NURS 682 WCU Expanding APRN Scope for Improved Care Discussion

NURS 682 Responses

Yenisleidy Gonzalez Leon Response 1

APRN Scope of Practice

APRN practice is based on evidence-based guidelines in the process of evidence-based practice (EBP). APRNs access these guidelines, assess their applicability to their practice situation and case, and use them to inform their qualitative and quantitative decisions. By using evidence-based guidelines, APRNs translate evidence into practice, facilitating EBP. Physicians and APRNs are held to the same evidence-based standards. This is mainly because their scope of practice intersects and; hence, they practice in the same setting. Despite requiring supervision from physicians depending on the state of practice, APRNs provide services that are similar to those offered by physicians (Van Wicklin, 2021). They are, therefore, expected to uphold the same evidence-based standards.

The scope of practice for APRNs depends on the state where they are licensed and practice. In some states, they have full independence and autonomy. However, in many states, APRNs need physician oversight to some extent including patient assessment, prescriptions, diagnosing, and treating patients. This may be restricted or reduced oversight levels. A collaborative practice agreement between an APRN and a physician is a written agreement on joint practice and complementary work in the healthcare sector. It is a legal document defining roles and responsibilities, providing oversight by the physician, and defining the procedures and approaches to ensure that oversight under the existing law (Buppert, 2023). APRNs in reduced and restricted autonomy states need to enter a collaborative practice agreement with a physician to operate in those states.

APRNs are expected to pay physicians for their collaboration in practice. This compensation is based on the roles and responsibilities that the physician handles on behalf of the APRN as dictated by law and defined by the collaborative practice agreement (Buppert, 2023). The APRN will incorporate consultation and collaboration in several ways. For instance, the APRN may call the physician for consultation before prescribing certain medications or require the physician to be present when treating specific issues.

References

Buppert, C. (2023). Nurse Practitioner’s Business Practice and Legal Guide. Jones & Bartlett Learning.

Van Wicklin, S. A. (2021). Determining scope of practice. Plastic and Aesthetic Nursing, 41(1), 40-42. https://doi.org/10.1097/PSN.0000000000000354

Maria Bates Response 2

Evidence-based guidelines are put in place so that they can be used to provide safe, efficient, and quality care to patients. APRNs are part of the healthcare team who must be knowledgeable and competent to be able to care for others using evidence-based practices (Clarke, et al, 2021). APRNs are busy clinicians but it is their responsibility to stay up to date with the evolving guidelines that are changing. There are various ways that APRNs can stay up to date such as subscribing to receive updates on evidenced-based topics and connecting with other professionals. Knowing how to filter out information can be beneficial to APRNs to be able to grasp the most important information.

Evidence-based research can be a topic of conflict. This can be due to trials with limited populations and not enough information for some clinicians. An obstacle can be that not everyone is on board with making changes. There could be different opinions on how things are being done and this can affect making changes. That is why it is important for APRNs to participate in studies and provide feedback, questions that they would want answered, and information to researchers to gain information that applies to their patient population. “APRNs play a vital role in implementing new interventions or guidelines and they should be active participants in constructing and testing implementation models and delivery systems” (Blair, 2018, p. 258). APRNs can implement evidence-based practices on an individual level and with patient consent called micro-level solutions. APRNs can implement evidence-based practices in organizations at a greater scale by being part of the clinical decision-making process called meso-level solutions. They would work in collaboration with other professionals to integrate evidence-based practices at a greater level. APRNs can influence policy making by providing their knowledge, skills, and evidence-based practices that benefit their patients and advocate for them called macro-level solutions.

APRNs, depending on the state that they live in, can be independent with full authority to prescribe medications. APRNs and physicians are healthcare providers who work collaboratively and APRNs are not required to pay physicians to practice. APRNs have the autonomy to use evidence-based practices when and if the facility or organization and physician they work for permits it. Some facilities, organizations, and physicians might not want to implement evidence-based practices due to costs. It might cost them more money to use a certain drug even if it is more effective. APRNs and physicians can work collaboratively to implement evidence-based practices. APRNs can bring new ideas and suggestions to physician or organizations but ultimately decisions might need to be made as a team.

Blair, K. A. (2018). Advanced Practice Nursing Roles (6th ed.). Springer Publishing LLC. https://online.vitalsource.com/books/9780826161536Links to an external site.

Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse Practitioners’ Implementation of Evidence-Based Practice Into Routine Care: A Scoping Review. Worldviews on evidence-based nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510Links to an external site.