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What are your thoughts 

When working and discussing issues with my preceptor, we have discussed what impacts hospitals the most especially right now and we both concluded that emergency rooms are still busy and now with Covid patients, the stress level is even higher. Patients are waiting to see their primary care providers because they are scared to go out and their medical problems that are normally managed are out of control. Due to an increase in sick medical patients and sick Covid patients, emergency rooms remain impacted. 

     Emergency rooms continue to face issues that arise and it seems to be the nurses that have the best suggestions to improve. A clinical problem that busy emergency rooms face is customer satisfaction. Patients are our customers and they want to be treated with high-quality care and with compassionate nurses. Nurses can work together to create a safe and comforting environment. Nurses provide a service to the communities that we serve and live in and it is our job to make sure they have a positive one. One implication or tool that nurses can use is AIDET. AIDET is a tool that “can improve patients’ perceptions of how they are treated; acknowledge, introduce, duration, explanation, thank you—is a framework that gives health care workers tools to improve communication with patients” (Barber, 2018, pg. 3). This tool can be used by nurses to help improve overall satisfaction. Another implication that nurses can use is to engage frontline staff by encouraging them to round on their patients and informing them of their plan despite delays. 

     Due to the increase in Covid patients, nurses and staff of hospitals are becoming sick with Covid. Despite personal protection equipment, nurses and emergency technicians in the ED are becoming sick. “We need to be extremely careful in decreasing the transmission of this nasty virus in the future” (AHC Media, 2020). Nurses and hospital staff are becoming sick with Covid-19 and are fighting the virus but are fearful of coming to work. With staff becoming sick, there is an increase in nursing shortage and this creates challenges among staff and schedules. It is our job to protect ourselves and protect our loved ones by practicing good hand hygiene and respecting good practices.

First

Comparison of Virginia, Maryland and District of Columbia APRN Regulations

     The region of Virginia in which I live is locally known as “the DMV” (the abbreviation for District/Maryland/Virginia). It is common for many practitioners to live in one jurisdiction and practice in another. For this reason, I chose to compare the three jurisdictions.

     According to the American Association of Nurse Practitioners, an APRN’s practice is restricted in Virginia. However, in the District and Maryland, APRNs may practice to their full scope of education and experience. Two differences I noted were in regulating agencies and in prescriptive authority. In Virginia, APRNs are regulated jointly by the Board of Nursing and the Board of Medicine. In contrast, in the District and Maryland, the respective Boards of Nursing are the only regulatory agencies.

     Regarding prescriptive authority, in Virginia, in order for a nurse practitioner (other than a nurse anesthetist or midwife) to have autonomy in practice, one must have practiced in a restricted capacity for at least five years (9000 hours). Also, nurse practitioners may only prescribe Schedule II – V medications in partnership with a physician. In the District, APRNs have full prescriptive authority (DC Health), and in Maryland, full prescriptive authority includes prescribing medical marijuana (Maryland Board of Nursing).

     Loversidge (2019), in addressing the regulation of Advanced Practice Registered Nurses (APRNs), proffered that it “has been inconsistent because…states [have] the right to establish laws governing professions and occupations” (p. 65). As a note of interest regarding practicing

RNs, the District does not participate in the Nursing Licensure Compact either, and an RN that wants to practice in DC must obtain a separate DC-specific license. In a region as geographically close as the DMV, especially during health-related crises, collaboration among the three regions Boards of Nursing could allow for scope expansion of a Virginia-licensed APRN. In the meantime, it is essential for APRNs crossing borders into other jurisdictions to familiarize themselves with the regulations of each in order to adhere to both prescriptive authority and other regulations.

References

American Association of Nurse Practitioners. Retrieved September 28, 2020, from https://www.aanp.org/advocacy/state/state-practice-environment

DC Health, Nursing Regulations, Nurse Practitioners. Retrieved September 28, 2020, from

https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Chapter%2059%20Nurse-Practitioners.pdf

Loversidge, J.M. (2019). Government response: regulation. In J. A.Milstead, & N. M. Short (Eds.), Health policy and politics: A nurse’s guide (6th ed., pp 57-86). Burlington, MA: Jones & Bartlett Learning

Maryland Board of Nursing Scope and Standards of Practice. Retrieved September 28, 2020, from http://www.dsd.state.md.us/comar/comarhtml/10/10.27.07.03.htm

Virginia Department of Health Professions Board of Nursing. Retrieved September 28, 2020, from https://www.dhp.virginia.gov/media/dhpweb/docs/nursing/leg/NursePractitioners.pdf

Second 

 APRN Board of Nursing Regulations in Texas and Florida.

Most states in the U.S of America have similar and different regulations to govern APRN in their practice acts because of the complexity of the health care system. According to Milstead & Short (2019), “Regulation means to control over something by rule or restriction, and health professions regulation is needed as a mechanism to protect the interest of the public safety (p. 60). Each states Board of Nursing in the U.S put in place regulations to protect the public of interest because of the potential risk for harm so that APRN can be held accountable and responsible of any rules that are outline in the practice acts. In Texas, to renew APRN license, applicant must completed an APRN educational program, attest to having a minimum of 400 hours of current practice within the preceding biennium, and attest to being in compliance of continuing competency and APRN with prescriptive authority (Office of the Secretary of States, n.d). In Texas, APRN with full valid prescription authorization number can obtain authority to order or prescribe control substance in Schedule II, III through V. Prescription for controlled substance in Scheduled III through V including refill of the prescription shall not exceed 90 days’ supply, beyond the initial 90 days the refill prescription cannot be authorized, and prescription of the controlled substance in Schedule III through V for child less than two years of age can not be authorize prior to consultation with delegating physician and notation of consultation in the patient’s chart (Office of the Secretary of States, n.d). This regulation enables the APRN to follow the guidelines when prescribing certain categories of control substance.

In Florida, to renew APRN license, the applicant must prescribe up to 30 hours of continuing education biennially as a condition for renewal of a license or certificate, must complete at least 3 hours of continuing education on the safe and effective prescription of controlled substances, and complete a 2-hour continuing education course on human trafficking. In Florida, APRN has been granted legal authority to prescribed drugs listed as controlled substance subject to approval by their supervising Practioner, will need mid-level Practioner DEA registration, APRN cannot prescribe more than 7-day supply of Schedule II control substance except the APRN is a psychiatric nurse who only can prescribe 7-day supply of Schedule II controlled substance that is mental health drugs, and ARNPs who are not psychiatric nurses cannot prescribe psychiatric mental health controlled substances for children younger than 18 years of age (Akerman LLP – Health Law Rx, 2016).

Regulations for Advance Practice Registered Nurse (APRNs): Legal Authority to      Practice

American Health care delivery system is face with so many complex issues which requires adequate access to health care for positive health outcome. There is a barrier to health delivery because of shortage of health care providers in the U.S and these are affecting millions of Americans to seek health care at their convenient time. Every year, foreign immigrants, people living in rural areas, lower-middle class citizen find it difficult to access health care due to race, color, ethnicity, nationality, sexual orientation or socioeconomic status. Granting APRN full legal authority to practice without limitation can help resolve the issue of the barriers facing health care delivery system in the U.S. Some states allow APRNs to practice independent without physician supervision to lessen the high demands of their health care delivery system while other states are still deliberately on the issue. In 2017, 15 states report that NPs are regulated solely by a BON and have independent scope of practice and prescriptive authority without physician supervision, delegation, consultation, or collaboration… (Milstead & Short, 2019 p.63). If an APRN with full legal right to practice moved to another states with limitation, the APRN must abide to the regulations of the new states when it comes to renewal of license and prescription of some categories of control substance. For example, Texas regulation requires APRN to obtain authority to prescribe control substance in Schedule II, III through V, the APRN with legal right to practice independently must abide to the rules of Texas with no exception to the law because the APRN is within the jurisdiction of the new states.

                                                References

Akerman LLP – Health Law Rx. (2016). Deciphering Florida’s New Laws on ARNP and PA Controlled Substance Prescribing. Retrieve from: https://www.jdsupra.com/legalnews/deciphering-florida-s-new-laws-on-arnp-25553.

Milstead, J & Short, N. (2019). Health Policy and Politics: A Nurse’s Guide. Government Response: Regulation. p. 60, 63, 6th edition. Burlington. MA. Jones & Bartlett Learning.

Office of Secretary of States. (n.d). Texas Administrative Code. Retrieve from: https://texreg.sos.state.tx.us/public/readta1c$ext.ViewTAC?tac_view=3&ti=22&pt=11

Think about a healthcare organization that you know (or have researched). In a 1-2 page paper, explain why they should devote time to planning. Identify and describe three things the organization can accomplish by the planning process.

Be sure to format your research sources per APA standards and use in-text citations where necessary. Also, be sure to include a reference page

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Question Paper (https://www.homeworkmarket.com/questions/picot-question-paper-19831505)

and Literature Evaluation Table (https://www.homeworkmarket.com/questions/literature-evaluation-table-19841955 )assignments to develop a 750-1,000 word review that includes the following sections:

1. Title page

2. Introduction section

3. A comparison of research questions

4. A comparison of sample populations

5. A comparison of the limitations of the study

6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance. 

Proposal and Problem Statement

Present and discuss a topic that you are interested in researching for this course. 

Explain why this topic interests you. 

Provide a brief background of the topic and speculate on arguments you could pose or problems you could solve. 

Additionally, draft a potential problem statement. 

Pose ideas and solicit feedback from your peers on your ideas.

The preceptor will perform a midterm evaluation with the faculty. The preceptor will input the evaluation content into the Lopes Activity Tracker. The student will upload the evaluation into LoudCloud after meeting with the preceptor to discuss the midterm evaluation.

Students must meet all clinical expectations of the course, earn a passing grade on all benchmark assignments, and successfully complete remediation (if necessary) in order to receive a passing grade in the NRS-493 course.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Resources:

• Stevens District Hospital Strategic Planning Scenario
• Importance of Mission and Vision Statements in Strategic Planning Grading Criteria

Write a 700- to 1,050-word executive summary in which you:

• Identify the mission and vision selected.
• Explain the rationale for why you selected the mission and vision statements.
• Identify the specific strengths of the mission and vision statement selected.
• Identify the weaknesses of the mission and vision statements not selected.
• Explain how the mission and vision drive the strategic plan for the health care organization.

Cite 2 peer-reviewed, scholarly, or similar references to support your summary.

Format your assignment according to APA guidelines.

Assignment Outcomes:

At the conclusion of this assignment, students will be able to: 

• Describe the scope of foodborne illness in the United States 
• Describe four core food handling practices to reduce the risk of foodborne illness 
• Identify foods most likely to be associated with foodborne illness

 Access information related to safe food handling at FightBac.org and the CDC. Although students may browse the entire site, they should focus the majority of their time reading the sections entitled, “Clean,” “Separate,” “Cook,” and “Chill.” 

Students will research a recent outbreak of foodborne illness in the news and write a written report. Although students may include additional information, the following information is required: 

• News source 
• Date of news report 
• Number of individuals affected 
• Food source 
• Microorganism causing the illness 
• Symptoms of illness 
• How could this foodborne illness have been prevented?

 Within the written report, students should also address these points:

• Define foodborne illness in your own words 
• Identify a favorite food that would be classified as a potentially hazardous food
• Give examples of cross contamination of food
• Provide at least one recommendation from each of the 4 core practices (e.g. prior to cooking, store chicken in refrigerator at 40 F or lower).

Please review attached grading rubric and for the sources please use credible online sources. 

The purpose of this assignment is to demonstrate your ability to critique one quantitative or qualitative nursing research article of interest from any refereed nursing journal.

Instructions:

Summarize and critique one research article, which meet the following criteria:

1. Original research studies, preferably published from 2013 to the present.

2. Utilize at least 5 cite sources to substantiate your findings or critique.

3. Visit American Nurses association and read the Article: “Reading and critiquing a research Article”.  Then read“ The John Hopkins Nursing Evidence Practice”  for suggested guidelines . This a 1-1 1/2 pages assignment  using APA format (see rubric).

Content of your critique should include:

1. Title Page.
2. Describe the problem and purpose of the research study (This is a summary) Is the problem of the study discussed in the introduction? What is the problem statement? Is the significance of the study established in the introduction? What is the significance of this study?
3. Describe the research methods, including process of data collection, sampling, and data analysis, for the research study. Identify research question, hypotheses, purpose and specific aims/objectives. Who were the subjects and or participants? What sampling approach was undertaken and why? How sample size was justified? What level of measurement was used for the variable(s)? What instrument(s) was used? How reliability and validity was established?
4. Summarize the major findings and conclusions of the study
5. Critique the strengths and weaknesses of the research methods. The expectation is that you also cite your textbook, when describing research methods or criteria for evaluating research.  
6. How this study is relevant to evidence-based practice in nursing?
7. At Least five References 

1. Choose a nursing research article of interest from a refereed nursing journal.
2. Utilize at least 5 cited sources to substantiate your findings or critique.
3. Visit the following website for suggested guidelines:’ 
   • American Nurses Association “Reading and critiquing a Research Article” @  chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.nursingworld.org/~4afdfd/globalassets/practiceandpolicy/innovation–evidence/framework-for-how-to-read-and-critique-a-research-study.pdf 
   • The “John Hopkins Nursing Evidence Practice” @  chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/https://www.mghpcs.org/EED_Portal/Documents/PI_EBP/Jon_Hopikins_Tools/Research_Evidence_Appraisal_Tool_fillable.pdf 
   • Create a 1-2 page critique.

Question 1

1. For this writing assignment, you will complete a research essay. Pick a topic and write 3-4 pages. Also, include a title page and reference page.

I will use your mapping exercise(attached) to ensure you are using the subtopics identified in your paper. 

 Use 2-3 articles or references to write your paper.  

Question 2

2. Under module 5, complete the APA worksheet(attached). Download the APA worksheet, type your answers directly on the worksheet, and upload it back into the canvas.