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Nurse Practitioners, Their Roles and Settings
Introduction
In this paper, the role of nurse practitioners will be discussed. The problems in collaboration with physicians, limited autonomy, and the growing shortage of the medical staff are the current problems nurse practitioners have to face.
Role
The advanced nurse role selected for the research is the nurse practitioner or the advanced practice registered nurse. The role of the nurse practitioner implies delivering primary care for individuals and families; furthermore, the role of the nurse practitioner also demands to promote health behaviors to clients and diagnosing common diseases. According to the National Patient Safety Goals, it is a clinical role because nurse practitioners diagnose, manage, and monitor patients diseases. The nurse practitioner can mark the procedure site, i.e. identify the procedures that require marking and perform other duties linked to it if there are circumstances that require this. Thus, nurse practitioners can take part in preventing wrong site, procedure, or person surgery. Moreover, nurse practitioners are responsible for delivering quality healthcare, whereby they use evidence-based practices, critical thinking, and leadership strategies to promote patient safety.
Review of Articles
The role of a nurse practitioner is to provide various primary care services, Yee, Boukus, Cross, and Samuel (2013) point out. Depending on the states legislation and laws, nurse practitioners can diagnose and treat patients without the oversight of a physician; other states require physicians supervision of the nurse practitioners decisions and diagnoses (Yee et al., 2013). The practice of nurse practitioners is governed by a set of scope-of-practice laws that influence the delivery of the services. Usually, NPs focus on chronic and preventive care management and rarely work on complex diagnoses (Yee et al., 2013, p. 2). Although the restrictive laws exist in many states, nurse practitioners are allowed to make clinical decisions there, but they have to pay attention to the documented supervision as well (Yee et al., 2013).
Some of the states require collaboration between a nurse practitioner and a physician, which adversely influences the working process because nurse practitioners cannot deliver services without physicians; this rule becomes a serious issue in underserved rural communities (Yee et al., 2013). Patients follow up can also be challenged if nurse practitioners are not provided with enough autonomy. Nurse practitioners role is also influenced by payer policies that determine the NPs payment rates and whether they can be seen as primary care providers (Yee et al., 2013).
The full practice authority is seen as a solution to the issue of inaccessible care by Hain and Fleck (2014). According to them, the role of nurse practitioners is often diminished or challenged by the existing barriers in legislation that prevent nurse practitioners from delivering the services they were trained to provide (Hain & Fleck, 2014). They also state that NPs assume various roles that include caring for ethnically diverse, underserved populations within an aging society (Hain & Fleck, 2014, p. 2). It is crucial for NPs and physicians collaborations to achieve best practices during the working process. Nevertheless, the problems with physicians and limited autonomy remain one of the main issues that nurse practitioners have to face. The lack of knowledge about their scope of practice negatively influences the collaboration. Moreover, the shortage of primary care providers can lead to an expansion of nurse practitioners autonomy, but it is not supported (Hain & Fleck, 2014). Thus, nurse practitioners are trained to provide various services and can work autonomously, but current laws often interfere with the practitioners role as a primary care provider.
Nurse practitioners, although trained not as extensively as physicians, are capable of providing multiple services and making clinical decisions about treatment and prescriptions. Although many duties of a nurse practitioner and a physician are alike, nurse practitioners have lower wages and are excluded from decision-making processes because policymakers do not take their experience and suggestions into consideration (Hain & Fleck, 2014). Nurse practitioners are allowed to prescribe medications in 50 states but are restricted from admitting patients, which has a negative impact on the continuity of care (Hain & Fleck, 2014). Limited career advancement opportunities linked to the limited autonomy often force a nurse practitioner to leave their current position (Hain & Fleck, 2014). As it can be seen, the role of a nurse practitioner is important and with a certain degree of autonomy, but it could be improved according to the demands of these professionals.
Experts Opinion
The opinions expressed above are supported by another expert, who points out that nursing practitioners could be a solution to the problem of a shortage of 130,000 physicians by 2025 if they are granted with fully independent practice (Iglehart, 2014, p. 1). According to the author, the autonomy of nursing practitioners will allow addressing the issue of primary care access. Moreover, the existing laws often prevent nursing practitioners from providing all the services they were educated and trained to provide (Iglehart, 2014). As it can be seen, the role of a nursing practitioner is diminished by some of the laws, which does not lead to any effective collaboration between a physician and a nursing practitioner. That is why Iglehart (2014) suggests giving the NPs more autonomy after they have worked in collaboration with a physician for a certain period of time. As it can be seen, although the role of a nursing practitioner is of absolute importance, it still demands more autonomy.
Conclusion
Nurse practitioners bear responsibility for patients safety, diagnoses, prescribed medications, and the treatment process. Nevertheless, their autonomy remains limited or even restricted in some of the states, which adversely influences their practice. It is crucial to address these limitations as the main issues that interfere with the working process of nurse practitioners.
Comments:
References
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing, 19(2), 1-5.
Iglehart, J. K. (2014). Meeting the demand for primary care: Nurse practitioners answer the call. Health Care Policy. Web.
Yee, T., Boukus, E., Cross, D., & Samuel, D. (2013). Primary care workforce shortages: Nurse practitioner scope-of-practice laws and payment policies. National Institute for Health Care Reform. Research Brief, 13(1), 1-7.
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