Policy and State Boards of Nursing

Within the far-reaching and multi-layered realm of policy and reform, government at the state level plays an essential role. Consider the federally enacted PPACA’s individual mandate which sought to increase the number of consumers who receive insurance coverage and, therefore, greater access to care. In a system that is already stretched beyond capacity and confronting a nursing shortage, how can the health care system meet this increased demand? Since state boards of nursing determine scope of practice, it is important to stay up to date and current with the policies and regulations that are created by the state board of nursing.

To prepare:

• Review      the Thomas, Benbow, and Ayars article and the Watson and Hillman article      focusing on how states regulate advanced nursing practice and how      legislative changes are impacting scope of practice.
• Visit      your state board of nursing website and/or contact the board to determine      how the state board controls advanced practice through regulations (google mbon.org for my state board      of nursing)
• Determine      if your state board has created any new policies or regulations that      address changes to scope of practice in response to legislative changes.

By tomorrow 04/25/2018 10am, write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below”

Post a cohesive response that addresses the following:

1) What are the most recent regulations promulgated through your state board of nursing for advanced practice?

2) How are the state regulations supported within your place of employment? (google mbon.org for my state board of nursing)

3) How do the states differ in terms of scope of practice? What impact does this have on professional nurses across the United States?

Required Readings

Chen, A. S., & Weir, M. (2009). The long shadow of the past: Risk pooling and the political development of health care reform in the States. Journal of Health Politics, Policy & Law, 34(5), 679–716. 

The authors provide an analysis of varying state health care policies, with a basic premise that health care risk is either “pooled”—shared, or “actuarial”—segmented by risk level. Most states have taken a segmented approach to health care, and therefore, have not solved health care issues such as rising costs and access to care. The authors maintain that federal action is needed to create a uniformed approach to health care.

Junghee, L. (2009). Cultural, social, and political influences on state-level indigent health care policy formation. Journal of Policy Practice, 8(2), 129–146.

This article provides details on a 50-state study of Medicaid spending. The authors concluded that political and economic factors can positively predict individual state Medicaid spending, and that actual need has a negative impact on spending. In conclusion, a uniform, federal structure may be the only method to ensure equal access to Medicaid.

Mills, A., Engelhard, C. L., & Tereskerz, P. M. (2010). Truth and consequences—Insurance-premium rate regulation and the ACA. New England Journal of Medicine 363(10), 899–901.

O’Connor, J. C., MacNeil, A., Chriqui, J. F., Tynan, M., Bates, H., & Eidson, S. K. (2008). Preemption of local smoke-free air ordinances: The implications of judicial opinions for meeting national health objectives. Journal of Law, Medicine & Ethics, 36(2), 403– 412.

Sommers, B. (2010). Enrolling eligible children in Medicaid and CHIP: A research update. Health Affairs, 29(7), 1350.

The enrollment and retention of eligible children in Medicaid and Children’s Health Insurance Program (CHIP) is a health care concern. The article concludes that some state processes have mitigated this issue but other requirements, such as providing citizenship documentation, may have a detrimental effect. Therefore, these concerns should be incorporated into the implementation on PPACA of 2010.

Thomas, M. B., Benbow, D. A., & Ayars, V. D. (2010). Continued competency and board regulation: One state expands options. Journal of Continuing Education in Nursing, 41(11), 524-528. 

The authors use the changes instituted by the state of Texas in regard to the licensing of nurses to illustrate the need to adapt state licensing requirements to the changing diversity and scopes of practice among nurses.

Watson, E., & Hillman, H. (2010). Advanced practice registered nursing: Licensure, education, scope of practice, and liability issues. Journal of Legal Nurse Consulting, 21(3), 25–29.

The expanded role of the advanced practice nurse has led to changes in licensure, education, certification, and scope of practice definitions. The author points out that this expanded role has led to increased liability and accountability concerns as well.

Yue, L., Harrington, C., Spector, W. D., & Mukamel, D. B. (2010). State regulatory enforcement and nursing home termination from the Medicare and Medicaid programs. Health Services Research, 45(6p1), 1796-1814. doi:10.1111/j.1475-6773.2010.01164.x

Those nursing homes receiving Medicare and Medicaid funding are subject to strict quality and safety regulations. This article examines the consequences of enforcing those federal quality standards.

  

Optional Resources

Wieck, K. L., Oehler, T., Green, A., & Jordan, C. (2004). Safe nurse staffing: A win-win collaboration model for influencing health policy. Nursing Education Perspectives, 31(3), 160-166.

 
COMPETENCIES

726.10.2 : Manager of the Healing Environment

The graduate responds to unpredictable situations and events common in the healthcare environment with appropriate flexibility and creativity.

726.10.3 : The Nurse as Scientist

The graduate correctly interprets and applies scientific evidence when planning and providing safe, quality, and culturally sensitive care for patients and families.

726.10.4 : The Nurse as Detective

The graduate detects subtle changes and deviations from expected health patterns while managing the care of patients.

740.2.8 : Interprofessional Practices

The graduate analyzes the impact of new and diverse advanced nursing and care provider roles on interprofessional practice.

INTRODUCTION

Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The LLE requires engagement with other people within the setting to complete. 
 

You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:

             •  Practice: joint commission standards, core measures as quality indicators, other data

             •  Policy: legislation, staffing ratio, regulations from state boards

             •  Population: children with diabetes, adult obesity

             •  Education: future of nursing, Benner’s recommendations about nursing education

You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Note: Any information that would be considered confidential, proprietary, or personal in nature should not be included. Do not include the actual names of people, stakeholders, or other personally identifiable information. Fictional names should be used. Also, agency-specific data, including financial information, should not be included but should be addressed in a general fashion as appropriate.

Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).

A.    Develop a written proposal by doing the following:

1.    Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.

Note: You may need to meet with your organization or practice setting, your manager, or your supervisor to help choose a current problem or issue.

a.    Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.

2.    Discuss your investigation of the problem or issue.

a.    Provide evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).

3.    Analyze the state of the situation using current data.

a.    Analyze areas that might be contributing to the problem or issue.

4.    Propose a solution or innovation for the problem or issue.

a.    Justify your proposed solution or innovation based on the results of your investigation and analysis.

5.    Recommend resources to implement your proposed solution or innovation. Include a cost-benefit analysis of your proposed solution or innovation.

6.    Provide a timeline for implementation based on your proposal.

7.    Discuss why each key stakeholder or partner is important for the implementation of the solution or innovation.

a.    Summarize your engagement with the key stakeholders or partners, including the input and feedback you received.

b.    Discuss how you intend to work with those key stakeholders or partners in order to achieve success.

8.    Discuss how your proposed solution or innovation could be implemented, including how the implementation could be evaluated for success.

B.    Explain how you fulfilled the following roles during your process of investigation and proposal development:

1.    scientist

2.    detective

3.    manager of the healing environment

C.    Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership experience.

D.    Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

E.    Demonstrate professional communication in the content and presentation of your submission.

File RestrictionsFile name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRICA1:PROBLEM OR ISSUE

NOT EVIDENT

An identification of the problem or issue is not provided.

APPROACHING COMPETENCE

The identified problem or issue is not related to practice, policy, population, or education, or it does not align with organizational priorities that are in need of solving.

COMPETENT

The identified problem or issue is related to practice, policy, population, or education, and it aligns with organizational priorities that are in need of solving.

A1A:EXPLANATION OF PROBLEM OR ISSUE

NOT EVIDENT

An explanation of the problem or issue is not provided.

APPROACHING COMPETENCE

The explanation addresses the problem or issue, but it does not include an appropriate, logical rationale for why the problem or issue applies to the chosen area of practice and the healthcare environment.

COMPETENT

The explanation of the problem or issue includes an appropriate, logical rationale for why the problem or issue applies to the chosen area of practice and the healthcare environment.

A2:INVESTIGATION

NOT EVIDENT

A discussion of the investigation of the problem or issue is not provided.

APPROACHING COMPETENCE

The discussion of the investigation of the problem or issue is illogical or vague, or the discussion is trivial or missing key details. Or the discussion of the investigation is irrelevant to the problem or issue.

COMPETENT

The discussion of the investigation of the problem or issue is logical and sufficiently detailed. The discussion of the investigation is thorough and relates to the problem or issue.

A2A:EVIDENCE OF PROBLEM OR ISSUE

NOT EVIDENT

Evidence to substantiate the problem or issue is not provided.

APPROACHING COMPETENCE

The provided evidence fails to substantiate the problem or issue because it is not an appropriate form of evidence, or the evidence does not logically support the problem or issue.

COMPETENT

The provided evidence substantiates the problem or issue because it is an appropriate form of evidence (e.g., organizational assessment, national source documents, or evidence from a stakeholder), and it logically supports the problem or issue.

A3:ANALYSIS

NOT EVIDENT

An analysis is not provided.

APPROACHING COMPETENCE

The analysis addresses the state of the situation, but current data is not used to support the analysis. Or the analysis is implausible or is not supported by specific examples.

COMPETENT

The analysis addresses the state of the situation using current data, and it is plausible and well supported with specific examples.

A3A:CONTRIBUTORS TO PROBLEM OR ISSUE

NOT EVIDENT

An analysis is not provided.

APPROACHING COMPETENCE

The analysis is limited to addressing minor areas that contribute to the problem or issue, or the analysis is implausible or is not supported with specific examples.

COMPETENT

The analysis addresses all the areas that potentially contribute to the problem or issue. The analysis is plausible and well supported with specific examples.

A4:PROPOSED SOLUTION OR INNOVATION

NOT EVIDENT

A proposal for a solution or innovation for the problem or issue is not provided.

APPROACHING COMPETENCE

The proposal of a solution or innovation to the problem or issue is illogical, inappropriate, or missing significant components.

COMPETENT

An appropriate solution or innovation is proposed for the problem or issue. The solution or innovation is logical, well reasoned, and includes all significant components.

A4A:JUSTIFICATION OF PROPOSED SOLUTION OR INNOVATION

NOT EVIDENT

A justification of the proposed solution or innovation is not provided.

APPROACHING COMPETENCE

The justification of the proposed solution or innovation does not make logical connections between the problem and the solution, or it is not based on the results of the investigation or analysis.

COMPETENT

The justification of the proposed solution or innovation makes logical connections between the problem and the solution, and it is based on the results of the investigation and analysis.

A5:RESOURCES AND COST-BENEFIT ANALYSIS

NOT EVIDENT

A recommendation or a cost-benefit analysis is not provided.

APPROACHING COMPETENCE

The resources recommended for implementation of the proposed solution or innovation are inappropriate for the needs of the solution or innovation, or the recommendation is missing key resources. Or a cost-benefit analysis is not included, or the analysis is illogical or not an accurate representation of the needs of the proposed solution or innovation.

COMPETENT

The resources recommended for implementation of the proposed solution or innovation are appropriate for the needs of the solution or innovation. The recommendation includes all essential resources. A cost-benefit analysis is included, and it is a logical and accurate representation of the needs of the proposed solution or innovation.

A6:TIMELINE

NOT EVIDENT

A timeline for implementation is not provided.

APPROACHING COMPETENCE

The timeline is not accurate or not achievable given the needs of the proposed solution or innovation.

COMPETENT

The timeline is accurate and achievable for the needs of the proposed solution or innovation.

A7:IMPORTANCE OF KEY STAKEHOLDERS OR PARTNERS

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

At least 1 of the stakeholders or partners that are identified in the discussion are inappropriate for the implementation of the solution or innovation, or essential stakeholders or partners are missing in the discussion, or the discussion does not address why each identified stakeholder or partner is important for the implementation of the solution or innovation.

COMPETENT

All of the key stakeholders or partners that are identified are appropriate for the implementation of the solution or innovation, and there are no missing essential stakeholders or partners. The discussion also addresses why each identified stakeholder or partner is important for the implementation of the solution or innovation.

A7A:ENGAGEMENT WITH KEY STAKEHOLDERS OR PARTNERS

NOT EVIDENT

A summary is not provided.

APPROACHING COMPETENCE

The summary of the engagement with the key stakeholders or partners is vague or trivial, or the summary does not include the input and feedback received from them.

COMPETENT

The summary of the engagement with the key stakeholders or partners is sufficiently detailed and meaningful, and it includes the input and feedback received from them.

A7B:SUCCESS

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

The discussion ineffectively addresses how to work with the key stakeholders or partners discussed in part A7 in order to achieve success. The discussion is illogical or is missing supportive details.

COMPETENT

The discussion effectively addresses how to work with the key stakeholders or partners discussed in part A7 in order to achieve success. The discussion is logical and includes supportive details.

A8:IMPLEMENTATION

NOT EVIDENT

A discussion is not provided.

APPROACHING COMPETENCE

The discussion ineffectively addresses how the proposed solution or innovation could be implemented, or the plan for implementation is illogical or missing key details, or the discussion does not include an appropriate, well-supported, or well-reasoned plan for how the implementation could be evaluated for success.

COMPETENT

The discussion effectively addresses how the proposed solution or innovation could be implemented. The plan for implementation is logical and thorough. The discussion includes an appropriate, well-supported, and well-reasoned plan for how the implementation could be evaluated for success.

B1:ROLE OF SCIENTIST

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the scientist was fulfilled during the investigation process and proposal development, or the explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the scientist was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

B2:ROLE OF DETECTIVE

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the detective was fulfilled during the investigation process and proposal development. The explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the detective was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

B3:ROLE OF MANAGER OF THE HEALING ENVIRONMENT

NOT EVIDENT

An explanation is not provided.

APPROACHING COMPETENCE

The explanation ineffectively addresses how the role of the manager of the healing environment was fulfilled during the investigation process and proposal development. The explanation is vague or lacks specific, relevant examples.

COMPETENT

The explanation effectively addresses how the role of the manager of the healing environment was fulfilled during the investigation process and proposal development. The explanation is detailed and includes specific, relevant examples.

C:VERIFICATION FORM

NOT EVIDENT

A submission is not provided.

APPROACHING COMPETENCE

The “Professional Verification Form” from the organizational leader advising leadership experience is submitted, but the submission is incomplete.

COMPETENT

The submission of the “Professional Verification Form” from the organizational leader advising leadership experience is complete.

D:APA SOURCES

NOT EVIDENT

The submission does not include in-text citations and references according to APA style for content that is quoted, paraphrased, or summarized.

APPROACHING COMPETENCE

The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized but does not demonstrate a consistent application of APA style.

COMPETENT

The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a consistent application of APA style.

E:PROFESSIONAL COMMUNICATION

NOT EVIDENT

Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.

APPROACHING COMPETENCE

Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.

COMPETENT

Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.