Melissa Hinkhouse

I decided to focus on Michigan (where I live) and the neighboring state of Wisconsin, it is a possibility one day we may relocate. As long as regulatory requirements differ from state to state, each state border represents an obstacle to portability—potentially preventing access to professionals and access to care (National Council of State Boards of Nursing, n.d.). Wisconsin and Michigan are both located within region five.

I first wanted to explore the practicing regulations for both states and what that means as a practitioner. Michigan’s Board of Nursing (B.O.N.) is the regulatory agency for the state in which I reside and plan to practice as a Psychiatric Mental Health Nurse Practitioner. Michigan’s Regulatory Structure is considered Restricted Practice, State practice and licensure laws restrict the ability of N.P.s to engage in at least one element of N.P. Practice. State law requires career-long supervision, delegation, or team management by another health provider for the N.P. to provide patient care (Michigan, 2020). Wisconsin Board of Nursing (B.O.N.), is the regulatory structure for our sister state. Wisconsin’s Regulatory Structure is considered Reduced Practice, State practice and licensure laws reduce the ability of N.P.s to engage in at least one element of N.P. Practice. State law requires a career-long regulated collaborative agreement with another health provider for the N.P. to provide patient care, or it limits the set of one or more elements of N.P. Practice (Michigan, 2020). After reading more into both regulations, it is my understanding in both states as a Nurse Practitioner that I would not be allowed to open my practice. I will always need to be in collaboration with a physician. Neither Wisconsin nor Michigan will recognize a Nurse Practitioner as a primary care provider. Both will allow a Nurse Practitioner to prescribe Schedules II-V controlled substances if delegated by a physician. For example, in either to state, if I were to see a patient that was diagnosed with Attention Deficit Disorder and wanted to prescribe Ritalin, I would have to have my collaborating physician review the chart consult before prescribing the medication. 

           The second regulation I would like to compare is the ability to have a Medical Staff Membership. According to the A.A.N.P., in Wisconsin per rule WI ADC s DHS 124.12 Nurse Practitioners are not permitted to join medical staffs. In the state of Michigan per the A.A.N.P. M.C.L.A. 331.1303 Each board of trustees and subsidiary board may select nurse practitioners for membership on their medical team. I was surprised when I read this regulation: Nurse Practitioners in our hospitals here in Michigan and round with the providers. The cost reduction in medical services alone, I feel, would be substantial enough to disseminate this regulation. A Nurse practitioner working with a physician to see patients in the hospital can lead to more efficient and quality care and provide decreased wait times for patients.

References

Michigan scope of practice policy – State profile. (n.d.). Scope of Practice Policy.

https://scopeofpracticepolicy.org/states/mi/

Michigan. (2020). American Association of Nurse Practitioners. Retrieved June 29, 2020, from

https://www.aanp.org/advocacy/michigan

National Council of State Boards of Nursing (NCSBN). (n.d.). Retrieved June 29, 2020, from

 https://www.ncsbn.org/index.htm

Wisconsin scope of practice policy – State profile. (n.d.). Scope of Practice Policy.

Cindy Salbino RE: Discussion – Week 5COLLAPSE

The nursing profession has a foundation that’s built on documents that are called regulations and policies and are designed to ensure patient’s safety. Governed by the board of nursing, the APRN’s practice is defined by the Nurse Practice Act. Although these have basic guidelines, they can vary from state to state.  State laws and regulations can impact some practices, as well as other state nursing boards (State laws and regulations, n.d.).

Two regulation comparisons

Giving nurse practitioners (NP’s) ability to work independently is one of the most controversial subjects today. Allowing NP’s to work according to their degrees and training isn’t always guaranteed.  In my home state of California, we still need to work closely under the supervision of a physician. This is not only limiting our ability to act as a primary provider, is also is confusing to the patients we care for (Staff Writers, 2020). My husband is an Acute Care Nurse Practitioner (AG-ACNP) and he works under the direction of the chief of staff and the Medical Director. Upon my graduation, we are seriously considering moving to Arizona where we can practice independently according to our degree and training.  As per the Arizona Board of Nursing site “Practice Authority for Nurse Practitioner:  Full independent practice authority. NP’s practice under the licensure authority of the State Board of Nursing instead of a licensed physician. Ariz. Rev. Stat. Ann. §32-1601(20)” (“Arizona scope of practice policy – State profile“, n.d.).

Another California regulation that gets in the way sometimes is that we cannot prescribe medications unless these are also approved by a physician.  Even prescription pads have the name of the supervising physician on them.   This sometimes hinders the care that our providers can give.  In the state of Arizona this isn’t the case at all.  NP’s are allowed to prescribe medications according to their population focus (“Arizona scope of practice policy – State profile”, n.d.).    

Another situation we were interested in was to be able to get reimbursed for services by insurance companies. According to the regulations in California, they keep track of RN’s who obtained their psychiatric master’s degree and remain on the board list after being supervised for two years with a qualified doctor. After doing so, these RN’s would be eligible to receive reimbursements directly from health care plans if the care they provide has to do with mental health services to the insured individuals (Psychiatric mental health nurse listing, n.d.). I attempted several times, several different ways to locate this information for the stated of Az. and I was unable to. This is concerning to me since we are considering moving there.

These two regulations that we have in California are a struggle sometimes.  Our night time hospitalists are nurse practitioners and they are restricted with what they can do. They for sure cannot discharge a patient, so that patient would either have to leave against medical advice (AMA), or wait until the morning.  Another issue we have is that they cannot sign for a transfer stating the patient is stable for that transfer. We then need to go and bother the emergency room physician to sign for a patient that they don’t know what’s going on.  We have a good relationship and they trust our judgment, but it still puts them at risk.

If we were to relocate, it would be a better opportunity for us as a family for jobs, and most certainly as professionals for careers.  Practicing independently and able to prescribe medications freely are the two major comparisons that I am concerned about right now. I believe that it would allow us to grow as providers, but in the same sense, we would then be isolating ourselves from any ‘medical back up’ we may need. This could be from anything really from law suits to the benefits of company provided education.  It will definitely be a lot of researching and conversations in the upcoming couple years.

References:

Arizona scope of practice policy – State profile. (n.d.). Scope of Practice Policy. https://scopeofpractice.org/states/az/

Psychiatric mental health nurse listing. (n.d.). California Board of Registered Nursing. Retrieved June 29, 2020, from https://www.rn.ca.gov/pdfs/applicants/pmg-app.pdf

Staff writers. (2020, May 21). California nurse practitioner full practice authority (FPA). NursePractitionerSchools.com. https://www.nursepractitionerschools.com/ blog/California-np-practice-authority/

State law and regulation. (n.d.). ANA. https://www.nursingworld.org/practice-policy/state-law-and-regulation/

Discussion: Healthcare Information Technology Trends

Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology—new and repurposed—will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.

In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.

To Prepare:

• Reflect on the Resources related to digital information tools and technologies.
• Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
• Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.

By Day 3 of Week 6

Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 14, “The Electronic Health Record and Clinical Informatics” (pp. 267–287)
Chapter 15, “Informatics Tools to Promote Patient Safety and Quality Outcomes” (pp. 293–317)
Chapter 16, “Patient Engagement and Connected Health” (pp. 323–338)
Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 341–355)
Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 359–388)

Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from https://www.healthit.gov/faq/what-electronic-health-record-ehr

Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. doi:10.1016/j.pmn.2017.11.002
Note: You will access this article from the Walden Library databases.

Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. doi:10.3390/informatics4030032
Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Producer). (2018). Public Health Informatics [Video file]. Baltimore, MD: Author.

Accessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Laureate Education (Producer). (2018). Electronic Records and Managing IT Change [Video file]. Baltimore, MD: Author. 

pls use three sources for this discussion

Review your problem or issue and the cultural assessment. Consider how the findings connect to your topic and intervention for your capstone change project. Write a list of three to five objectives for your proposed intervention. Below each objective, provide a one or two sentence rationale.

After writing your objectives, provide a rationale for how your proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations.

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

You are not required to submit this assignment to LopesWrite.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.5:  Advocate for autonomy and social justice for individuals and diverse populations.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

1. Describe the clinical manifestations present in Mrs. J.
2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.