Ethical Situation with an APRN in A Family Practice Setting.

Practice Innovation Project

Topic: Prediction of Recidivism to the Hospitals by Use of Clinical Readmission Risk Assessment Methodology for Patients with a Psychiatric Diagnosis.Ethical Situation with an APRN in A Family Practice Setting.

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Chosen concept: Health literacy and adult learning

Minimum of 15 scholarly references. References may be from peer-reviewed journals within the past five years or textbooks (latest edition). Governmental websites such as the CDC, US Census Bureau, AHRQ may be used sparingly. Lay websites and publications may not be used.

APA format, 7^th edition. Times New Roman font, 12 points, double spaced. Must include title page and references.Ethical Situation with an APRN in A Family Practice Setting.

Discussion Questions:

Write the following:

1. Identify and name the concept of interest.
2. Identify and select an appropriate realm for the literature search.
3. Identify attributes of the concept.
4. Identify the references, antecedents, and consequences of the concept.
5. Identify concepts related to the concept of interest.
6. Identify the model case of the concept.
7. Develop a definition of the concept based on your reading and thinking.
8. Describe how the nursing model of care fits with the definition you created.
9. Create a concept map that links the concept to the phenomenon and population of interest
10. Discuss the role of the DNP-prepared APRN as it relates to the concept. What opportunities did you discover?
11. Critically appraise the literature you reviewed. What were the strengths, weaknesses, and gaps in knowledge?

Annually, nurses continue education to validate their knowledge, hone skills, and develop a strong foundation that promotes professional practice. Influential organizations like the AACN (American Association of Colleges of Nursing), ANA (American Nurses Association), and NLN (National League for Nursing) support a similar call to higher education since nursing as a profession bases on continuous and lifelong learning. Enrolment to a master’s or doctoral program enables an RN to pursue a specific and meaningful practice area to advance professionally to an APN.  This paper describes the evolution of the APN role, the difference between APNs and RNs, evaluates the confusion of roles between APNs and RNs, and provides an ethical situation with an APRN in a family practice setting. This information is vital to empower APNs to articulate their roles, provide quality care, and quantify their contributions to population health outcomes.Ethical Situation with an APRN in A Family Practice Setting.

Evolution of APN Role and Traits to Develop

According to Hu & Forgeron (2018), the initial roles of APNs that emerged in the 1940s in the US were nurse-midwives and anesthetists in response to shortages in the health workforce, escalating costs of care, and inadequate distribution of healthcare resources. Despite the rapid and successful expansion of the aforementioned programs to multiple areas of specialization, there was a lot of controversy and opposition to the new roles. However, over time, there was a lot of evidence to support APN practice. Today, APNs are integral to promoting access to care in ambulatory care settings, reduce the costs of care, promote clinical outcomes through the following roles; CNS (clinical nurse specialists), nurse practitioners (NPs), nurse case managers, nurse anesthetists, and nurse midwives (Hu & Forgeron, 2018).Ethical Situation with an APRN in A Family Practice Setting.

Most APNs are equipped at master’s level with a certificate, license, or both as the key requirement for practice. To meet the trends for preparation for advanced nursing at the doctoral level today, higher learning institutions that train nurses are developing Doctor of Nursing Practice (DNP) programs.  Therefore, throughout schooling, the most significant traits to develop as suggested by Hu & Forgeron (2018), are optimism, enthusiasm, advocacy, active listening, communication, and empathy since they are patients’ advocates, and are key contributors to overall job satisfaction for APNs.Ethical Situation with an APRN in A Family Practice Setting.

ANP Definition and Difference between APN and Expert Nurse

An APN is an RN with highly complex skills in decision-making, clinical competency, and expert knowledge acquired through post-graduate education in a general or specific area in nursing. According to Hu & Forgeron (2018), the cornerstone of competency of an APN is direct clinical practice where nurses apply new skills, prescriptive authority, role autonomy, and specialization to influence individual and population health outcomes. The key difference between an APN and an experienced nurse in an area of expertise is that the latter directly care for patients as specified in the care plan while the former conduct supervisory duties, and create the care plans in conjunction with other advanced practice providers thus, have a broad patient oversight (Wilson, 2017).Ethical Situation with an APRN in A Family Practice Setting.

According to Boman, Levy‐Malmberg & Fagerström (2020), nurses in both roles provide preventive and medical care at the patient’s bedside accomplishing the vital tasks for monitoring and maintaining a patient’s health by conducting patient assessments, ordering diagnostic tests, operating medical equipment and administering drugs. However, the later do not receive academic training to work with particular patient groups but can focus on patients with specific medical conditions such as critical care or labor and delivery and the later have additional responsibilities to coordinate care using specialized knowledge to manage complex conditions.Ethical Situation with an APRN in A Family Practice Setting.

Role Confusion

There was role confusion in the place the author did her summer assessment which increased transition anxiety. The author felt insecure about the capacity to make decisions and taking responsibility to write orders and diagnose patients rather than following the RN role orders. Confusion of the new role was also associated with significant changes from nursing care such that, the FNP role centered on the medical diagnostic care aspect. The commonality in both roles was direct patient care. However, both roles were somewhat ambiguous since they lacked objectivity, boundaries, and parameters to distinguish the scope of practice from legislatively defined roles.

The author will promote her APN role by aligning her practice with the target patient population. This will not only help to build recognition but also reflect the care provided, which makes it easy for a collaborative physician to identify the niche and practice scope. Another strategy suggested by Wilson (2017) is by attending interprofessional policy and national conferences, and local organizations between physicians, APNs, and other healthcare providers, which provide a platform to connect and share knowledge.Ethical Situation with an APRN in A Family Practice Setting.

Ethical Situation with an APRN in A Family Practice Setting

An ethical situation in APRN is establishing professional boundaries with close friends and family. A perfect example is when a family member requests for two prescriptions over the phone to purchase drugs for cough and mild flu for his/her two children. The author would handle this ethical situation based on the state’s laws and regulations, which forbids providers from prescribing drugs to friends and family since the close relationship between the provider, and family members can cloud judgment. Instead, the author would advise the patient to visit a healthcare provider for assessment, diagnosis, and management.  As highlighted by Gilman (2018), an APRN can face legal implications for prescribing to friends and family, and even in states that require APRNs to have a collaborative relationship with physicians to prescribe; the prescriptive authority is limited to the practice setting.Ethical Situation with an APRN in A Family Practice Setting.

The ethical duties of APRNs in health promotion are; to advocate for patients and ensure a balance in healthcare delivery while considering the ethical principles of non-maleficence, autonomy, beneficence, and justice. APRNs should further refrain from maltreating, reduce harm, and promote goodness towards patients by providing patients with a balance of benefits against risks through health education and public awareness.Ethical Situation with an APRN in A Family Practice Setting.

Conclusion

An APN is an RN with highly complex skills in decision-making, clinical competency, and expert knowledge acquired through post-graduate education in a general or specific area in nursing. Today, APNs are integral to promoting access to care in ambulatory care settings, reduce the costs of care, promote clinical outcomes through the roles of clinical nurse specialists, nurse practitioners (NPs), nurse case managers, nurse anesthetists, or nurse-midwives. The key difference between an APN and an RN is that the latter directly care for patients as specified in a care plan while the former conduct supervisory duties, and create the care plans in conjunction with other advanced practice providers thus, have a broad patient oversight. To prevent role confusion in clinical practice, APNS must understand and distinguish the scope of practice of APN from that of RNs.Ethical Situation with an APRN in A Family Practice Setting.

1. Describe the evolution of the advanced practice nursing (APN) role. What specific traits of the APN role do you feel are necessary to develop throughout your schooling?

2 . Describe an advanced practice nurse in your own words. what is the difference between an APN and a nurse who has experience in an area of expertise?

3. Do you feel there is any role confusion in the place where you did your summer assessment hours if there was an FNP on staff that you were working with? If so, how?Ethical Situation with an APRN in A Family Practice Setting.

b,  How will you promote your APN role and educate a collaborative physician on your scope of practice within your role?

4. Give an example of an ethical situation with an APRN in a family practice setting in regards to the APN promoting health and safety for a patient?

#2. How would you handle this situation?

#3. What are you ethical duties as an APRN in the realm of health promotion?

Ethical Situation with an APRN in A Family Practice Setting.