week 1 discussion 

 Research is used in my facility. The type of research used in my facility is mainly is clinical trials. This is different from other nursing roles in that the nurses like myself focus on taking care of patients using the knowledge and skills that we have gained through college and on the job training, etc. And we use evidence-based practice to administer care for the best proven outcomes. On the other hand, “A clinical trial is a controlled research study that evaluates the safety and benefits of new medications or medical devices” (Mangel, 2017).

         My hospital’s healthcare system has a research institute which is the centralized research facility serving all the five hospitals in the Wellstar health System. The institute offers progressive top of the line therapies to patients and contributes to the advancement of medical science. It is beneficial to patients, physicians, the community and society as a whole. The institute supports doctors and others who conduct the research, as well as patients who receive new drugs, devices and procedures through clinical trials. According to Mangel (2017), “Some drugs and therapies being studied have not yet been approved by the U.S. Food and Drug Administration. But they have been approved for human trial and are believed to be better, more effective or result in fewer side effects than existing treatments.” All research performed at WellStar is approved by an Institutional Review Board for oversight of all trials. 

        Research is an important component of clinical practice because it provides a foundation for clinical decision-making. It gives nursing care has a scientific base, and helps to save cost for interventions.  Evidence based practice proves that there is professional accountability for the work that we take on, and the knowledge gained from research can be put to practice for better health outcomes

  

Case Study

Heart Failure

Patient Profile

M.G. is a 77 year old woman who saw her health care provider for dyspnea. She is now being admitted to the hospital for acute heart failure. She was diagnosed once before with heart failure 6 years ago. She is currently taking the following medications:

Furosemide 40mg po daily

Potassium chloride 20meq po daily

Enalapril 10mg po BID

Subjective data

Was taking furosemide at home but ran out two days ago and has not been able to refill her prescription

Complains of difficulty breathing; had to “sleep in the chair” last night

Has some swelling in her feet that is worse than usual

Objective Data

Physical examination

· Temp 98.4 F, pulse 92 irreg., resp. 24 labored, blood pressure 144/86, oxygen saturation 89% on Room air

· Ht. 5’5”, wt. 170 lbs.

· Alert and oriented to person, place, and time

· Fine crackles bilateral lower lobes

· Shortness of breath with minimal exertion

· S1 and S2 without murmur or extra heart sounds

· Capillary refill sluggish in lower extremities, normal in upper extremities

· 2+ pitting edema bilateral lower extremities

Interprofessional Care

Admission orders include: 

· Oxygen 2L/ nasal cannula

· Furosemide 40mg intravenous BID

· Enalapril 10mg po BID

· ECG now

· Vital signs with SPO2 q 4 hrs

· 2 gm sodium diet

· Strict I&O

· Daily weight

Answer the following questions thoroughly and cite resources appropriately in APA format.

Describe a plan for implementing these orders. 

Based on M.G.’s clinical manifestations, what type of heart failure do you suspect? Support your answer

What assessment data will you use to determine the effectiveness of the provider’s orders?

What is the rationale for the oxygen, IV furosemide, and enalapril?

What are the priority nursing diagnoses for this patient? (list at least 3)

What other orders might you anticipate for this patient?

Think about plans for discharge, what are your primary concerns for this patient?

Any other information you need or would like about this patient?

I need a reply for this 2 peers. 

A minimum of 2 paragraphs is required for all posts  

Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years). 

All posts are to be written in APA 6th edition format  

Peer 1 

The Role of Advanced Practice Nursing in Safe Prescribing 

The s. 893.03 Florida Statutes mandate the APRNs to prescribe controlled substances in line with the supervisory standards. The professionals have to engage in three-hour training sessions on safe prescribing and the effective implementation of the related strategies (Florida Board of Nursing, 2016). The APRNs have to evaluate and define the patients’ health issues to offer the right prescriptions. They should also equip patients with relevant information about warnings as well as how one should take the prescribed drugs (Pigman et al., 2016). Additionally, the practitioners monitor the patients regularly to make sure they receive the intended benefits of the prescriptions at hand. According to the state requirements, the APRN practitioners have to meet the same prescription standards as physicians. 

Prescribing Barriers for APRNs 

Various barriers limit the APRN practitioners from undertaking their prescription roles effectively. First, state licensure restricts the APRNs from engaging in full practice in line with their educational qualifications. The practitioners can only engage in one of the NP roles based on collaborative agreements. Secondly, APRN training programs may fail to equip learners with advanced skills for delivering high-quality health care services. Negative perceptions of the existing working conditions and inadequate knowledge also limit the practitioners from performing their prescription roles effectively (Jun, Kovner, & Stimpfel, 2016). Additionally, certain payer policies deter the APRN from engaging in health care delivery activities to the full extent of their training as well as licensure. For instance, some scope-of-practice policies restrict practitioners to specific roles. Job satisfaction issues also hinder practitioners from undertaking their prescription roles in a way that impacts significantly on patient outcomes. Some practitioners experience unfavorable working conditions, which reduce their productivity. 

Peer 2 

ARNPs have in their hands a high level of responsibility when prescribing medications. The degree of responsibility depends on whether they can or not prescribe medicines that rely on the state’s laws related to the prescriptive authority given to APRNs. There are twenty-one states that are fully independent prescribing by nurse practitioners (Teri, & Marylou, 2015). The responsibility for the final decision on which drug to use and how to use it depends on the APRN prescriber. To be a safer prescriber, it is important that APRN assume the higher level of legal responsibility that is required. Also, the knowledge of medicine, pharmacology, determine the diagnose for which the drug will be ordered, prescribe the appropriate drug, monitor the outcome, and educate the patient about the medication and possible adverse effects. 

Despite many positive expansions to the APRN role that include caring for ethnically diverse, underserved populations within an aging society and across many healthcare settings, there are a lot of barriers requiring attention. Prescribing medications is one of the main components of the APRN role and essential to his/her practice. One of the barriers is the restrictions on prescriptive authority that limit the ability of NPs to provide comprehensive health care services. AANP recommends that NP prescribing authority be solely regulated by state boards of nursing and in accordance with the NP role, education and certification. This process of license and regulation exclusively by the nursing board promotes public safety and competent practice (Hain, D., & Fleck, L., 2014). 

The Florida Board of Nursing states that ARNP may only prescribe or dispense a controlled substance as defined in s. 893.03 Florida Statutes if the ARNP graduated from a program with a master’s or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills. However, all ARNPs and PAs are required to complete at least three hours of continuing education on the safe and effective prescribing of controlled substances. Also, Under the new law, an ARNP’s prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic medications for children under 18 years of age, unless prescribed by an ARNP who is a Psychiatric Nurse. The bill also clarifies that only allopathic physicians licensed under chapter 458, Florida Statutes, or osteopathic physicians licensed under chapter 459 Florida Statutes may dispense medications or prescribe controlled substances in a registered pain management clinic (Florida Board of Nursing, 2016).In addition, every person who prescribe controlled substances must register and obtain a registration number with the US Drug Enforcement Administration. Also, they have to maintain and keep on file for a minimum of 2 years accurate records of controlled drugs they purchase, distribute, administer, and dispense.  (Teri, & Marylou, 2015). 

This is the original assignment if you needed: 

Discuss the role of advanced practice nursing in safe prescribing and 3  prescribing barriers for APRNs. 

https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424 

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html 

https://floridasnursing.gov/new-legislation-impacting-your-profession/ 

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-prescriptive-privilege 

SCHOOL POLICY 

NO PLAGIARISM 

AT LEAST 120-150 WORDS FOR EACH QUESTION PLEASE AND THANK YOU 

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*** DUE TODAY IF POSSIBLE .. 8 PM EASTERN TIME***

1- Who would ultimately determine and approve the mission and vision of an organization?  Why? 

2-   Consider a large organization with maybe 500 employees – how would you be able to get all staff involved in creating the mission and vision?  Doesn’t final approval need to reside with one person or a small group of key leaders?

3- Describe the difference between mission and vision of an organization.