Nurse Practitioner Professional Issues

NRNP 6565: Synthesis in Advanced Nursing Practice Care of Patients in Primary Care Settings
Week 1: Nurse Practitioner Professional Issues
In the 1940s and 1950s, Loretta Ford, known as the pioneer for nurse practitioners (NPs), was a public health nurse in rural Colorado. During that time period, there was a shortage of physicians to care for children and families. To address this gap, Loretta Ford and Dr. Henry K. Silver started the first pediatric nurse practitioner program at the University of Colorado Medical Center in 1965. Since this time, nurse practitioners have been in great demand to meet the evolving healthcare needs of individuals, families, and communities. Nurse practitioners are prepared to prevent diseases, promote health, provide treatment, and support health maintenance. They are well equipped to provide safe, high-quality, cost-effective, and accessible care.

After your program ends—you’re almost there—the next step toward becoming an NP is knowing what the requirements for certification and licensure in your state are and preparing to meet them. Each state has different laws regarding the role of the nurse practitioner that may significantly impact NP practice. You will also explore other nurse practitioner professional issues and complete a Knowledge Check to gauge your understanding of them.

Learning Objectives
Students will:

Summarize nurse practitioner certification and licensure processes
Explain state-specific scope of practice for primary care nurse practitioners
Explain state-specific restrictions or limitations for practice
Explain nurse practitioner prescriptive authority and DEA registration processes
Explain legislative and advocacy activities related to nurse practitioner practice
Identify key concepts of professional issues related to nurse practitioner practice
Learning Resources
Required Readings (click to expand/reduce)
Required Media (click to expand/reduce)
Discussion: Certification and Licensure
Now that you are in your final course in your program, it is time to turn in earnest to preparing for certification and licensure. You will need to take and pass a national AGPCNP certification exam. Once certified, you will then be eligible to apply for licensure as an advanced practice registered nurse (APRN) in the state desired. It will be up to you to ensure you are knowledgeable about the practice agreements, scope of practice, and prescriptive authority in your state.

Photo Credit: Getty Images/iStockphoto

Although there is a movement called the APRN Consensus Model to standardize NP regulations nationally, it is still the case that requirements vary state to state. In some states, NPs may establish independent practice without the supervision of an MD. Additionally, states are currently categorized as either allowing full practice, reduced practice, or restricted practice. Full practice states allow NPs to evaluate, order diagnostics, diagnose, and treat patients. They are licensed under the exclusive authority of the state board of nursing for the appropriate state. Many states may require prescriptive authority protocols in addition to collaborative agreement.

Another important area to consider and plan for is prescriptive authority. Prescriptive authority is granted under state law by the appropriate board. The board granting prescriptive authority may be the medical board, state board of pharmacy, or nursing board for the appropriate state licensure being pursued. The authority to write for a controlled substance is granted at a federal level and is verified through the Drug Enforcement Administration (DEA) by the appropriate state board. Drug Enforcement Agency registration is granted at the federal level and has additional requirements/fees for the registration process.

Finally, the legal landscape for NPs is constantly changing as the status of NPs as providers improves on a national level. Legislative changes may occur annually, bi-annually, or during an emergency legislative meeting at the state or federal level. These legislative sessions and any subsequent changes will significantly impact your scope of practice as a nurse practitioner.

For this Discussion, you examine professional issues for your state, including certification and licensure, scope of practice, independent practice, prescriptive authority, and legislative activities.

To prepare:

Review practice agreements in your state.
Identify whether your state requires physician collaboration or supervision for nurse practitioners and, if so, what those requirements are.
Research the following:
How do you get certified and licensed in your state?
What is the application process for certification in your state?
What is the primary nurse licensure office resource website in your state?
How does your state define the scope of practice of a nurse practitioner?
What is included in your state’s practice agreement?
How do you get a Drug Enforcement Agency (DEA) license?
How does your state describe a nurse practitioner’s controlled-substance prescriptive authority and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?
In what legislative and advocacy activities are your state nurse practitioner organization(s) involved?
By Day 3
Post a summary of your findings on your state based on the questions listed above. Explain the types of regulations that exist and the barriers that may impact nurse practitioner independent practice in your state. Be specific. Also, describe what surprised you from your research.

Read a selection of your colleagues’ responses.

By Day 6
Respond to at least two of your colleagues on 2 different days in one or more of the ways listed below.

Share an insight from having viewed your colleagues’ posts.
Suggest additional actions or perspectives.
Share insights after comparing state processes, roles, and limitations.
Suggest a way to advocate for the profession.
Share resources with those who are in your state.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information
Grading Criteria
To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6
To Participate in this Discussion:

Week 1 Discussion

Knowledge Check: Professional Issues
This Knowledge Check consists of 10 short-answer and true/false questions that focus on the following content areas:

Scope of Practice
Professional Role
Certification and Licensure
Ethics

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.
By Day 7
Complete the Knowledge Check.

Submission Information
Submit Your Knowledge Check by Day 7
To submit your Knowledge Check:

Week 1 Knowledge Check

What’s Coming Up in Week 2?
In Week 2, you will continue your exploration of professional issues related to advanced nursing practice and complete a Knowledge Check on these topics. You will also take a practice exam in your certification review textbook. Because this is a pre-assessment used to gauge your current knowledge, there is no need to worry about preparing for this test.

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Practicum – Upcoming Deadline
In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, you will need to submit your application via Meditrek .

For information on the practicum application process and deadlines, please visit the Field Experience: College of Nursing: Application Process – Graduate web page.

Please take the time to review the Appropriate Preceptors and Field Sites for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the Field Experience: College of Nursing: Student Resources and Manuals web page.

Field Experience: College of Nursing Quick Answers
Field Experience: MSN Nurse Practitioner Practicum Manual
Student Practicum Resources: NP Student Orientation
To go to the next week:

Week 2

Week 2: Nurse Practitioner Professional Practices
As healthcare providers, we strive to deliver optimal, safe care. Ongoing healthcare research, evidenced-based care, and effective guidelines for practice offer a stabilizing force. Our duty, as healthcare providers, is to “do no harm.” As providers, primary care nurse practitioners provide preventive and primary care, which entails complex management. Understanding legal terminology is essential to the role. Terms such as “standard of care,” “malpractice,” and “negligence” are inevitable and essential components for understanding the legal challenges advanced practice nurses will experience during their careers.

Another essential professional element in clinical practice is reimbursement. All NPs must give due diligence and ensure all services provided are accurately coded and billed appropriately. Avoiding fraudulent billing is a key element to your success as an NP. As providers, we are ultimately responsible for billing that occurs with our assigned Medicare, Medicaid, and other third-party reimbursement entities’ assigned numbers.

This week, you will explore nurse practitioner professional practices and complete a Knowledge Check on those topics. You will also take a practice exam, which will help you assess your current knowledge level in the content areas that will be assessed on the certification exam.

Learning Objectives
Students will:

Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
Identify key concepts of professional issues related to coding/billing, malpractice, and negligence
Learning Resources
Required Readings (click to expand/reduce)
Assignment: Practice Exam Questions
Chapter 31 of your Nurse Practitioner Certification Intensive Review text contains practice exam questions that will help you prepare to take the national certification.

To Prepare:

You do not need to study or prepare for this test. It is being used as a diagnostic pre-assessment to gauge your current knowledge.
Set aside time to complete 100 of these questions.
By Day 7
Complete the practice questions and afterward, score your results using the answer key in the text.
Save your score for next week, when you will create a certification exam study plan based on your results.
Note: Your grade for the Week 3 Assignment will not be derived from your test results but from your self-reflection and study plan.
Knowledge Check: Professional Practices
This knowledge check consists of 10 short-answer and true/false questions that focus on the following content areas:

Coding/Billing
Malpractice/Negligence

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.
By Day 7
Complete the Knowledge Check.

Submission Information
Submit Your Knowledge Check by Day 7
To submit your Knowledge Check:

Week 2 Knowledge Check

Looking Ahead to the Week 10 Assignment: Nurse Practitioner Career Planner
For this Assignment, you will create a professional Career Planner that includes a cover letter, resume, philosophy statement, and letters of recommendation that you may use as you pursue your next professional role.

It is recommended that you review the Career Planner guide in this week’s resources and work on your planner throughout the term. See the Week 10 Assignment area for complete instructions.

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you will begin a systematic review of disease processes in the body systems. Through complex case analysis and comprehensive review, you will have the opportunity to synthesize and deepen your knowledge.

Comprehensive Practice Questions
Beginning in Module 2, you will practice taking multiple-choice questions designed to help you prepare for your certification exam. Each set of Comprehensive Practice Questionsconsists of 30 questions. Unlike the Knowledge Checks, which focus only on the topics of the week, these comprehensive questions may be pulled from any area of knowledge that might appear on the certification exam.

To go to the next module:

Module 2

Week 3: HEENT Conditions
Which simple pleasures do you most enjoy? Perhaps there is a certain comfort food that always hits the spot. It may be that you enjoy listening to your favorite music—or even singing along. Or perhaps you simply enjoy stopping to smell the flowers. The beauty of a simple pleasure is that while it may not change the course of your day, it can briefly put a smile on your face. But what if your ability to enjoy these simple pleasures was suddenly impaired? Suddenly, minor pleasures would make a significant impact on your life.

Conditions of the head, eyes, ears, nose, and throat (HEENT) can impair many of the activities that put smiles on faces. Hearing, balance, taste, swallowing, speech, and breathing are just some of the functions that can suffer as a result. HEENT issues represent some of the most common reasons that patients visit primary care offices. And while the conditions can be relatively minor issues, such as allergies or sinusitis, HEENT issues can also result from injury, infection, or serious disease.

This week, you practice assessing, diagnosing, and treating patients with HEENT conditions and complete a Knowledge Check on these disorders. You will also reflect on your practice exam results from last week and use them to create a study plan that you will use throughout this course to prepare for the national certification exam.

Learning Objectives
Students will:

Create a study plan for the nurse practitioner national certification examination
Evaluate patients with HEENT conditions
Develop differential diagnoses for patients with HEENT conditions
Develop treatment plans for patients with HEENT conditions
Identify key concepts related to HEENT conditions
Learning Resources
Required Readings (click to expand/reduce)
Recommended Reading (click to expand/reduce)
Assignment 1: Study Plan
Based on your practice exam question results, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress.

Photo Credit: AJ_Watt / E+ / Getty Images

To Prepare:

Reflect on your practice exam question results. Identify content-area strengths and opportunities for improvement.
Also reflect on your overall test-taking. Was the length of time allotted comfortable or did you run out of time? Did a particular question format prove difficult?
The Assignment:

Summarize your practice exam results, including your strengths and opportunities for improvement.
Note: Your grade for this Assignment will not be derived from your test results but from your self-reflection and study plan.
Create a study plan, including 3–4 specific goals and the tasks you need to complete to accomplish each goal. Include a timetable for accomplishing them and a description of how you will measure your progress.
Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.

By Day 7
Submit your study plan.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn1+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn1+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:

Week 3 Assignment 1 Rubric

Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7
To participate in this Assignment:

Week 3 Assignment 1

Assignment 2: Assessing, Diagnosing, and Treating Patients With HEENT Conditions
Most everyone has at some point experienced minor HEENT conditions, such as a head cold or seasonal allergies, and symptoms, such as a runny nose, watery eyes, or a sore throat. While they are relatively minor and short-lived, they nevertheless impair many of the simple pleasures so many enjoy.

HEENT symptoms can represent a wide variety of issues, some of which suggest problems that extend well beyond their temporary impact on life’s simple pleasures. HEENT conditions can result in dangerous respiratory impairment or be symptoms of life-threatening conditions or disease.

For this Assignment, your instructor will assign a case study, which will give you the opportunity to practice assessing, diagnosing, and treating patients with HEENT conditions.

Photo Credit: Getty Images/iStockphoto

To Prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with conditions of the head, eyes, ears, nose, and throat.
Review the case study provided by your Instructor. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate in order to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with HEENT conditions.
The Assignment

Use the Focused SOAP Note Template to address the following:

Subjective: What details are provided regarding the patient’s personal and medical history?
Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any morbidities or psychosocial issues.
Assessment: Explain your differential diagnoses, providing a minimum of three. List them from highest priority to lowest priority and include their CPT and ICD-10 codes for the diagnosis. What would your primary diagnosis be and why?
Plan: Explain your plan for diagnostics and primary diagnosis. What would your plan be for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
Reflection notes: Describe your “aha!” moments from analyzing this case.
By Day 7
Submit your focused SOAP note.

Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn2+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment 2 Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn2+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:

Week 3 Assignment 2 Rubric

Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:

Submit your Week 3 Assignment draft and review the originality report.

Submit Your Assignment by Day 7
To participate in this Assignment:

Week 3 Assignment 2

Knowledge Check: HEENT Conditions
This Knowledge Check consists of 10 short-answer and true/false questions that focus on conditions of the head, eyes, ears, nose, and throat (HEENT).

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.
By Day 7
Complete the Knowledge Check.

Submission Information
Submit Your Knowledge Check by Day 7
To submit your Knowledge Check:

Week 3 Knowledge Check

What’s Coming Up in Week 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 4, you will continue your review of disease processes related to various body systems, with a focus on cardiac and pulmonary conditions. You will also complete your first set of Comprehensive Practice Questions, which are designed to help you prepare for your certification exam.

To go to the next week:

Week 4

Week 4: Cardiac and Pulmonary Conditions
Cardiac and pulmonary conditions account for an overwhelming number of the annual deaths in the United States. Additionally, more than 1.5 million people suffer heart attacks and strokes each year, while hundreds of thousands suffer from a variety of other cardiovascular diseases. Infectious diseases such as COVID-19 present special dangers to high-risk, vulnerable patients. The good news is that medical science continues to make remarkable breakthroughs that offer hope in terms of prevention and treatment. Nurses and the teams with which they collaborate diagnose complex health conditions related to cardiovascular and pulmonary issues, and they work tirelessly to develop and administer treatment plans.

Despite the hope offered by new medications and treatments, patients typically experience stress and anxiety that compound their cardiac and pulmonary conditions. Nurses may use their compassion and expertise to help patients address the realities of their conditions and the requirements of their treatments.

Top 10 Causes of Death Annual number of deaths in the United States (2017 CDC data)
Heart disease 647,457
Cancer 599,108
Accidents (unintentional injuries) 169,936
Chronic lower respiratory diseases 160,201
Stroke (cerebrovascular diseases) 146,383
Alzheimer’s disease 121,404
Diabetes 83,564
Influenza and pneumonia 55,672
Kidney disease 50,633
Intentional self-harm (suicide) 47,173

This week, you examine cardiac and pulmonary conditions and complete a Knowledge Check on these topics. You also complete the first set of Comprehensive Practice Questions, which are designed to help you prepare for your licensure exam.

Reference:
National Center for Health Statistics. (2017). Leading causes of death. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Learning Objectives
Students will:

Identify key concepts related to cardiac and pulmonary conditions
Demonstrate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination
Learning Resources
Required Readings (click to expand/reduce)
Recommended Reading (click to expand/reduce)
Knowledge Check: Cardiac and Pulmonary Conditions
This Knowledge Check consists of 10 short-answer and true/false questions that focus on cardiac and pulmonary conditions.

Photo Credit: Getty Images

To Prepare:

Review this week’s Learning Resources.
By Day 7
Complete the Knowledge Check.

Submission Information
Submit Your Knowledge Check by Day 7
To submit your Knowledge Check:

Week 4 Knowledge Check

Comprehensive Practice Questions
One goal for this course is to help you prepare for the national certification exam. This week—and again in Weeks 5, 7, and 8—you will practice taking multiple-choice questions designed to help you do just this. Each set of Comprehensive Practice Questions consists of 30 questions. Because the certification exam will assess you on the entire body of nurse practitioner knowledge in which you are obligated to be competent, these questions, too, may be pulled from any area of knowledge that might appear on the exam. This differs from the Knowledge Check questions, which focus solely on the topic for a given week and are designed to give you targeted practice.

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

Continue to review sections of Adult-Gerontology Nurse Practitioner Certification Intensive Review and your other resources, as needed.
By Day 7
Complete the Comprehensive Practice Questions.

Submission Information
Submit Your Comprehensive Practice Questions Check by Day 7
To submit your Comprehensive Practice Questions:

Week 4 Comprehensive Practice Questions

What’s Coming Up in Week 5?
Next week, you will continue to review disease processes in various body systems, focusing on the gastrointestinal and renal systems. You also complete the next set of Comprehensive Practice Questions.

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