Independent Nurse Practitioner its Future & Scope in nursing in India Click to edit Master subtitle styleProf. Mrs. Krishna Das Prof. Pediatric Nursing Regional College of Nursing Date:

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When you have the dream, you must have the patience to see it through and the stubbornness to never give 4/25/12

Changes in health care and the nursing profession have provided nurses with more opportunities to apply their expertise independently. It is a significant development for nurses making the best use of their knowledge and skills and ensuring improved 4/25/12 access for patients service.

MEANING

Independe nt means selfgoverning, autonomou s, free or not dependent 4/25/12 on others.

I n d e p e n d A e n n t u N r u s r 4/25/12 e

N P s f o c u s N u l r a s r e g e p 4/25/12 l

The Nurse Practitioner functions as a clinician, educator, case manager, consultant, and researcher within his or her area of practice to plan or improve the quality of nursing.

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AREAS OF SPECIALIZED INDEPENDENT PRACTICE:Cardiovascular q Orthopaedic Nurses.q

Nurses. q Psychiatry Nurses. q Dermatology q Respiratory Nurses. Nurses. q Gastroenterology q Urology Nurses. Nurses. q Obstetric Nurses. q Gynaecology Nurses. q Oncology Nurses. q Nephrology q Paediatric Nurses. Nurses. q Neuroscience 4/25/12 Nurses.

REQUIREMENTS FOR HOLDING OUT AS A NURSE PRACTITIONER S v

h o v u A l c d t i v h C v a e v r v E e t l x 4/25/12 i p

In 1974, the American Nurses Association published educational guidelines for the preparation of NPs and implemented a credentialing program in 1976 that still exists. Other specialty nursing organizations have likewise approved credentialing requirements. In many states, this certification is required for 4/25/12 licensure as a NP.

THE CURRENT CREDENTIALING ORGANIZATION FOR NPs

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SCOPE OF INDEPENDENT NURSE PRACTITIONERScope can be defined as the activities that an individual healthcare practitioner is permitted to perform within a specific profession.

Scope of Practice determines what you can see, who you can treat, & under what circumstance or guidance you can provide this care.4/25/12

Scope of Practice also determines the limits & privileges of the licensure & certification as an advanced practice nurse. In the United States, scope of practice determines the ability to bill and be paid for what she do, as well as the ability to be covered by malpractice insurance. Significant liability issues are created when NPs practice outside of their scope.4/25/12

IMPORTANCE OF HAVING LEGAL DESCRIPTION OF SCOPE OF PRACTICEq

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To allow INPs to allow to perform at their level of education. To avoid any charges of practicing medicine without a license. To avoid imputation of liability for medical malpractice some one other than the nurse practitioner, usually a physician. To place accountability for benefits to patients & harm to patients squarely on the INPs. To provide a basis for inclusion of INPs in the legal definition of primary care providers, which is necessary for admission to provider panel. To establish that the INP is a professional entity, 4/25/12 not just a non-physician, a physician extender

The American Academy of Nurse Practitioners (1993) developed standards for practice that specify activities within the NP scope of practice and govern the services provided. The standards cover qualifications, the process of care, environment, collaborative responsibilities, documentation, client advocacy, quality assurance, supporting roles, and research. NPs provide primary health care services to individuals, families, groups of clients, and communities. In general, NP care is characterized by an emphasis on health promotion and disease 4/25/12

In the provision of these services, NPs may order, conduct, and interpret appropriate diagnostic and laboratory tests and prescribe pharmacologic agents, treatments, and non-pharmacologic therapies. Educating and counseling individuals and their families regarding healthy lifestyle behaviors are key components of NP care. The general scope of services provided by NPs has three main 4/25/12 categories: assessment of health

SPECIFIC SERVICES IN EACH CATEGORY ARE LISTED AS:

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NPs with a designated clinical focus or specialty may add specific activities to their scope of practice which reflect the needs of the target population served.

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TABLE REPRESENT ADDITIONAL POPULATION-BASED SKILLS WHICH SPECIALTY NPs PERFORM

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NURSE PRACTITIONERS CARE SETTINGSv Health maintenance organizations (HMO) v Clinics public & private v Private physicians offices v Alternative Living Situations v Ambulatory clinics associated with hospital group

homes, vocational training.v Hospital based skilled nursing facilities hospices. v Correctional facilities communities, shelters. v School based clinics oncology, cardiac, hematology v Mobile medical clinics v City & country clinics jails, juvenile justice

institutions.v Age related developmental centers schools,

colleges. 4/25/12

COMPARISION OF INPs SCOPE WITH RNs SCOPE

INPs scope of practice usually includes Medical Diagnosis & Treatment , while RNs scope of practice includes Nursing Diagnosis & Nursing Interventions or Nursing Treatments.

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COMPARISION OF OREGONS SCOPE OF PRACTICE FOR AN RN WITH OREGONS SCOPE OF PRACTICE FOR AN NP

The RN shall: Conduct & document nursing assessment of the health status of individuals & groups by objective & subjective data from observation, examinations, interviews, and written records appropriate to clients health care needs. Establish & document nursing diagnosis which serve as a basis for plan of care. Develop & modify plan of care based on assessment & nursing diagnosis. Implement the plan of care by initiating nursing interventions through giving direct care; assisting with care; following nursing orders; 4/25/12

The INP is independently responsible & accountable for the continuous & comprehensive management of a broad range of health care, which may include: Promotion & maintenance of health & Prevention of illness & disability Assessment of clients, synthesis & analysis of data, & application of nursing principles & therapeutic modalities. Management of health care during acute & chronic phase of illness. Admission of his/her clients to hospitals & long term care facilities & management of client care in these facilities. Counseling Consultation &/or collaboration with other health care providers & community resources. Management & coordination of care Use of research skill & Diagnosis of health/illness status. 4/25/12 Prescription &/or administration of therapeutic devices

Scope of the practice is pressured by "factors

including: fluctuations in the health care workforce and specific health care specialties; geographic and economic disparities in access to health care services; economic incentives, and consumer demand

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Fees Scope of professi onal practice Prescri . ptive authori ty Lack of carrier advance ment Adverti 4/25/12 sing Lack of understa nding of the nurse practition er role ISSUES OF Endors ement Conflic t of interes t Ambiguit y surroundi ng the legal status of Nurses the nurse self percep tion

INDEPEND ENT NURSING PRACTICE

Attitude towards the

Public

Medical mal practice like failure to diagnose, procedural complication s and improper treatment

LEGAL ISSUES

Legal risk is not followed the standard practice by nurse practitioner

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Physician liability _ lack of adequate supervision, untimely referred to consultant, failure to properly diagnose, in adequate examinations & negligent

Accountabili ty/professio nal liability Business structure

Informed Consent

Confidentia lity

ETHICAL ISSUESLiability protection Documenta tion, Storage and Profession al regulation

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STRATEGIES TO OVERCOME THE ISSUES

E s t U a n b i l D f i u o s r h C i m o n s l g n p I 4/25/12 l u e

EVOLVING FOR THE FUTURE

NPs work independently, as well as in collaboration, with a variety of individuals to diagnose and manage clients health care problems. For example, a NP might be the only health care provider in a rural, underserved community. In this setting, the NP would function fairly independently, with physician consultants available when needed. Conversely, a NP might function autonomously while in a joint practice with a physician or group of physicians. In this setting, the physician(s) or NP provide initial care for clients. The NP would manage the care of clients with minor acute or 4/25/12 stable chronic conditions. In this collaborative

NPs serve as health care resources, interdisciplinary consultants, and patient advocates. The autonomous nature of advanced clinical practice of NPs requires accountability for outcomes in health care. NPs are committed not only to seeking and sharing knowledge that will promote quality health care, but also to improving clinical outcomes by conducting research or applying the research findings of others.4/25/12

INDIAN SCINERIOIn India, there are a number of care activities that nurses can undertake because of their educational background but cannot carry out because physicians may not delegate responsibility to them. Having nurses take on some of the care that they are trained for independently will be cost-effective. Nurses with a Master's degree in advanced nursing practice can deal with complex health problems, have a better clinical judgement and can select the proper option for the patient by using evidencebased practice. They can also provide 4/25/12

The National Population policy 2000 includes reduction of maternal and infant mortality as one of the sociodemographic goals to be achieved by 2010. The single most important way to reduce maternal death in India would be to ensure that a skilled health professional is present at every birth. Skilled care during childbirth is important because millions of women and newborns develop serious and hard to predict complications during or immediately 4/25/12

Aimed to ease the impact of the shortage of Gynaecologists in community health centres, INC performed a pilot study for the Independent Nurse Practitioner Project in West Bengal at SSKM Hospitals female medical and surgical wards. The project provides an 18 months training in midwifery, besides an additional training in emergency obstetric care to candidates who have completed their BSc in nursing and have two to three years of clinical experience in ob-gyn wards to take care of ANMS in rural sector. These nurses are called independent nurse practitioners as they are trained to prescribe medicines 4/25/12 following approved protocols and take

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May we all celebrate our roles as Independent Practitioner and embrace our profession with enthusiasm dedicated, and renewed commitment. Thank You