work.
• Examine at least two (2) eligibility requirements for Medicaid. Debate the extent to which you agree with the fairness of these requirements. Provide support for your rationale.
• Analyze two (2) changes to Medicaid resulting from the implementation of the Affordable Care Act. Determine the impact that these changes will have on both Medicare eligibility and your state(GA) government’s fiscal responsibility. Provide examples to illustrate the impact of such change.

Identify at least one sociocultural factor from Tina Jones below. Identify one health promotion need and discuss at least one strategy for cultural competency that you could apply during a health promotion teaching activity.

About Ms. Jones:

She’s a 28yr old African American, has asthma and diabetes. She does not have hypertension or high cholesterol but has a family history back ground of her parents, grandparents, and great grandparents having high blood pressure, high cholesterol, and not being obese however slightly overweight. 

 1.

It was very nice meeting with you and learning more about the LPN position in Family Medicine that you have interviewed me for. I appreciate you taking the time out of your day to meet with me and get to know me a little more, while looking through my resume at my qualifications. The job that you have posted and interviewing for seems like it would be a very good match for my knowledge and interests. After looking over and talking with you more in depth about the job description, allowed me to confirm that I would enjoy working at Park Nicollet and would be a great addition to your health care teams. With my 9+ years of experience working in the health care field, I believe that I have valuable qualities that will help provide your patients with the best quality of care possible. I am very honored and appreciative that you chose to interview me and hope we will have the opportunity to work together in the near future. Thank you again.

Tawna Postel

I feel that it is a good idea to send a thank you letter to a company who has taken the time to interview you. Not only does it show that you respect them and their company, but that you are interested in the job itself. I also feel that sending a thank you letter will make a canidate stand out amongst others. I dont feel that just because someone sends a thank you letter, that they will receive the job; that is based off how qualified the employee is. 

2.

 

Good Afternoon Mrs. Anderson,

I wanted to take a moment in time to express my gratitude to you for allowing me the opportunity to meet you. It was an absolute pleasure to enter the clinic as I was greeted with a warm welcome from the staff and the uplifting ambiance. It was lovely to see all the employees work well together as a team.  I appreciate you taking the time to explain the hiring process and how the training program works at your clinical. I am very impressed with the opportunity you have available here and I would be delighted to add to your team as an LPN. 

It would be a honor to be considered for a LPN position at this clinic. I am very much looking forward to hearing from you in regards to the next steps. Please do not hesitate to contact me if you need any additional information than I provided or if you have any further questions. I hope to hear from you soon!

Sincerely,

Morgan Koivisto,

When I first watched the videos, I thought writing a thank you letter would be rather simple and quick. I do think that less words are better than more words and it leaves a lasting impression. However, when I sat down looking at a blank slate, I had a hard time coming up with the right words to say. I wanted my letter to be genuine and not too scripted. I thought this was a very good experience as this is something we will be needing to write to our potential employers. I liked it. 

i just need a respond for these two post