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The Role of Nurses in Advanced Practice Sample Paper

The healthcare industry has become increasingly complex necessitating the need for highly trained nurses.  To deal with these demands, a group of highly trained, educated, and skilled nurses have emerged to provide highly specialized nursing roles in a complex medical setting. As highly educated, trained, and experienced nurses, APRNs are often tasked with the duty of providing advanced patient care as well as supervising other staff.

Advanced nursing is important because it helps caregivers to deal with extremely complex nursing situations that cannot be handled effectively by registered nurses or ordinary nurses. For example, critical care requires advanced knowledge, education, and training to handle satisfactorily. APRN nurses have obtained at least a master’s degree and further specializations within the sphere of APRN (Kim et al. 2017). The advanced education by APRN nurses makes them have high skills and specialization in a specific patient population. At the very least, APRN nurses must have an RN- Registered Nurse license, clinical experience, and a master’s degree in nursing. Advanced nursing helps nurses to take on greater roles and specialties essential to the advancement of public health. In advanced practice, nurses have an enlarged scope as far as nursing is concerned.

Advanced Nursing and Nursing Philosophy

While many theories are beneficial to nurses, every nurse identifies with only specific models that work best for them considering their objectives and nursing philosophies. For me, I choose Jean Watson’s Caring theory as my nursing theory. I choose this theory because it offers the best results for patients-care, love, empathy, and quality services. At the same time, this theory appeals to my nursing philosophies. The Jean Watson’s Caring nursing theory has numerous critical advantages to me as a nurse and my patients. For patients, this nursing theory emphasizes quality care, empowerment, creating awareness, cooperation with patients, and meeting the needs of patients

Prescriptive Authority Comparison between Texas and California

1.Texas

Prescription of medicine in Texas is done under strict guidelines as provided for in section SB 406. Since its creation in 2013, section SB 406 allows physicians to delegate the duty of prescribing medication to nurse practitioners based in any location in Texas. TMB Rule 193.6 further gives physicians the power to delegate the work of ordering and prescribing prescription drugs, nonprescription drugs, medical devices, and medical equipment to a physician assistant and APRNs. This means that in Texas, all APRNs can prescribe all drugs in schedules II-V with very few limitations (Molassiotis et al., 2021). The Prescriptive Authority Agreement-PAA is the tool that allows APRN nurses to have the authority to prescribe medication in Texas. There are certain conditions that nurses must meet in Texas before being conferred the power to prescribe. One of the conditions is that an APRN must have an active practicing license given by the BON. Without a valid license, a APRN cannot and must not do prescription. The second critical requirements for APRNs before being allowed to prescribe medicine is to have a valid authorization number issued by BON. This prescriptive authorization number identifies each nurse every time they order for a prescription. The last condition for APRNs in Texas to complete before being allowed to prescribe drugs is not having a prior ban or investigation by BON.

2. California

Just like Texas, prescriptive laws in California are very strict and highly regulated. The California Nursing Practice Act-CNPC asserts that all registered NPs-Nurse Practitioners have the authority to provide basic primary care. However, when it comes to prescription, a collaborative agreement is used in prescribing pharmaceuticals. Even then, NPs in California cannot prescribe medicine without authorization from a supervising physician. California has a tool called a ‘restricted practice authority’ which requires nurses to have an agreement with a doctor before being allowed to prescribe medicines, interpret any diagnostic tests, or perform any other critical services (O’Connor et al. 2018). Still, NPs in California can prescribe all drugs and medications in schedules II-V. This is inclusive of all the highly addictive drugs in schedule II. However, any restrictions by Californian NPs must be done under a collaborative practice agreement.

Pros and Cons of Each State

Cons

The cons noticed in both the state of California and Texas is that both states do not allow their NPs to prescribe medicine/drugs without authority from a physician. In the case of California, a collaborative practice agreement is the tool that allows NPs in the state to prescribe medicine, handle any sensitive, tools, and interpret diagnoses. In Texas, TMB Rule 193.6 give physicians the power to delegate the work of ordering and prescribing prescription drugs, nonprescription drugs, medical devices, and medical equipment to a physician assistant and APRNs. This means that in Texas, all APRNs can prescribe all drugs in schedules II-V with very few limitations.

Pros

In both California and Texas, all NPs have the right to prescribe even the most sensitive drugs such as schedule II drugs. Another con is that NPs in the 2 states have the capacity to order for drugs even remotely without having to be physically present. The only requirement is that NPs must have an active practicing license prescriptive registration number. This means that NPs in the state of California and Texas can prescribe just about any drug as long as it is authorized by the supervising doctor.

Discussion on Changes

In the case of California, there has been a spirited fight by nurses to have the limitation on prescriptions lifted. For example, in this state NPs work alongside doctors through standardized protocols that require collaboration, signatures and approvals. In my view, these protocols are critical in ensuring patient safety. However, it is my view that there are some prescriptions that nurses can make without needing the approval of physicians. For example, APRNs who are highly trained, educated, and experienced nurses can accurately prescribe some medication on their own based on the years of education and the experience they have in the field. Having to wait for approval from doctors is sometimes painful for nurses because sometimes they see situations that they can handle effectively but have to wait for approval which sometimes take long depending on a doctor’s schedule.

Future Stakes

            From my reading, I find that California has the best future opportunity for my practice. This is because the level of prescriptive restrictions in this state is much lower compared to that of California. Secondly, it looks like the push by nurses in Texas to lift the prescriptive limitations is almost bearing fruit. There are a number of current bills seeking to overturn the limitations which means that there is a likelihood that things may get better soon. This is unlike California where doctors continue to strongly lobby the government against giving nurses the authority to freely prescribe drugs. In my opinion, it will be some time before any gains are made in this state regarding prescription by nurses.

Advanced Nursing and the Health of Organizational

Advanced nursing is a critical factor for the success of modern organizations. Organizations need to identify values, behaviors, structures, and attitudes that enhance employee performance. Similarly, organizations need to cultivate a culture of linguistic competence. Effective communication in organizations creates more cohesive teamwork leading to enhanced productivity. Linguistic competence helps organizations to relay information in a way that is easily understandable to a diverse audience. From the advanced practice, I learned that health organizations need to identify how culturally diverse the communities they serve are. Health organizations must realize that cultural beliefs, vulnerabilities, strengths, and values of different cultures influence their operations and profits.

References

• Kim, U., Halpin, J., & Morrison, G. (2017). Diversity and Inclusion in Healthcare: A Leadership Perspective. The Graduate Schools Executive Guest Lecture Series. 1. https://digitalcommons.otterbein.edu/grad_guest/1
• Molassiotis, A., Liu, X. L., & Kwok, S. W. (2021). Impact of advanced nursing practice through nurse‐led clinics in the care of cancer patients: A scoping review. European Journal of Cancer Care, 30(1), e13358.
• O’Connor, L., Casey, M., Smith, R., Fealy, G. M., Brien, D. O., O’Leary, D., … & Cashin, A. (2018). The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?. Journal of clinical nursing, 27(5-6), e882-e894.