Reflection of the Practice and Prescribing of a Nurse Practitioner
The laws and regulations of the practice and prescribing privileges of Advanced Practice Register Nurse Practitioner (APRN) in North Carolina is jointly regulated by North Carolina Board of Nursing and North Carolina Board of Medicine (NC Board of Nursing, 2016). These privileges can only be granted under a collaborative practice agreement (CPA) with a licensed physician. The CPA provides ongoing supervision and collaboration between the APRN and physician, however the APRN can practice independently, without direct supervision, under the CPA (NC Board of Nursing, 2016).
North Carolina Board of Nursing (2016) states that the selection of drugs prescribed by a nurse practitioner
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I have been a register nurse for 15 years and feel comfortable with indications for many drugs, however I know that there are many other aspects of pharmacology that I have neglected throughout my nursing career. One of the expectations I have during my transition as an APRN is to become proficient in pharmacology. To achieve this expectation, I plan to master many of the pharmacology aspects that I have neglected since nursing school, such as pharmacokinetics and pharmacodynamics. I realize that the indication for a drug and knowing common dosages is only a small portion of proscribing a medication, knowing how the drug functions and focusing on individual patient pros and cons is essential when prescribing a medication. Another goal I would like to gain from this course and my shift to prescribing medications, is knowledge of the appropriate resources I can use for pharmacology information in the clinical setting. There is a tremendous amount of resources in this area and I am confused on what sources to utilize as I move forward with my …show more content…
The greatest influence in our community is our vast elderly population, with an extremely extensive medication list. The average geriatric patient in my community in typically prescribed about 15 to 20 different medications. I have discovered from this course that this polypharmacy is actually a norm for the elder population and not specific to my community. As a practicing nurse, I would like to analyze the use of polypharmacy in the elderly with evidence based practice. I believe there is a problem with the use of polypharmacy in the geriatric population, however at the same time there needs to be a balance because medications have increased our longevity throughout generations. Another cultural norm in my community is lack of acceptance with western medications, especially those living in the rural Appalachian Mountains. This culture believes in more folk medicine and often do not even receive health care except in acute illness. As an APRN I will need to be aware of this culture norms, especially in areas as adherence to medications and follow up
Nurse practitioners (NPs), one type of advanced practice nurses, are licensed by the states where they practice and certified by private boards. Nurse practitioners hold advanced degrees in clinical practice and function in a wide variety of settings and across the life span. They provide a broad array of healthcare services ranging from managing treatment plans, to prescribing medications, to implementing health promotion services. As of 2014, 205,000 NPs were licensed in the United States with 86% of those prepared to deliver care to patients in primary care settings (NP Facts, 2015). The progression of the Nurse Practitioner movement that occurred in the 1960 and 1970s emerged as a creative and
This discussion board is about the nurse’s scope of practice. The purpose of this posting is to discuss the definition and standards of the nurse’s scope of practice as defined by the American Nurses Association (ANA) and by the Ohio Board of Nursing with an example of how to use the standards of practice. Per the ANA, when determining the nurse’s scope of practice there is no one specific explanation that can be provided due to the fact that registered nurses can have a general practice or a practice that is very specialized. The limits that are placed on a RN’s scope of practice will depend on a registered nurse’s education, type of nursing, years as a nurse, and the patients receiving care. At the basic level, every nurse’s practice
o Type of healthcare worker: Nurse practitioner o When this type of work entered the market: The medical profession of nurse practitioner was developed in the mid 1960s. The job of nurse practitioners grew from implementing work from primary care physicians into that of traditional nurses. o Reasons for creation and growth: In the late 1950s and early 1960s, increased specialization amongst physicians was taking place, which led to many doctors exploring other avenues of medicine, resulting in a large shortage of physicians practicing primary care. This left many rural and inner city areas with very limited access to medical care.
The geriatric population is rapidly growing as individuals continue to benefit from medical advances and pharmaceutical treatments. A large number of this population will need to take some form of medication to maintain a functional lifestyle. Multiple medications can affect the elderly population differently than younger generations. This paper will discuss how polypharmacy impacts geriatrics and the will focus specifically on analgesics and antihistamines. It will also examine demographic factors, changes within the aging body, prescription and nonprescriptive medications, and the role of the nurse practitioner when caring for these patients.
Licensed practical nurses (LPN 's) fill an important role in modern health care practices. Their primary job duty is to provide routine care, observe patients’ health, assist doctors and registered nurses, and communicate instructions to patients regarding medication, home-based care, and preventative lifestyle changes (Hill). A Licensed Practical Nurse has various of roles that they have to manage on a day to day basis, such as being an advocate for their patients, an educator, being a counselor, a consultant, researcher, collaborator, and even a manager depending on what kind of work exactly that you do and where. It is the nursing process and critical thinking that separate the LPN from the unlicensed assistive personnel. Judgments are based
In the United States, depending upon the state in which they work, nurse practitioners may or may not be required to practice under the supervision of a physician, frequently referred to as a “collaborative practice agreement”. However, in consideration of the shortage of primary care/internal medicine physicians, many states are eliminating or lessening the restrictive authority which allows and nurse practitioners the ability to function more autonomously (AANP 2015).
As we age, the use of medication is often increased in an effort to treat illness and disease. In older adults this frequently results in the administration of multiple medications, both appropriately and inappropriately, at the same time. This is known as polypharmacy. While polypharmacy can exist with any age demographic, it is much more prevalent in older adults where the risk of multiple health conditions is greater. It is not uncommon, for example, for a patient to be treated with multiple therapeutic drug combinations in order to manage disease such as diabetes, heart failure and chronic obstructive pulmonary disease (Kaufman, 2011, p. 49). Polypharmacy is associated as a major factor placing older adults at risk for an adverse drug event. As the number of medications increase, the need for monitoring becomes much more crucial. When there is a breakdown in proper monitoring, the older adult is significantly placed at a higher risk for negative health outcomes due to serious side effects, poor adherence, adverse drug reactions and adverse drug interactions.
During the years of 1999-2000 only 6.3 percent of Americans used five or more medications, and then in the years of 2007-2008 about 10.7 percent of Americans used five or more medications, that is a 4.4 percent increase. In the last decade alone the use of five or more medications has increased 70 percent. Creating the stronger need for healthcare providers to communicate about the care of their patients is becoming evident. However in recent years more hospitals are using electronic medical records that can be sent to each healthcare provider, this helps the patient relive some of the stress in remembering what all medications they take and the dosages they are taking. Also healthcare providers can now see when their patient was last in to see another doctor and what there diagnosis was creating a more stable health system and less medication reactions. Although there is always room error but if every hospital adopts this system there is a good possibility that polypharmacy may be a thing of the past. Polypharmacy is becoming a fatal epidemic for the elderly, it is pertinent to know the risks and ways to prevent
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
The CNO’s scope of practice statement is, “The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function” (College of Nurses of Ontario, 2015). The goal I set for myself is, to learn and understand the scope of practice of an RPN in order to be accountable for all my actions as a future nurse. The reason I feel I need further development in IV therapy is because, in my current clinical setting at the hospital, the majority of the patients I have cared for are on IV therapy. As a nursing student, we have just started learning about IV therapy. I will also use the CNO standards for medication when administering an IV solution because it is a medication and the 10 rights need to be applied (CNO, 2015).
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
Continuing to review a patient’s medication profile while residing in a healthcare facility every six to twelve months and with any medication alteration (Pham and Dickman, 2007). This frequency of review would allow for re-evaluation of current medications and discontinuation if applicable (Pham and Dickman, 2007). In addition, adverse drug reactions are known to occur more often in women, children, the elderly and in patients with renal insufficiency (Woo and Wynne, 2012). Close monitoring of these high risk populations would also provide opportunity to minimize adverse drug reactions in combination with close monitoring of the known high risk medications such as antiepileptic drugs, and antidepressants (Woo and Wynne,
The following essay is a reflective paper on an event that I encountered as a student nurse during my first clinical placement in my first year of study. The event took place in a long term facility. This reflection is about the patient whom I will call Mrs. D. to protect her confidentiality. Throughout this essay I will be using LEARN model of reflection. I have decided to reflect on the event described in this essay since I believe that it highlights the need for nurses to have effective vital signs ‘assessment skills especially when treating older patients with complex medical diagnoses.
When dealing with polypharmacy in older adults, whether in a home healthcare, acute or assisted living setting, the nurse has a large role in helping to identify a problem. According to the Brown article “Nurses in particular play an important role in education, monitoring and advocating” for elderly patients with five or more prescriptions. They can help with strategies to fix or alleviate the stress of multiple prescriptions on the older population. Polypharmacy in older adults affects everything from the patients’ psychological to physiological well being and needs to be looked at through all aspects on the nurses part.
Pharmacists often work together in a team with other healthcare professional like physicians and nurses. In the process, pharmacists will give advice to them on the selection of medication, by providing the evidences based on the dosage form, the side effects and possible interaction with food of the medication. On the other hand, pharmacists also take part in research and clinical studies. Recently, pharmacists are recruited to conduct pharmacy-based research in pharmacies. (Swanson, 2005)