NURS 610 Summation Paper – Health System Project Proposal.

Posted: November 11th, 2022

NURS 610 Summation Paper – Health System Project Proposal.


Summation Paper Rubric Summation Paper Rubric Criteria Ratings Pts This criterion is linked to a Learning OutcomeOverall scholarly tone, APA, grammar, spelling, punctuation, sentence structure, etc. Overall scholarly tone, adherence to APA format, including grammar, punctuation, spelling, sentence structure, etc. Minimum of 5 references not including your text. 10.0 pts Full Marks 0.0 pts No Marks 10.0 pts This criterion is linked to a Learning OutcomeHealth care system BRIEFLY described including the state located. Briefly described,including state located and which type of APN would be added to the system, what type of services they would deliver, as well as if PAs would be added ( and what services they would deliver). NURS 610 Summation Paper – Health System Project Proposal.


10.0 pts Full Marks 0.0 pts No Marks 10.0 pts This criterion is linked to a Learning OutcomeWhat education/certification is required Summarize the basic education required for APNs 10.0 pts Full Marks 0.0 pts No Marks 10.0 pts This criterion is linked to a Learning OutcomeScope of practice, how each APN specialty would be used in health system Pertinent details of scope of practice of how each APN specialty would be used specifically in your health system. 20.0 pts Full Marks 0.0 pts No Marks 20.0 pts This criterion is linked to a Learning OutcomeElements of credentialing, privileging; if admitting privileges allowed Explanation of the credentialing and privileging (admitting privileges). 15.0 pts Full Marks 0.0 pts No Marks 15.0 pts This criterion is linked to a Learning OutcomeQuality/safety issues Explain the quality and safety issues and how you plan to address these issues. 15.0 pts Full Marks 0.0 pts No Marks 15.0 pts This criterion is linked to a Learning OutcomeLiability/risk management issues Explain the basic liability/risk management issues when hiring APNs. 20.0 pts Full Marks 0.0 pts No Marks 20.0 pts This criterion is linked to a Learning OutcomeCollaboration and Interdisciplinary teamwork and the APN role Explain how APNs fit into the interdisciplinary/interprofessional team. Can an APN lead an interprofessional team? Explain how APNs collaborate within this team. 20.0 pts Full Marks 0.0 pts No Marks 20.0 pts This criterion is linked to a Learning OutcomeEconomic impact of using APNs Explain the economic impact of using APNs in a health system. Describe how using APNs will benefit your health system. Include how APN care impacts cost. 20.0 pts Full Marks 0.0 pts No Marks 20.0 pts Total Points: 140.0

Health care system

Lynwood Nursing Home is a senior living medical facility located in Mobile, Alabama. It is a 127 bed facility that receives funding from Medicare and Medicare. Services offered at the facility include 24-hour skilled nursing care, wound care, swallowing therapy, speech therapy, respite care, physical therapy, outpatient rehabilitation, oncology care, occupational therapy, neurological care, memory care, and medication administration. Other medical services include IV therapy, dialysis care, diabetes management, balance training, and assistance with activities of daily life. Also, the facility makes arrangements for support services to include private home care, hospice care, laboratory, x-ray, podiatry, and mental health consultation (Family Assets, 2020). The facility prides itself in offering a variety of care services and therapies to help its elderly residents regain their independence. Through its staff of licensed care professionals, therapists and skilled nurses, the facility is able to offer its residents personalized care (Nursing Homes, 2020).

A review of the services offered at the facility reveals that there is a need to advanced practice nurses (APN), specifically certified registered nurse practitioner (CRNP). A CRNP is an APN who provides primary care throughout the lifespan of a patient. Based on the training received, the CRNP will provide quality health care to all patients’ age groups by performing focused and comprehensive examinations and diagnoses as well as treating common injuries and acute ailments. In addition, CRNP manage chronic health issues such as depression, diabetes, high blood pressure, and provide immunization. Also, a CRNP can order and interpret laboratory and diagnostic tests such as EKGs and x-rays. Additionally, they prescribed therapies and medications, and can perform procedures based on the federal and state practice guidelines. Moreover, they counsel and educate patients and their families concerning disease prevention, healthcare options, and healthy lifestyles (Joel, 2018).

Although CRNP cannot practice independently within Alabama, they have the advantage of being physician-extenders who increase health care access for patients by bringing greater access to more of the population. Being utilized in every aspect of health care provided at the facility (from clinics to emergency room, critical care, outpatient, and inpatient care), the CRNP would become an asset for the facility. As APN, CRNP would provide nursing interventions that influence health care outcomes to include developing and implementing health policy, administrating the nursing facility, managing care for populations and individuals, and direct care of individual patients. It must be noted that direct clinical practice is a core competency for any CRNP who build on the competency of their nursing skill set and demonstrate significant role autonomy, increased complexity of interventions and skills, greater synthesis of data, and greater breadth and depth of knowledge. Through engaging CRNP, the facility would get an APN prepared to assume accountability and responsibility for health promotion and the management, diagnosis and assessment of patients’ problems, to include the prescription and use of non-pharmacological and pharmacological interventions (Kaakinen et al., 2015).

Hunt (2015) adds to the discussion by noting that CRNP are registered nurses who are prepared through clinical training and advanced education to offer a wide range of acute and preventive health care services to persons of all ages. They take histories offer complete physical examinations, diagnose and treat many common chronic and acute health problems, interpret x-ray and laboratory results, prescribe and manage therapies to include medications, and offer supportive counseling and health teaching. By engaging CRNP, an organization gains the capacity to emphasize health maintenance, illness prevention, and patients refers to other medical personnel as needed. Besides that, benchmarking CRNP against physician care could help the organization combat rising care costs since CRNP offer most of the same services as physicians but at a much lower cost (Hunt, 2015).

Education and certification

CRNP practice in the State of Alabama is managed by the Alabama State Board of Nursing (ASBoN). For the board to approve an individual to work as a CRNP, there is a need to have at least a master’s degree in APN corresponding to CRN as a category. The educational program from which the individual graduates must be recognized by the ASBoN and accredited by an organization recognized by the Council of Higher Education Accreditation or the United States Department of Education. Individuals are exempt from the master’s degree requirement if they graduated before 1984 from a non-bachelor’s program preparing nurse midwives or NPs. Also, individuals can be exempt if they graduated before 1996 from an ASBoN recognized post-bachelor’s program preparing nurse midwives or NPs. In addition, they can be exempt if graduated before December of 2003 from an accredited school of nurse anesthesia. The ASBoN follows the national consensus model in stating that all APN practicing in the state must include the following three core courses in the education. Firstly, they must attend advanced pharmacology courses to include pharmacotherapy, pharmacodynamics and pharmacokinetics of broad categories of agents. Secondly, they must attend an advanced health assessment course that includes assessment of all body systems and advanced assessment concepts, techniques and methods. Thirdly, they must attend an advanced physiology/pathophysiology course that includes the general principles applicable across the human lifespan (Graduate Nursing Edu, 2020). For the facility needs, it would be prudent for the CRNP to specialize in gerontology since it is a senior living medical facility and having such a specialty infers that the CRNP holds a national certification in the area and can legally practice in that area.

The ASBoN requires that all CRNP be nationally certified in their area of specialization. The certification process is based on rules offered by the independent national verification organization for the specialization area. The board recognizes three certification organizations for CRNP that are relevant for the nursing home. The first certification organization is the American Association of Critical Care Nurses that certifies acute care nurse practitioners (ACNP) through the AACN Certification Corporation. The second certification organization is American Academy of Nurse Practitioners that certifies adult nurse practitioners and adult-gerontology primary care NP. The third certification organization is the American Nurses Credentialing Center that certifies psychiatric mental health nurse practitioners (PMNHNP), gerontological nurse practitioners (GNP), family nurse practitioners (FNP), adult nurse practitioners (ANP), and acute care nurse practitioners (ACNP) (Graduate Nursing Edu, 2020).

In addition, the ASBoN recognizes some sub-specialty certifications in palliative/hospice care and oncology. The board does not extend reciprocity to out-of-state CRNP, but it can allow previously licensed individuals to practice as CRNP on the basis of lesser requirements. Besides that, CRNP can get provisional approval to practice prior to meeting the certification requirements. The provisional approval is offered if there is authorization to sit for the certification examination from a recognized certifying agency (Nursing Licensure Organization, 2020).

Scope of practice

CRNP are not explicitly recognized as primary care providers. In addition, they are subject to a collaborative practice agreement with a physician to practice in the State of Alabama. The agreement entails the physician providing direction and oversight for the CRNP as required by the ASBoN and State Board of Medical Examiners (SBME). The agreement includes quality assurance, prescription orders, and practice sites. It is important to note that although CRNP practice in Alabama is restricted, it does not require onsite and direct supervision by the collaborating physician. CRNP with a collaborative practice agreement are permitted to prescribe prescription medication provided that the prescribed quantity, number of refills, dosage and drug type is authorized by the approved protocol signed by the collaborating physician Scope of Practice Policy, 2020. The CRNP and collaborating physician must state in the protocol the types of drugs that will be prescribed as well as the refills, quantity and dosage. The prescriptive authority is regulated by the ASBoN and is based on completion of pharmacology course content or integration of pharmacology clinical application and theory, a requirement for the board to grant the CRNP prescriptive authority. Also, the drug must be in the list of medicines adopted by the ASBoN. Additionally, CRNP can prescribe schedules III-V controlled substances. It is important to note that the CRNP scope of practice in Alabama only allows them to treat patient populations for which they hold certification. They are certified to provide registered nursing services along with additional population-focused practice are for which their education qualified them (Scope of Practice Policy, 2020).

It is clear that Alabama State applied a reduced practice approach in defining the scope of practice for CRNP. In this case, the state licensure and practice laws reduce the ability of CRNP to engage in some elements of their practice for which they are trained and are qualified. They must have a career-long regulated collaborative agreement with physicians in order to provide patients, and this limits the settings of some of the elements of their practice. Also, practice is regulated by the ASBoN and SBME. Any CRNP found exceeding their scope of practice are subjected to ASBoN initiated disciplinary action as indicated in the nurse practice act (American Association of Nurse Practitioners, 2020). CRPN hired by the nursing home will practice based on their nursing specialty and collaborative agreement details.

Elements of credentialing and privileging

Credentialing and privileging for CRNP practice in Alabama State follows a defined process. It begins with an application to the ASBoN with the official transcripts and documentation of certification status. Provisional approval can be granted prior to meeting the certification requirements only if the individual has authorization to take a certification test from the applicable certifying agency recognized by the board. The individual must apply for the certification examination before attempting the exam, a condition that must be met in order to qualify for the provisional credentialing. A CRNP working with provisional credentials and ends up falling the certification examination loses the privilege of the provisional approval and must retake and pass the exam before reapplying for practice approval. Persons using the provisional approval are permitted to use the CRNP title (Nursing Licensure Organization, 2020).

The CRNP credentials must be renewed biennially. Before renewal, the CRNP must demonstrate current verification with official verification offered by the certifying agency to the board. In addition, they are expected to complete six hours of pharmacology as part of the requirements for continuing education (Nursing Licensure Organization, 2020).NURS 610 Summation Paper – Health System Project Proposal.

All applications for credentialing must be completed by the CRNP, and not a third party. The application process requires that the applying CRNP attest to the completeness and accuracy of the information provided to ASBoN. Any inaccurate or incomplete information could result in the CRNP being denied practice approval, or the license being withdrawn or other disciplinary actions. It is important to note that some CRNPs are not required to collaborate as indicated by the VA, and must file a copy of the VA APRN notice of existing grant of full practice authority (Alabama Board of Nursing, 2020).NURS 610 Summation Paper – Health System Project Proposal.

Quality and safety

CRNP practice roles are developing and opportunities are expanding to meet the need for expert nursing care at an advanced practice level. In fact, a CRNP has acquired clinical competencies, complex decision-making skills and expert knowledge base, characteristics that that are shaped by the practice environment. Still, a CRNP’s capacity to deliver safe and quality care could be hindered by four primary factors. The first factor is the capacity for training and education opportunities to prepare the CRNP for the specific workplace roles. The second factor is the impact of regulation and legislation in the CRNP scope of practice. The third factor is the organization of funding and care mechanisms. The final factor is divergent professional interests (specifically between CRNP and physicians) that are most often in opposition from medical profession. There are a range of three strategies that the facility can apply to address the identified barriers. The first strategy is to provide training and education opportunities for the CRNP personnel. The second strategy is to encourage fill scope of practice to include all legally permitted privileges. The third strategy is to support new care delivery modes and create incentives that encourage inter-professional collaborations. It is important to note that although distinctive from physicians, CRNP delivery care that is at least equivalent to that of physicians are regards quality and safety across setting (Stanhope & Lancaster, 2014).NURS 610 Summation Paper – Health System Project Proposal.

The intense drive to measure safety and quality is a deep concern for all health care stakeholders who include consumers, regulators, providers and payers. As informatics and data systems evolve, there is an increasing attention to the notion of paying for performance. This means that a level of transparency and accountability will be demanded from CRNP regardless of health care setting or provider type. Given that quality and safety data will be embedded in the information systems, it is imperative that CRNP personnel be involved in developing safety and quality measures. Their inclusion is distinct from the inclusion of other health professions. Towards this end, there will be a need to build a database on CRNP-sensitive indicated for safety and quality. The Medicare and Medicaid objective to align safety and quality incentives through payments emphasizes the need for CRNP inclusion in the process. Even as new evidence is collected on effective strategies intended to promote safety and quality improvement, there is a need to recognize that these activities are central to CRNP functions (Black, 2016).NURS 610 Summation Paper – Health System Project Proposal.

Liability and risk management

As the CRNP are hired to provide services, they turn into a critical component of the health care services offered at the facility. Their increasing responsibility and demand similarly causes an increase and evolution of the risks they face in the work environment. In fact, the majority of claims against CRNP are developed from failure concerning core competencies such as care management, treatment, medication prescription and diagnosis. The most common claims are against improper prescription and management of controlled drugs and failure to diagnoses. Such claims demonstrate that SRNP are responsible the review and documentation of appropriate test results and consultation in a timely manner. Other than these claims, CRNP can face action from professional liability claims that involve the practice license as it related to treatment and care provided (Black, 2016).NURS 610 Summation Paper – Health System Project Proposal.

While these liabilities and risks may be difficult to prevent, the facility can enhance clinical practice to control them. Four risk control strategies have been identified as appropriate for evaluating and enhancing liability and risk management practices at the facility. The first strategy is to engage in informed consent discussions when prescribing medication to patients. Educating the patients on the need for follow up and importance of sticking to the prescription, as well as symptoms and signs that would prompt urgent attention could help in keeping the patient safe and addressing issues of concern before they escalate. For instance, educating the patient on the signs of an overdose can help in bringing attention to the overdose promptly so that the patient’s life is not risked with a visit to the emergency room (Finkelman, 2016).

The second strategy is to conduct a discussion with the patient on the informed consent. This is an important step for managing the expectations of the so that there are not concerns that what was promised was not delivered. Discussing and documenting the nature of the proposed treatment approach, foreseeable risks and benefits, and treatment alternatives can help with priming the patient on what treatment outcomes to expect as being within the realm of possibilities (Finkelman, 2016).

The third strategy is to document the treatment phases to include medication provided in an objective and timely manner, procedures performed, diagnostic and laboratory testing. The substance of all communications related to the CRNP practice should be documented in the patient’s health care records as this helps with tracking decision structures and steps taken in providing care (Finkelman, 2016).

The final strategy is applying evidence-based practice approaches, and remaining current with regards to medical equipment use, biologics, medications, and clinical practice. Also, remaining current regarding conditions related to CRNP specialty, diagnosis and treatment of chronic and acute ailments as they related to the individuals practice specialty. In addition, there is a need for the CRNP to obtain regular continuing education on the specialty subjects (Finkelman, 2016).

It is clear that although there have been significant advances in CRNP clinical practice and patient safety, claims continue to develop against the nurses in their practice. This demonstrates that CRNP are expected to diligently screen for, test, monitor and treat ailments. Also, they are responsible for obtaining the appropriate test, referrals and consultations to meet the medical needs of their patients. CRNP have a responsibility to prescribe the right medication for the right person, in the right dose, through the right route at the right time for the right duration and for the right indications (Joel, 2018). With this insight, the facility can apply the risk control resources and strategies to focus efforts on CRNP practice areas that have statistically demonstrated liability and risk.NURS 610 Summation Paper – Health System Project Proposal.

Collaboration and Interdisciplinary teamwork

Health care is a highly complex generalization with a vast number of professions and disciplines that contribute to the wellbeing and total care of the patient. For this reason, interdisciplinary teams and collaborative approaches are a highly effective approach for the different medical disciplines to come collaborate to discuss and solve the care problems affecting the patients. This is done in the hope that collaboration provides access to a larger knowledge repository that can be leveraged to produce high quality outcomes for the patients while promoting quality, cost-effective and safe care. These interdisciplinary teams give the CRNP the opportunity to enhance their commitment to the patients’ care, serve as a member of the team, serve as a leader of the team, and advocate for the patients. Also, it helps CRNP to use decision-making and problem solving skills to achieve desired outcomes, and to apply group skills that include consensus, conflict resolution, compromise, and negotiation (Kaakinen et al., 2015).NURS 610 Summation Paper – Health System Project Proposal.

CRNP identify cases that they anticipate will benefit from interdisciplinary teams intervening, then plan and arrange for the teams, and they participate in them. Planning for these teams is typically challenging, requiring the CRNP to develop an agenda, collect information for presentation, invite team members, set a meeting location, data and time, and encouraging the patients to attend. Given that participation requires preparation, the nurse must have information and data readily available to discuss and have recommendations for future care that could enhance the care outcomes for the patient. In addition to expressing themselves, the CRNPs should attentively listen to the suggestion and thoughts of other team members in a respective manner while also negotiating and compromising to identify the best care plan (Kaakinen et al., 2015).NURS 610 Summation Paper – Health System Project Proposal.

In addition to assessing and reassessing patients throughout the continuum of care, CRNP also communicate and report significant information to other medical professions when the occasions calls for such. For instance, the CRNP will report changes in levels of oxygen saturation to the respiratory therapist even as the patient is taken off the ventilator. The nurse will report adverse reactions to prescribed medication to the pharmacist, and report changes in social support systems to the case manager/discharge planner/social worker. The collaboration ensures that care is appropriate, timely and un-fragmented to meet the current and often changing needs of the patients in response to changes in the social, emotional and biological status. As team leaders, coordinators, managers and collaborators, CRNP are expected to continuously and consistently review the care plan. This ensures that all the appropriate professions within the team contribute their services based on the care plan, and that care seamlessly shifts the patient towards expected goals and outcomes (Hunt, 2015).NURS 610 Summation Paper – Health System Project Proposal.

Broadly described, collaboration and teamwork involves the CRNP working with other medical disciplines in a mutually respectful and collegial manner. Other than collaborating with other medical professions, nurses also collaborate with patients to solve their care problems while providing option quality care levels. This requires that the nurse possess unique skills to facilitate credible and effective collaboration. The specific skills include the ability to identify and understand contributors, critical thinking, establishing and maintaining trust, respect for others, and communication and interpersonal skills (Joel, 2018).NURS 610 Summation Paper – Health System Project Proposal.

Economic impact

Engaging CRNP services in the medical facility has economic implications for the facility. They are a proven response to the evolving trend towards preventing care and wellness that is driven by patients’ demands. Also, they are consistently proven to be cost effective in providing high quality care. Firstly, they provide equivalent medical care at a lower total cost when compared to physicians. They have the potential for decreasing the cost of patients’ visits to the medical facility when they see patients in an independent manner. Secondly, they attract lower salaries when compared to physicians. In fact, their preparation/education costs are approximately 22.5% lower that when the physicians spend in preparation. The compensation for CRNP is about half that of physicians. Through engaging the nurses, the facility will only require fewer physicians so that less money is spend on personnel compensation. When the education costs, salaries and productivity measures are considered, CRNPs are more cost effective than physicians (Joel, 2015).NURS 610 Summation Paper – Health System Project Proposal.

Thirdly, the cost related outcomes of care such as hospitalizations, emergency visits and length of stay are equivalent for CRNPs and physicians. In fact, the nurses deliver care at 23% lower average costs when compared to physicians as primary care providers. Also, they achieve 24% lower laboratory utilization rates and 21% reduction in hospital inpatient rates when compared to physicians. By engaging the CRNPs, the facility can anticipate significant cost savings from fewer hospitalizations and emergency visits, as well as less costly interventions. The benefit-to-cost ratio of engaging CRNPs could range from 2-1 to 15-1 depending on the practice model with restricted practice having a lower ratio when compared to unrestricted ratio (Joel, 2015). Hunt (2015) notes that engaging APNs reduces costs by 26% for long term stays and 42% for intermediate stays. Additionally, care teams with CRNP have significantly fewer specialty visits, short hospital lengths of stay, and lower rates of transfers in the emergency department. Fourthly, CRNP have lower time lost from work when compared to physicians thus helping the facility to save costs. In addition to the absolute costs and benefits that have been discussed, CRNP have a significant impact on the effectiveness of other health care costs. These include treatment outcomes, health promotion, and illness prevention (Hunt, 2015).NURS 610 Summation Paper – Health System Project Proposal.

Finkelman (2016) explains that CRNP reduce costs while improving care quality. They achieve this by reducing the cost of care across health care settings, costing about 23% less than physicians to deliver managed care. They keep patients away from medical facilities to reduce income and time lost at work. They are cost-effective, dedicated and high quality clinicians who are trained and educated to act independent of physicians thus reducing care redundancies and bottlenecks. They excel at managing complex health conditions, a common concern among elderly populations. They are trusted and liked more than other primary care providers, fostering a relationship that ensures patients are engaged in their care, adhere to the treatment plan, and schedule wellness and follow-up visits. They spend more time with patients, allowing them to provide holistic care that is patient centered to reduce costs and improve health (Finkelman, 2016). It becomes clear that the potential for CRNP to reduce costs and increase benefits cannot be denied, not to talk of improving the care intensity so that patients experience fewer care days. As such, the facility is best served by hiring CRNP to complement the efforts of physicians while improving costs and benefits management.NURS 610 Summation Paper – Health System Project Proposal.


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