Need ONE Response Per Each Discussion Total 6 Responses. Attached Are The Discussions And Rubric Please Follow Them. Posts Will Be A Minimum Of 2 paragraphs , APA Format.Two References Per Each Discussion

Evelin

According to the last report of the American Association of Nurse Practitioners, the scope of the nurses' practices is not limited by their titles. On the contrary, advanced nursing practice allows nurses to actively participate in clinical diagnoses, interventions, treatment monitoring, prescribing, and examinations physical (Batey & Holland, 2018). At present, the concept of advanced practice nurses has achieved worldwide development, for this reason, the health system prefers advanced practice nurses because they are trained professionals to meet the needs of patients and meet the administrative requirements of the system sanitary (Coulehan & Sheedy, 2017).

Prescribing for advanced practice nurses (APRNs) is a new integration to their responsibilities and duties with the health of patients. The prescribing of these nurses, has demonstrated effectiveness and efficacy, and allows APRNs to approach the integral and efficient management of patients from the viewpoint of other nurses, given that, according to each state, APRNs have the power to prescribe, that is, if APRNs have experience in prescribing, each state can limit this practice (Scudder, 2016).

Regarding the education of APRNs, these nurses should be specially educated to formulate prescription medications, to train about safe practices based on formulas and the combination of controlled medications. On the other hand, the limited APRNs for the formulation of medications, have the option of working interdisciplinary with other professionals to participate in the prescription, this ensures that nurses know the risks and benefits of the prescription (Coulehan & Sheedy, 2017). However, this seems to be a barrier, like the laws in each state, since it does not allow trained APRNs to exercise their knowledge and skills in this regard. Although this practice aims to protect the integrity of patients, it limits the experience and autonomy of nurses with the knowledge and certified education (Batey & Holland, 2018).

Finally, another barrier faced by nurses trained and endorsed by the state, are the regulations of each health institution, since, each hospital can determine the scope of APRNs, that is, hospitals can limit the APRNs to formulate prescriptions of medications, even if, they are accredited and allowed by the state, since, federal and state laws give hospitals autonomy to determine the competencies and functions of each of their workers (Jiao & Murimi, 2018). Likewise, it is possible to affirm that the main consequence of these barriers affects the quality and effective care of patients, since, in some cases, there may be delays in medical care until a certified physician supervises the activities of APRNs, increasing health costs and decreasing patient satisfaction (Batey & Holland, 2018).

 Guillermo

The Role of Advanced Practice Nursing in Safe Prescribing

APRNs consist of nurse midwives, nurse anesthetists, clinical nurse specialists, and nurse practitioners. They are all involved ensuring the future of health care. APRNs are in most cases providers of primary care, and are at the forefront of offering preventive care services to the entire public. The usually diagnose and treat illnesses, manage chronic diseases, advises the public on health matters, and take part in incessant education for the purposes of remaining ahead of methodological, technological, and other developments within the health care fields (Blair & Jansen, 2015). NPs offers specialty, acute, and primary health care across the lifespan via treatment, diagnosis, and assessment of injuries and illness. Certified Nurse-Midwives offers reproductive, gynecological and primary health care. Certified Registered Nurse Anesthetists offers a full array of pain management and anesthesia services. Clinical Nurse Specialists offers treatment, diagnosis and continuing patient management.

Prescribing Barriers for APRNs

The three main barriers for APRNs include state practice and licensure, physician related issues, and payer policies. The practices of NPs are usually controlled by the state licensure. It is only a third of the entire nation which has assumed a complete practice licensure and practice laws for the NPs. State licensure controls the practice of NP and is a barrier to them performing to the completest level of their training and education. Physical related issues may comprise of some of the physician profession organizations, which includes the American Medical Association.  They have a belief that since the physicians have more and longer rigorous training than the NPs, nurse practitioners do not have the ability of providing safe and quality care at a similar level like the physicians. Lastly, under the payer policy barrier, a number of NPs have reported that payer policies have a substantial impact on their capability of practicing to the fullest level of their training and licensure (Kung et al., 2015).

 

 

 

Dailamis

Advanced Practice Nursing (ARPNs) takes a vital role in the upcoming expectations of healthcare. These nurse practitioners establish illness and recommend the community on health concerns and management of importunate diseases (Michelle, 2018).  As well, the evolvement in healthcare recommends nurse practitioner to partake a crucial position in improving a range of health outcomes of various populations. This involves exercising safe medical prescriptions authorities for patients they handle as well as demonstrating core competencies in the profession. This will respond to the various needs of the highly revolutionizing healthcare surroundings.

Alongside with safe prescriptions nursing practitioners require core competencies such as skills on advanced pharmacology that help them manage medications. Nursing practitioners must know the potentially harmful combination of medications. This will reduce inflict of medical interactions that would lead to severe complications such as organ damage (Michelle, 2018). Moreover, gives them the basis of safe dosage range and effective monitoring of some drug medications.

Besides skills of advanced pathophysiology gives a future nursing practitioner with a basis of making proper clinical decisions relating to diagnosis and cure of severe and chronic infections (Jordon, 2017). These skills help them perform more effective treatments for their patients and create a better connection with them concerning certain body alterations.

 Furthermore, proper, precise, and well-timed advanced health assessment skills are crucial in maintaining safety in hospitals by nursing practitioners. Inclusion of highly developed physical assessment proficiency such as auscultation, thumping, and palpation prepares them for intricate patient presentations over a significant range of clinical situations (Jordon, 2017).

However, despite the prescriptive authority endowed to ARPNs existing barriers in the healthcare environment limit APRN practice. The State Practice Licensure is a barrier to ARPN practice as it restricts this practice. It only enables a nursing practitioner to engage in at least one aspect of the practice and controlled management by an external health regulation to administer patient care (Michelle, 2018). Besides, there are physician related issues where certain physician bodies view nursing practitioners unskilled of giving eminent, protected care like that of physicians (Jordon, 2017). This has contributed to the confusion that exists among various physicians concerning the responsibility of nursing practitioners. Additionally, harsher payer policies as a result of restricted scale of practice have limited nursing practitioners’ ability to perform independently. They do not identify them as chief care providers and at times are defiant to credentialing them for their services (Jordon, 2017).

To suffice it, the unrelenting discussion concerning the preparedness of nursing practitioners in provision of eminent and cost-efficient healthcare has reduced the ability of more meaningful conversations. This will create a platform about more effective strategies that will address the rising need for prime care provision and reduce the disparities existing in healthcare. Moreover, there is need to formulate public, state, and confined levels of nursing organizations that will counteract the barriers to ARPN practice.

 

 

Dailyn

Family nurse practitioners (FNPs) have fluctuating degrees of prescriptive authority over medications and controlled substances. In addition to understanding the legal implications of prescribing medications, FNPs must also understand their ethical obligations, particularly considering the ongoing opioid crisis (Bachmann, Messer & Hacker, 2014).

FNPs and other providers who have the legal authority to prescribe must follow ethical guidelines to ensure patients are safeguarded from harm (McCuistion, Vuljoin-DiMaggio, Winton, Yeager & Kee, 2018). Responsibility starts with providers being educated about the new medications and specialty drugs on the market. The responsibility of conducting a comprehensive patient interview and obtaining a complete medication list is just the beginning of the critical analysis of possible interactions and side effects

Studies show nearly one-third of adults in the United States takes five or more medications daily. The more medications a person takes, the greater the chance of adverse drug events.

The World Health Organization suggests a multi-step approach to prescribing that may help providers better focus the intent for the treatment. The guidelines were established in 2007 and are still applicable today.

1. Evaluate and define the patient’s problem.

2. Determine the therapeutic objective of the drug therapy.

3. Select an appropriate medication.

4. Provide patients with information, warnings, and instructions.

5. Monitor the patient regularly.

6. Consider drug costs when prescribing.

7. Use appropriate tools, such as prescribing software and electronic drug references, to reduce prescription errors.

Muler

Drug safety is a priority for all health professionals, not just APNs.  Proper drug safety approaches within the field of advanced practice nurses has positive effects not only on the nursing practitioners but also on the physicians, other non-medical staff, as well as the healthcare facility. For APNs, proper drug safety approaches makes way for advancement in practice as well as chances of moving up into leadership positions (Basch, 2014).

 I mostly deal with the elderly population.  The geriatric group is considered to be most vulnerable to the effect of medications and so it is very important to consider their health status before prescribing any medication (Surratt, O'grady, Stivers & Chen, 2014). The physiological functions of many body organs decline with age, especially important organs such as the liver and kidneys. Older people may also suffer from dementia or “impaired memory” and so forget to take their medications.  A strategy we employ to enhance drug safety in this population is to follow up with phone calls, mailings, and health education on a regular basis.  This strategy is called “Med Safety First.”  It has enhanced our efforts to provide medication safety and adherence.

 

Barriers to prescribing 

1. 1. State practice and Licensure 

Gretel

1. 2. Medical and nursing profession law HB 423 

1. 3. Physician related Issues 

 

      In advanced nursing practice there are a few barriers when it comes to practicing in the real world. Although nurse practitioners are not doctors, I believe that they should be respected and taken into consideration when making laws that can affect this profession. As a future nurse practitioner, I am now aware of the barriers I will face when I graduate be employed. The first barrier we have as nurse practitioners is that in most states we have to practice under a medical doctor. In order to prescribe we need to be practicing under an MD in most states (States with Full NP Practice Authority: Maryville Online NP Programs. 2020). The 3 main barriers nurse practitioners encounter for prescribing is state are practice and licensure, medical and nursing profession law HB 423, and physician related issues.  

     The first prescribing barrier we as nurse practitioners face is determined by the state we practice in. For example, when prescribing scheduled II controlled substances Nurse Practitioners are limited in certain states with certain rules to follow. In Florida a Nurse Practitioner is not allowed to prescribe a schedule II controlled substance past 30 days supply (The Florida Senate. 2016). The prescription can only be written for a 7 day supply. Also, only psychiatric Nurse Practitioners can prescribe a psychiatric medication to children under 18 years of age. Another prescribing barrier is law HB 423 which is for medical and nursing professionals (Important Legislative Update regarding HB 423. 2016, April 15). Law HB 423 states that nurse practitioners and physician assistants are allowed to prescribe controlled substances in drug class II, III, and IV. The Psychiatric Nurse Practitioner can also prescribe some controlled substances. However, both professionals need to make sure certain certifications are completed to do so. Last but not least, one of the barrier nurse practitioners encounter for prescribing is the lack of support that certain physicians provide them with. There are physicians out there who don’t trust nurse practitioners to prescribe class II scheduled controlled substances to patients so they are limited to strong pain killers and other drugs that fall under that category (Hain, D., & Fleck, L. M. 2014, May 2). 

      I believe that a nurse practitioner although not a medical doctor is capable of determining if a patient needs a drug class II controlled substance. Limiting nurse practitioners ability to prescribe certain medications is insane. Nurse practitioners are required to have nursing degree in which most of the graduates have background experiences in either the hospital in acute care or in outpatient areas where they have witnessed people in pain and the administration of analgesics. Their experience not only gives them logic on how to approach a pain management patient but. it also gives them a sense as to who is actually in pain and who is going to misuse a drug.