interviewing a nurse
nur495journalw3
Each week you will be expected to provide the following information to your community practice instructor through your journal entries:
- What are your upcoming week’s specific learning goals and objectives?
- What is your upcoming week’s detailed schedule at your community practice experience placement?
- Were there any placement items/issues that occurred this week that you feel your instructor should be aware of that are private in nature and are more appropriately shared here than in the discussion board with your classmates?
- Give a brief description of an objective you worked on this week. Make sure to cite at least one reference showing how your objective relates to the public health knowledge you’ve studied during this course or the public health course. You may choose to reference your e-text, journal articles, or videos you’ve studied during these courses or you may find an outside reference on your own to further enhance your public health knowledge and practices.
Remember, your journal entries are an important aspect of clinical learning as they serve to help you reflect upon and get the most out of your community practice experience. Therefore, your journal entry should include the who, what, where, and when of your community practice experience. Remember, this should simulate a dialogue that would normally take place face-to-face with your community practice experience instructor.
Number your responses to make sure you have responded to all journal requirements.
Change Implementation and Management Plan
As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.
To Prepare:
- Review the Resources and identify one change that you believe is called for in your organization/workplace.
- This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
- Reflect on how you might implement this change and how you might communicate this change to organizational leadership.
The Assignment (5-6-minute narrated PowerPoint presentation):
Change Implementation and Management Plan
Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.
Your narrated presentation should be 5–6 minutes in length.
Your Change Implementation and Management Plan should include the following:
- An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
- A description of the change being proposed
- Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
- Details about the type and scope of the proposed change
- Identification of the stakeholders impacted by the change
- Identification of a change management team (by title/role)
- A plan for communicating the change you propose
- A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.
Chapter 8, “Practice Model Design, Implementation, and Evaluation” (pp. 195–246)
Pollack, J., & Pollack, R. (2015). Using Kotter’s eight stage process to manage an organizational change program: Presentation and practice. Systemic Practice and Action Research, 28(1), 51-66.
Seijts, G. H., & Gandz, J. (2016). Transformational change and leader character. Business Horizons, 61(2), 239-249. https://doi.org/10.1016/j.bushor.2017.11.005
Progress notes
List 8 PROGRESS NOTES in SOAP format of the Psychiatric Mental Health Nurse Practitioner Role with Adult and Older Adult . Describe the activities you completed during this time period with patients.
NOTE: ( The progress notes has to be related with what the Psychiatric Mental Health Nurse Practitioner do with Adult and Older adult with different psychiatric conditions). 8 different notes with different patients scenarios.
Professional Capstone and Practicum Reflective Journal
Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.
This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).
In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below. In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.
- Health care delivery and clinical systems (This topic for this week)
- While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Refferences needed for each disussion; The states I did was Newyork and Alabama
Respond to at least two of your colleagues* on two different days and explain how the regulatory environment and the regulations selected by your colleague differ from your state/region. Be specific and provide examples.
1 Response for each discussion. Discussion 1 and 2
Discussion 1
APRN Board of Nursing Regulations in Kansas and Missouri
MAIN QUESTION POST- Throughout history, defining APRNs scope of practice has been an ongoing issue in different states. According to Loversidge (2019), “the actual practice acts are inevitably a product of individual states’ political forces, so titles, definitions, criteria for entrance into practice, scopes of practice, reimbursement policies, and models of regulation are state-specific” (p.63). APRN regulations are state-specific and can differ in multiple ways. In Kansas, it is important to know the license renewal regulations. When renewing your license in Kansas, you must complete 30 hours of continuing nursing education about the advanced practice registered nurses role (“Kansas Administrative Regulations,” n.d.). Also, you can’t roll-over continuing nursing educations hours from different years. If the Kansas Board of Nursing asks for proof of the education you completed, you must provide it. As an APRN in Kansas, when prescribing controlled substances, you must put the D.E.A. registration number issued to the advanced practice registered nurse (“Kansas Administrative Regulations,” n.d.). When prescribing medications, it is crucial to know the rules behind what an APRN can and cannot prescribe and the correct way to fill out prescriptions.
In Missouri, as an APRN, you do not have to do continuing nursing education hours to renew your license. Also, in Missouri, APRNs do not have the authority to prescribe schedule II controlled substances. Only being one state apart shows that each state defines its regulations for APRNs. In Missouri, when renewing your license, you need to know your “RN license expires every odd-numbered year on April 30th and you must keep your RN license current to maintain your APRN recognition (“State of Missouri Advanced Practice Registered Nurse Document of Recognition Renewal Instructions,” n.d.). In Kansas, when renewing your license, you need to know “advanced practice registered nurse licenses shall be renewed on the same biennial cycle as the cycle for the registered professional nurse licensure renewal” (“Kansas Administrative Regulations,” n.d.). As you can see, each state has specific regulations on when to renew your license, which shows the importance of researching your state board of nursing regulations.
Regulations for Advanced Practice Registered Nurses (APRNs): Legal Authority to Practice
When it comes to allowing full practice authority for APRNs it differs from state to state. Not all states allow full practice authority as an APRN and this causes a barrier to the accessibility and affordability to health services for low income citizens (Bosse et al., 2017).With the shortage of primary care doctors, the states that do not allow full practice authority limit healthcare access to their vulnerable populations (Bosse et al., 2017). The regulations of license renewal requirements and the ability to prescribe controlled substances apply to all APRNs, depending on their educations and state laws. Even though they differ by state, APRNs need to abide by the rules for renewing and keeping their current licenses, such as through education hours and meeting renewal deadlines. When prescribing controlled medications following the rules for what to write, such as DEA numbers or the physician they are working under, is essential for APRNs. Researching and understanding your state board of nursing APRN regulations is crucial for your success in your career as an APRN.
Discussion 2
Comparison between South Carolina and North Carolina Nursing Regulations
South Carolina, my home state, is a part of AANP Region 4, which includes KY, NC, SC and TN.
Nurse Practitioner in South Carolina
Practice Authority
Written protocol with a physician is required. The protocol must outline information for delegated medical acts and a description of how consultation with the physician is provided. The protocol must be reviewed annually.
Prescriptive Authority
Drugs and devices prescribed must be within the NP’s specialty and listed in the written protocol developed by the NP and the supervising physician. An NP may also prescribe Schedules II-V controlled substances.
Nurse Practitioner as a Primary Care Provider
NPs are recognized in state policy as primary care providers. The South Carolina Medicaid Provider Manual lists the provider types that may enroll as a primary care provider.
(Scope of Practice Policy.2020)
Nurse Practitioner in North Carolina
Practice Authority
Collaborative practice agreement required between the NP and the supervising physician. The agreement must establish minimum standards of consultation and must be reviewed yearly.
Prescriptive Authority
The drugs and devices an NP may prescribe must be outlined in the collaborative practice agreement. Schedules II-V controlled substances may be prescribed if outlined in the agreement.
Nurse Practitioner as a Primary Care Provider
NPs are recognized in state policy as primary care providers. Primary care means preventive, diagnostic, treatment, consultant, referral and other services rendered by physicians, physician assistants and nurse practitioners.
(Scope of Practice Policy.2020)
In the states of South Carolina and North Carolina nurse practitioners are not allowed to practice to their full scope of practice without the oversight of a Medical doctor. As far as I can tell through some research is that only 14 states allow for nurse practitioners to practice without physician oversight. These states include Alaska, Arizona, Hawaii, Idaho, Iowa, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, Utah, Washington, Wyoming. (Beckers, 2019). While I feel that having no limits on my education and training in the practice setting, I think that have a physician to collaborate with will help me with the anxiety of being an autonomous provider. I might can see where this may get redundant when becoming a more experienced family nurse practitioner. In both SC and NC, the NP can prescribe Schedules II-V controlled substances within the scope of the agreement guidelines with overseeing physicians. Both states only allow for no more than a 30-day supply of these medications. It is the position of AANP that NP prescriptive authority be solely regulated by state boards of nursing and in accordance with the NP role, education and certification. (AAPN.2020). Both states recognize nurse practitioners as a primary care provider. Therefore, allowing reimbursement from Medicaid and Medicare and private insurance companies. For nurse practitioners wanting to open their own practice in the states of NC and SC would have to live with in 45 miles of the overseeing physician. If this were one’s goal to own their own practice it would probably be a lot less headache to do so in one of the states that allow full scope of practice with out an agreement with a physician.
Best Practice in Nursing
Write at least 5-7 sentences about some of the Best Practices you have learned about in your Professional Nursing course during this quarter. How will these practices improve patient outcomes? You must use APA and have at least three references less than three years old to support your choices.
Case Study
Mrs. Smith was a 73-year-old widow who lived alone with no significant social support. She had been suffering from emphysema for several years and had had frequent hospitalizations for respiratory problems. On the last hospital admission, her pneumonia quickly progressed to organ failure. Death appeared to be imminent, and she went in and out of consciousness, alone in her hospital room. The medical-surgical nursing staff and the nurse manager focused on making Mrs. Smith’s end-of-life period as comfortable as possible. Upon consultation with the vice president for nursing, the nurse manager and the unit staff nurses decided against moving Mrs. Smith to the palliative care unit, although considered more economical, because of the need to protect and nurture her because she was already experiencing signs and symptoms of the dying process. Nurses were prompted by an article they read on human caring as the “language of nursing practice” (Turkel, Ray, & Kornblatt, 2012) in their weekly caring practice meetings.
The nurse manager reorganized patient assignments. She felt that the newly assigned clinical nurse leader who was working between both the medical and surgical units could provide direct nurse caring and coordination at the point of care (Sherman, 2012). Over the next few hours, the clinical nurse leader and a staff member who had volunteered her assistance provided personal care for Mrs. Smith. The clinical nurse leader asked the nurse manager whether there was a possibility that Mrs. Smith had any close friends who could “be there” for her in her final moments. One friend was discovered and came to say goodbye to Mrs. Smith. With help from her team, the clinical nurse leader turned, bathed, and suctioned Mrs. Smith. She spoke quietly, prayed, and sang hymns softly in Mrs. Smith’s room, creating a peaceful environment that expressed compassion and a deep sense of caring for her. The nurse manager and nursing unit staff were calmed and their “hearts awakened” by the personal caring that the clinical nurse leader and the volunteer nurse provided. Mrs. Smith died with caring persons at her bedside, and all members of the unit staff felt comforted that she had not died alone.
Davidson, Ray, and Turkel (2011) note that caring is complex, and caring science includes the art of practice, “an aesthetic which illuminates the beauty of the dynamic nurse-patient relationship, that makes possible authentic spiritual-ethical choices for transformation—healing, health, well-being, and a peaceful death” (p. xxiv). As the clinical nurse leader and the nursing staff in this situation engaged in caring practice that focused on the well-being of the patient, they simultaneously created a caring-healing environment that contributed to the well-being of the whole—the emotional atmosphere of the unit, the ability of the clinical nurse leader and staff nurses to practice caringly and competently, and the quality of care the staff were able to provide to other patients. The bureaucratic nature of the hospital included leadership and management systems that conferred power, authority, and control to the nurse manager, the clinical nurse leader, and the nursing staff in partnership with the vice president for nursing. The actions of the nursing administration, clinical nurse leader, and staff reflected values and beliefs, attitudes, and behaviors about the nursing care they would provide, how they would use technology, and how they would deal with human relationships. The ethical and spiritual choice making of the whole staff and the way they communicated their values both reflected and created a caring community in the workplace culture of the hospital unit.
Critical thinking activities
Based on this case study, consider the following questions.
1. What caring behaviors prompted the nurse manager to assign the clinical nurse leader to engage in direct caring for Mrs. Smith? Describe the clinical nurse leader role established by the American Association of Colleges of Nursing in 2004.
2. What issues (ethical, spiritual, legal, social-cultural, economic, and physical) from the structure of the theory of bureaucratic caring influenced this situation? Discuss end-of-life issues in relation to the theory.
3. How did the nurse manager balance these issues? What considerations went into her decision making? Discuss the role and the value of the clinical nurse leader on nursing units. What is the difference between the nurse manager and the clinical nurse leader in terms of caring practice in complex hospital care settings? How does a clinical nurse leader fit into the theory of bureaucratic caring for implementation of a caring practice?
4. What interrelationships are evident between persons in this environment—that is, how were the vice president for nursing, nurse manager, clinical nurse leader, staff, and patient connected in this situation? Compare and contrast the traditional nursing process with Turkel, Ray, and Kornblatt’s (2012) language of caring practice within the theory of bureaucratic caring
Standardized Terminology and Language in Informatics (Nursing)
Standardized Terminology and Language in Informatics is an important part of healthcare. Nurses and healthcare workers need to understand and be able to communicate clearly.
Please select one of the following options and discuss your understanding of the role in healthcare and its potential impact on your practice.
- Usability
- Integration
- Interface
- Interoperability
- Meaningful Use
- Reimbursement from Centers for Medicare and Medicaid Services (CMS) payment
- NANDA
- NIC/NOC
Evidence Base in Design
When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.
In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.
To Prepare:
- Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
- Review the health policy you identified and reflect on the background and development of this health policy.
Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.